Carpus arthroscopy Flashcards
Carpal arthroscopy can be performed in LR?
yes LR or DR
Dr is universally adopted
What is the angle of flexion for middle carpal evaluation?
70º
name the landmarks for portal in the middle joint
Lateral portal is halfway between the extensor
carpi radialis tendon and the common digital extensor tendon
and midway between the two rows of carpal bones.
Medial arthroscopic portal is made approximately 10 mm
medial to the extensor carpi radialis tendon, to avoid its tendon
sheath, and creates an opening dorsal and lateral to the
medial dorsal intercarpal ligament
Do you create distension before skin incision of middle joint?
In contrast to other joints, the skin incision for these portals is made before distention of the joint to avoid damage to the tendon sheaths.
how do you check the middle carpal joint?
commencing medially and moving the
arthroscope in a circular motion with the lens moving from
medial to lateral to inspect the distal row of carpal bones and
then from lateral to medial to examine the proximal row
where is situated the medial intercarpal ligament
dorsal medial intercarpal ligament extends between the radial and
second carpal bones - predominantly intracapsular with radial insertion intrasynovial
the intermediate carpal bone is divided in ?
The articular surface of the intermediate carpal bone is
divided by a dorsopalmar ridge into two facets.
where is located the lateral palamr intercarpal ligament
ulnar, intermediate, fourth, and third carpal
bones
What is the angle of flexion for antebrachio carpal evaluation?
120-130º (less flexionthan middle carpal)
are the lateral and medial portals of the antebrachial different from middle?
Same portals but different row the dorsolateral arthroscopic portal is halfway between the common digital extensor and the **extensor
carpal radialis tendons, and the dorsomedial portal** is medial to
the extensor carpi radialis tendon
medial portal is at the center of a triangle formed by the extensor carpi radialis, the distal rim of the radius, and the dorsal rim of the radial carpal bone.
on the antebrachial joint, on a close lateral view, the articular groove
between the lateral styloid process and the
distal epiphysis of the radius
how much flexion has the carpus for palmar approach
20-30º for both ACB and MC joints
what is the most common reason for palmar approach to the antebrachiocarpal joint?
The most frequent target is a fracture of the palmaromedial corner of the radial carpal bone, for which the instrument portal is made closer to the medial collateral
ligament
name the portals for palmar arthrocopy of the middle antebrachiocarpal joints
It is approached** palmar to the medial collateral ligament**
at the level of the distal radius,
** dorsal to the tendon of insertion of flexor carpi radialis**
and medial palmar vein.
The arthroscope cannula is inserted in a 45-degree palmaromedial to dorsolateral trajectory to avoid
entry to the carpal sheath
what is the most complex approach to the palmar ACB joint? palmarolat or palmaromed?
The palmarolateral approach to the antebrachiocarpal joint is
made more complex by several outpouchings around the accessory
carpal bone
are all palmarolat ACB joint accessible?
No,** the distal pouch proved inaccessible** while the middle pouch
provided visibility of the articulation between ulnar and accessory
carpal bones The proximal outpouching between the caudal
radius and proximal margin of the accessory carpal bone is larger
and provides clinically useful access to the accessoriocarpal radial
articulation.
Describe portal acess to the palmarolateral cul-sac
Distension esstential. No. 11 or 15 blade is then used to create a portal in the
most proximal region of the palmarolateral cul-de-sac, and the
arthroscope can be inserted in a palmarolateral to dorsomedial
direction, angling distally to enter near the accessorio-radial
articulation
what is the proximal landmark in the proximal articular surface of the acessory carpal joint?
proximo acessorio-radial ligament
describe the palmar portal for the MC joint
An arthroscopic portal is created in a conventional manner in
the center of the appropriate medial or lateral outpouching
**Medially **this is located between radial and second carpal bones
palmar to the medial collateral ligament. The portal
is created and cannula inserted in a medial 45-degree palmar
to dorsolateral oblique trajectory angling slightly (20 degrees). Instrument portals are made with the aid of percutaneous needles
is more easy to enter palmaromedial or palmarolateral in the middle carpal joint?
LATERAL The carpal fascia is thinner laterally, and this is a more voluminous cavity than its medial counterpart.
describe the lateral palmar portal for the MC joint
between the ulnar and fourth carpal bones palmar to the lateral collateral ligament and between the** accessoriocarpal ulnar and
accessoriocarpal quartal ligaments.**
which structures are not visible palmar?
The palmar lateral aspect of the third carpal bone, lateral
palmar intercarpal ligament, and palmarodistal aspect of the
intermediate carpal bone are not visible from either palmar
approach.
Figure 4-10 A, Structures visualized in the palmaromedial aspect of the middle carpal joint, including the palmaromedial
surface of the radial carpal bone (RC) and second carpal bone (C2), and the medial palmar intercarpal ligament
(MPICL). B, Flexion of the joint relaxes the MPICL.
