Carpus arthroscopy

Question 1

Answer 1

Question 2

Carpal arthroscopy can be performed in LR?

Answer 2

yes LR or DR
Dr is universally adopted

Question 3

What is the angle of flexion for middle carpal evaluation?

Answer 3

70º

Question 4

name the landmarks for portal in the middle joint

Answer 4

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

Question 5

Do you create distension before skin incision of middle joint?

Answer 5

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.

Question 6

how do you check the middle carpal joint?

Answer 6

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

Question 7

where is situated the medial intercarpal ligament

Answer 7

dorsal medial intercarpal ligament extends between the radial and
second carpal bones - predominantly intracapsular with radial insertion intrasynovial

Question 8

the intermediate carpal bone is divided in ?

Answer 8

The articular surface of the intermediate carpal bone is
divided by a dorsopalmar ridge into two facets.

Question 9

where is located the lateral palamr intercarpal ligament

Answer 9

ulnar, intermediate, fourth, and third carpal
bones

Question 10

What is the angle of flexion for antebrachio carpal evaluation?

Answer 10

120-130º (less flexionthan middle carpal)

Question 11

are the lateral and medial portals of the antebrachial different from middle?

Answer 11

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.

Question 12

on the antebrachial joint, on a close lateral view, the articular groove
between the lateral styloid process and the

Answer 12

distal epiphysis of the radius

Question 13

how much flexion has the carpus for palmar approach

Answer 13

20-30º for both ACB and MC joints

Question 14

what is the most common reason for palmar approach to the antebrachiocarpal joint?

Answer 14

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

Question 15

name the portals for palmar arthrocopy of the middle antebrachiocarpal joints

Answer 15

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

Question 16

what is the most complex approach to the palmar ACB joint? palmarolat or palmaromed?

Answer 16

The palmarolateral approach to the antebrachiocarpal joint is
made more complex by several outpouchings around the accessory
carpal bone

Question 17

are all palmarolat ACB joint accessible?

Answer 17

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.

Question 18

Describe portal acess to the palmarolateral cul-sac

Answer 18

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

Question 19

what is the proximal landmark in the proximal articular surface of the acessory carpal joint?

Answer 19

proximo acessorio-radial ligament

Question 20

describe the palmar portal for the MC joint

Answer 20

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

Question 21

is more easy to enter palmaromedial or palmarolateral in the middle carpal joint?

Answer 21

LATERAL The carpal fascia is thinner laterally, and this is a more voluminous cavity than its medial counterpart.

Question 22

describe the lateral palmar portal for the MC joint

Answer 22

between the ulnar and fourth carpal bones palmar to the lateral collateral ligament and between the** accessoriocarpal ulnar and
accessoriocarpal quartal ligaments.**

Question 23

which structures are not visible palmar?

Answer 23

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.

Question 24

Answer 24

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.

Answer 25

Question 26

where are the majority of chip fragments in the middle carpal joint?

Answer 26

distal radial carpal bone

Question 27

where are the majority of chip fragmetns in ACB joint?

Answer 27

distal lateral radius