Small Joint Arthroscopy

ABSTRACT

The development of small and micro-arthroscopes has ushered in an era of small joint arthroscopy that remains in a state of progression. Despite these technological advances, clinical indications for small joint arthroscopy in the hand remain scant and underutilized. This is mainly due to a scarcity of papers utilizing this technique in the literature, as well as rare hands on training in the technical aspects of small joint arthroscopy. Despite the fact that these small joint arthroscopes have been readily available for decades, hand surgeons have been slow to adopt this methodology within their treatment protocols of both traumatic and degenerative conditions involving small joints. This discussion will focus on small joints within the hand, namely the trapeziometacarpal, scaphotrapezial-trapezoidal, metacarpophalangeal, fifth carpometacarpal (CMC), proximal (PIP), and even distal (DIP) interphalangeal joints. Similar instrumentation is used in the temporomandibular joints and small foot articulations but is beyond the “scope” of this chapter. Both traumatic and degenerative afflictions in the hand are ideally suited for use of small joint arthroscopy. Basic arthroscopic techniques such as synovectomy, debridement, chondroplasty, capsulorrhaphy, joint resurfacing, and arthroscopic-assisted internal fixation or soft tissue repairs are all ideally suited for the small joints. Further advances in fiberoptic technologies, and particularly in small joint instrumentation, will help contribute to expanding treatment options in articular pathology within the small joints.