Abstract book 6th RMS 16.indd

and in the first visit to the clinic after the
surgery for pain, satisfaction, acceptance
of the procedure and the complications.
Pain during surgery was evaluated using
the four- level score with0=no pain; 1=mild
pain; 2=moderate pain; and 3=severe pain.
Results: 47 patients were male with an
average age of 30years. The average
duration of surgery was 30 min
(15-60min.). Discomfort and pain were
mainly felt during injecting the local
anesthetic and was the most painful phase
of the entire procedure. 2 cases (4%), had
to be abandoned during the procedure due
to pain and uncooperation and converted
to general anesthesia. 2 patients required
additional dose of local anesthesia and
the procedure was completed. All patients
were discharged soon after procedure
completion.90% of patients experienced
little to no pain during the surgery.
48 patients accepted the local anesthesia
method and were ready to repeat the
same method for the other knee if needed.
No complication of the local anesthesia
encountered.
Conclusion: Knee arthroscopy under
local anesthesia is a safe, comfortable
and known technique with many
diagnostic and therapeutic procedures
can be performed successfully.
Hall B Session 4
Orthopedic Surgery: Hand &
Upper Limb
314
Advances in Hand and Wrist
Arthroscopy
Alejandro Badia MD (USA)
Indications for small joint arthroscopy in
the hand remain poorly understood. This
is due to a paucity of papers discussing
this technique in the literature, as well as
inadequate hands on training in the pearls
and pitfalls regarding this application
within the commonly used “scope” of
arthroscopy. Despite the fact that small joint
arthroscopes have been available for over a
decade, hand surgeons have been slow to
adopt this technique within their treatment
armamentarium for the treatment of both
traumatic and degenerative conditions
involving the thumb and the digital
metacarpophalangeal joints.
A proposed arthroscopic classification for
basal joint osteoarthritis provides additional
clinical information and can direct further
treatment depending on the stage of
disease. This chapter will also review
the brief history of trapeziometacarpal
arthroscopy and provide insight as to how
this technique can be incorporated into
a treatment algorithm in managing this
common affliction.
Metacarpophalangeal joint arthroscopy is
even less commonly used, while traumatic
and overuse injuries are frequently seen in
the thumb, and present an ideal indication
in certain scenarios. Painful conditions
affecting the metacarpophalangeal joints
of the fingers are less commonly seen,
yet the small joint arthroscope presents
a much clearer picture of the present
pathology compared to other imaging
techniques or even open, and potentially
deleterious, surgery.
Wrist arthroscopy is better understood as
this technique was developed in the late
80s, and is now a key part of most wrist
specialists surgical armamentarium. While
initially developed for diagnostic purposes,
arthroscopy of the wrist is now vital for
such common pathologies as triangular
fibrocartilage tears (TFCC), carpal ligament
injuries, ganglion cysts, articular injuries
including distal radius fractures etc.
Alerting colleagues about the availability
of wrist arthroscopy is now supplanted by
actually ensuring that hand surgeons are
facile in these techniques and cadaveric
courses are crucial to this end. Wrist
arthroscopy can eliminate the perpetual
“wrist sprain” diagnosis and actually
allows us to visualize and even treat the
underlying problem.
The application of this technology to
the smaller joints will soon make the
treating surgeon realize that a myriad
of pathologies are readily visible and
can augment treatment, as well as
diagnosis. Similar to the wrist, small
joint arthroscopy may one day supplant
imaging techniques such as MRI or CT
in establishing an accurate diagnosis.
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