Artroscopia y Tenoscopia en el Tratamiento de la Tenosinovitis del Sexto CompartimentoDescripción Técnica y Serie de Pacientes

Laburpena

We call tenoscopy the procedure where an endoscopic approach to tendon sheaths is performed. It has already been described for the treatment of ankle, elbow, shoulder, wrist, and hand disorders. We have treated with tenoscopy a series of eight wrists in six patients with chronic inflammatory processes of the sixth extensor compartment of the wrist with no improvement with initial conservative treatment. The procedure begins with an arthroscopy of the radiocarpal and midcarpal spaces to rule out other intra-articular causes of ulnar-sided pain in the wrist. Then, through the 6R portal, the capsule, and the deep portion of the sheath of the extensor carpi ulnaris are resected, gaining access to the inside aspect of the sixth compartment. With the full view of the inner sixth compartment, a specific portal is created for the extensor carpi ulnaris located two centimeters proximal to the joint. Then a wide synovectomy of the compartment is performed with a shaver, both proximal and distal to the joint. The dorsal sensitive branch of the ulnar nerve remains safe throughout the procedure. We have performed a tenoscopy of the sixth extensor compartment in eight wrists of six patients who had failed conservative treatment and obtained great improvement of symptoms with the procedure, with no serious complications or lesion recurrence. Tenoscopy of the extensor carpi ulnaris allows synovectomy of the sixth extensor compartment, preserving the extensor retinaculum. With a minimally invasive approach, this procedure causes less local damage to soft tissues, with less scar tissue formation when compared with classic open procedures. By using a clear view of the compartment through tenoscopy, the risk of adhesions and injury to the ulnar extensor tendons is decreased.