Alejandro Badia, MD, FACS
Arthroscopy simply means observation of a joint utilizing an instrument. Watanabe first developed this in Japan nearly 50 years ago and it was soon obvious that the minimally invasive nature of this procedure lead to better visualization of a joint while simultaneously minimizing pain and joint morbidity.
As in many orthopedic procedures, the knee was for decades the sole benefactor of this new technology but soon other joints such as shoulder and elbow began to be explored. It is perhaps these joints, and others in the upper extremity, that best benefit from this technology since motion and dexterity are more important than in the weight-bearing lower extremity articulations.
A discussion regarding shoulder surgery is basically an arthroscopic review where perhaps only prosthetic implant surgeries are done open for the vast majority of pathology. Therefore, it is perhaps more interesting to discuss the nuances of arthroscopy of the fingers, thumb, and wrist in more detail with later mention of elbow and certainly the commonplace shoulder arthroscopy during this review.
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 perils 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.