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Sunday, 19/11/17 02:25:43 (GMT+7)
Surgery Information
Ankle, wrist arthroscopy

Small joint arthroscopies are cutting-edge, effective techniques to treat ankle, wrist and hand pain or other chronic problems.

ANKLE ARTHROSCOPY

What is an ankle arthroscopy?
Also known as key hole surgery or minimally invasive ankle surgery. Ankle arthroscopy involves using very small incisions to gain access into the ankle joint. Each incision is less than 1cm and usually two incisions are required. The ankle joint is relatively small and to allow good surgical access to the joint, its dimensions need temporarily to be increased. This is done using a combination of distraction across the joint together with having a stream of pressurized fluid circulating through the joint which distends it.

ankle arthroscopy

Not all ankle surgery can be done or is sensible to try using arthroscopy. The list of conditions below is comprehensive for those disorders in which the technique is useful. The alternative is open ankle surgery which results in larger scars and generally more post-operative pain. For certain cases though this is unavoidable.

standard two anterior ankle arthroscopic wounds

The inside of the ankle joint can be inspected using a small camera with operations carried out on the joint using small, specially designed instruments.

The various disorders in which the technique is useful :

- Ankle arthritis
- Footballers ankle (Anterior Ankle Impingement)
- Unstable ankle
- Lateral ligament reconstruction
- Ankle pain following fracture
- Loose bodies within the ankle
- Osteochondral defects of the talus
- Diseases of the synovium
- Undiagnosed ankle pain

Why ankle arthroscopy?
The alternative to ankle arthroscopy is open ankle surgery. The very small incisions used result in minimal soft tissue disruption and trauma. This in turn results in:

  • Significantly lower pain levels than an open approach
  • The ankle is comfortable to weight bear through on the day of surgery
  • Most cases can be performed as day cases
  • Lower infection rates than open surgery
  • Earlier return to work/function/sports
  • Little scarring
  • Minimal effect if further surgery to the ankle is required

What Happens After My Ankle Arthroscopy?

For the first 24 hours:

Pain Relief
When you wake up after the surgery your ankle should feel comfortable. You will have had injections of local anaesthetic both into the joint and into the nerves around the joint whilst asleep. Following surgery you will be given a combination of three pain killers to take regularly for the first 36 hours post-operatively and then only to be used as required.

Mobility
After the ankle arthroscopy, once you are back on the ward the physiotherapist will start mobilising you. You may put as much weight through the ankle as is comfortable. The conditions where this is not the case are with an osteochondral defect and if your arthroscopy has been part of a lateral ligament reconstruction. You will be more comfortable using crutches for a day or two and then these can be discarded.

Your operated leg will need to be elevated when non-weight bearing for the first 24 to 48 hours.

You are encouraged to exercise your ankle within the bandage both by moving it up and down as well as moving it from side to side. This is from as soon as you are able to do this.

Length of Stay After Ankle Arthroscopy
As long as your general medical condition and domestic circumstances permit, most ankle arthroscopy cases can be performed as a day case surgery.

Return to Sport
After ankle arthroscopy you will be back to walking at 1-2 days following your ankle arthroscopy. This will be without use of a crutch. Any sporting activity is best left for at least two weeks following the procedure. Realistically, things can be built up from two weeks post-operatively but will probably take in excess of four weeks before more vigorous sporting activity will be possible.

 

ENDOSCOPIC CARPAL TUNNEL RELEASE

This standard surgical technique for median nerve decompression -- that is, carpal tunnel release -- has been a very successful operation restoring most patients to their prior activities.

One of the major draw backs to standard, open carpal tunnel release was the slowness of recovery in the palm side surgical scar. Often, the 5cm palm side scar would remain sensitive to direct pressure for approximately six to eight weeks. in the working patient, this scar sensitivity could preclude return to normal work activities. Recently, orthopedic technology has advanced to the point where a standard arthroscope has been specially modified to be of use in carpal tunnel surgery.

 

To employ the endoscopic technique in carpal tunnel release, a small 1cm horizontal incision is made at the wrist and the arthroscope is introduced underneath the transverse carpal ligament. A cannula is inserted into the hand, just under the offending ligament. The surgeon looks through a scope and uses a small knife to simply cut the ligament, thus freeing the nerve. A special blade attached to the tip of the arthroscope is then utilized to incise the transverse carpal ligament from the inside of the carpal tunnel. In effect, by cutting through the transverse carpal ligament, the compression on the median nerve is alleviated and the nerve is thus allowed to go on the heal. With nerve healing, the painful wrist syndrome is corrected.

Endoscopic carpal tunnel surgery is performed utilizing a local anesthetic to numb the arm. After the procedure, a splint is applied to the wrist and the patient is discharged and allowed to go home. Within a week, the splint is removed, a temporary wrist splint is applied and hand rehabilitation is initiated.

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