Surgical technique

The arthroscopic procedure is performed under regional anesthesia with tourniquet control. A single Chinese finger trap is used on the thumb with 5 to 8 lbs of longitudinal traction. A shoulder holder, rather than traction tower, is used to more easily facilitate fluoroscopic intervention. The TMC joint is then detected by palpation. The incision for the 1-R (radial) portal, which is used for proper assessment of the DRL, posterior oblique ligament (POL) and ulnar collateral ligament (UCL), is placed just radial to the APL tendon. The incision for the 1-U (ulnar) portal, which allows better evaluation of the anterior oblique ligament (AOL) and UCL, is made just ulnar to the extensor pollicis longus (EPL) tendon. Joint distension is achieved by injecting 2 to 5 mL of normal saline. A short-barrel, 1.9 mm, 30° inclination arthroscope is used for complete visualization of the TMC joint surfaces, capsule, and ligaments, and then appropriate management is performed as dictated by the pathology found. A full-radius mechanical shaver with suction is used in all cases, particularly for initial debride-ment and visualization. Many cases are augmented with radiofrequency ablation to perform a more thorough synovectomy. This technology and clinical applications are later expanded upon. Radiofrequency is also used to perform chondro-plasty in cases with focal articular cartilage wear or fibrillation. Ligamentous laxity and capsular attenuation are treated with thermal capsulorra-phy, also using a radiofrequency shrinkage probe. The author and colleagues are careful to avoid thermal necrosis, and therefore a striping technique is used to tighten the capsule of lax joints. Although the use of radiofrequency is relatively new, we can gain further understanding by prior basic science studies and the clinical application in other joints.

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