Small joint arthroscopy is a minimally invasive surgical technique used to diagnose and treat a wide range of conditions affecting the small joints of the hand, wrist, ankle, foot, and sometimes the elbow. While arthroscopy is commonly associated with larger joints such as the knee and shoulder, advances in technology and surgical instrumentation have allowed surgeons to apply the same principles to smaller, more delicate joints. This procedure has become an important tool in orthopedic and hand surgery, offering patients faster recovery, less postoperative pain, and smaller scars compared to traditional open surgery.
Arthroscopy involves the use of a small fiber-optic camera called an arthroscope, which is inserted into the joint through tiny incisions. The camera transmits high-definition images onto a screen, allowing the surgeon to visualize the inside of the joint in real time. Specialized miniature instruments can also be inserted through additional portals to perform repairs, remove diseased tissue, or address structural abnormalities. In small joint arthroscopy, the instruments are specifically designed to be delicate and precise, considering the limited space and fine anatomy of small joints.
For diagnostic purposes, arthroscopy is particularly valuable when imaging modalities such as MRI or CT scans are inconclusive. It allows direct visualization of intra-articular structures, leading to accurate diagnosis.
The procedure is usually performed under regional or general anesthesia, depending on the joint involved and the patient’s condition. The joint is carefully prepared and marked to identify safe entry points. Small incisions, often just a few millimeters in size, are made to introduce the arthroscope and instruments. Fluid is introduced into the joint to expand the space, improving visibility and allowing safe manipulation of instruments.
During the procedure, the surgeon systematically inspects the joint surfaces, ligaments, synovium, and other intra-articular structures. If necessary, therapeutic interventions are performed, such as debridement, removal of loose bodies, synovectomy, ligament repair, or cartilage treatment. Once completed, the instruments are withdrawn, and the tiny incisions are closed with sutures or adhesive strips.
Like any surgical procedure, small joint arthroscopy carries some risks, although complications are relatively uncommon. Potential risks include:
With experienced surgeons and proper postoperative care, these risks are minimized.
Recovery after small joint arthroscopy is generally faster compared to open surgery. Patients are usually advised to keep the operated joint elevated to reduce swelling. Ice packs and prescribed medications help manage pain. Depending on the procedure, physiotherapy may be recommended to restore range of motion, strengthen surrounding muscles, and prevent stiffness. Most patients can resume light activities within a few days, though return to full function varies with the extent of surgery and the joint involved.
With continuing advancements in arthroscopic technology, including high-definition cameras, improved fluid management systems, and finer instruments, the scope of small joint arthroscopy is expanding. Research into biologic therapies such as cartilage restoration and minimally invasive ligament reconstruction techniques may further enhance outcomes. The integration of robotics and navigation systems may also improve precision and safety in the future.
Small joint arthroscopy has revolutionized the diagnosis and treatment of conditions affecting the wrist, hand, ankle, and other smaller joints. By offering a minimally invasive approach with superior visualization, it provides patients with less pain, quicker recovery, and excellent cosmetic results. While it requires specialized skills and equipment, in appropriately selected cases, small joint arthroscopy is a safe and highly effective surgical option that continues to grow in importance within orthopedic and hand surgery practice.