DRUJ Arthroscopy, Is It Necessary for TFCC Management?

DRUJ Arthroscopy is highly recommended for complete assessment of the wrist for ulnar sided lesions such as triangular Fibrocartilage Complex fovea tears and pathologies around the ulnar head and the joint itself. It is a relatively small joint compared to the radiocarpal and the midcarpal joint. If the TFCC and DRU ligaments are still very much intact, there may be difficulty in negotiating the tight space. This may deter some from pursuing this procedure. Nakamura et al 2014 has demonstrated the benefits of DRUJ arthroscopy for the assessment of DRUJ instability in particular the fovea tears through direct vision, thereby enabling the accurate classification of the TFCC tears from such. 

However, despite such benefits shown, there are still many surgeons who are able to diagnose and treat TFCC fovea tears without the need for DRUJ arthroscopy, limiting to just visualization through the radiocarpal joint and performing intra-articular assessment and test such as the hook test and elicit trampoline sign. In patients with a sizable central perforation of TFCC, DRUJ assessment can be adequately performed through the lesion. 

A long learning curve is required to enable to surgeon to be competent in DRUJ arthroscopy procedure. it is recommended to practice on cadavers and simulators till a competent level is reached to minimize surgical trauma to the DRUJ and the surrounding structures as potential complications include perforation of the TFCC and injury to the cutaneous nerves and extensor tendons can happen.