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Wrist Arthroscopy

Diagnostic and therapeutic wrist arthroscopy — what it is, when it's used, and recovery.

Overview

Wrist arthroscopy has evolved from a purely diagnostic modality into an essential therapeutic tool with an expanding list of indications [1, 11]. It serves as a valuable adjunct for managing myriad wrist disorders, including TFCC pathology, carpal instability, fracture reduction assistance, and salvage procedures [2, 11]. Recent technical and technological innovations, such as new portals and smaller arthroscopes, have further expanded its applications for difficult wrist disorders [5, 11]. The procedure is generally safe with minor and transient complications, though the true incidence may be underestimating documented rates [3, 8].

Clinical utility centers on the accurate assessment of articular surfaces and the detection of concomitant soft-tissue injuries [15]. Participants undergoing arthroscopic investigation for persistent wrist pain improved by approximately 50% at one year, though most continued to experience some pain and disability [4]. Specific techniques emphasize traction for joint distention, utilizing various portals and instruments for diagnostic and therapeutic purposes [6]. The radial anterior wrist arthroscopic portal is particularly invaluable for assessing and treating intraarticular conditions, dorsal intraarticular fractures of the distal radius, radial styloidectomy, and synovectomy while respecting safety requirements [29].

Outcomes for specific applications are well-documented; arthroscopic wrist arthrolysis after fracture is a safe, minimally invasive procedure that significantly improves pain and wrist flexion-extension [12]. Nonrandomized studies demonstrate satisfactory results for arthroscopically assisted reduction of distal radius fractures [15]. Detailed anatomical knowledge remains essential to minimize complications during these procedures [2].

Anatomy & Pathophysiology

Vascular & Neural

Detailed knowledge of anatomy is essential to minimize complications during wrist arthroscopy [2]. Trauma to the posterior interosseous nerve (PIN) may occur more frequently during creation of the 3-4 wrist arthroscopy portal than previously reported [7].

Ligamentous

Tears of the dorsal radiocarpal ligament (DRCL) are commonly seen with injuries to the primary wrist stabilizers [27].

Imaging & Biomechanics

A negative magnetic resonance imaging scan using a technique that does not employ a dedicated wrist coil does not exclude triangular fibrocartilage complex or scapholunate ligament injuries [19]. The maximum allowable navigation force during wrist arthroscopy is 7.3 N (90th percentile) [26].

Classification

General Utility: Wrist arthroscopy is an essential diagnostic and therapeutic tool for the orthopaedic surgeon with an ever-expanding list of indications and procedures [1]. It has grown from a diagnostic tool to a valuable adjunctive procedure for myriad wrist disorders [2]. The procedure serves as a crucial tool for diagnosing intra-articular pathology [3] and treating multiple wrist conditions [3]. Recent technical and technological developments allow for advanced treatments of difficult wrist disorders [5]. Innovations like new portals and smaller arthroscopes are expanding the applications of wrist arthroscopy [11].

Specific Indications: Wrist arthroscopy has evolved into an essential diagnostic and therapeutic tool with a wide list of indications including management of TFCC pathology [11], carpal instability [11], fracture reduction assistance [11], and salvage procedures [11]. It has a pivotal role in the assessment and treatment of scapholunate ligament complex derangements [9] and distal radioulnar joint instability [9]. Dry wrist arthroscopy is an ideal intervention for the management of intra-articular distal radius fractures given the lack of fluid extravasation [10] and can assist when performing concomitant open procedures [10].

Outcomes: Participants who underwent arthroscopic investigation for persistent wrist pain improved on average by approximately 50% at one year [4]. However, most participants who underwent arthroscopic investigation for persistent wrist pain continued to have some pain and disability at one year [4].

Safety and Complications: Wrist arthroscopy is a safe procedure with minor and transient complications [3]. Detailed knowledge of anatomy is essential to minimize complications in wrist arthroscopy [2]. There may be more instances of trauma to the posterior interosseous nerve (PIN) during routine creation of the 3-4 wrist arthroscopy portal than previously reported [7]. The previously documented rate of wrist arthroscopy complications may be underestimating the true incidence [8].

Technical Considerations: Surgical technique, instrumentation, and indications for wrist arthroscopy emphasize the use of traction for joint distention [6]. Various portals and instruments are available for diagnostic and therapeutic procedures in wrist arthroscopy [6]. Dry wrist arthroscopy circumvents problems associated with fluid-based paradigms such as fluid extravasation and tissue swelling [14] and allows for larger portals and instruments [14].

Diagnostic Correlation: There is only a fair correlation between arthroscopy and MRI for assessing wrist cartilage [17]. Wrist arthroscopy and MRI cannot be concluded to be equivalent methods for assessing wrist cartilage [17]. Wrist arthroscopy still has an important role to play in the assessment of a painful degenerative wrist [17].

Other Considerations: Portal Creation: Routine creation of the 3-4 wrist arthroscopy portal carries a risk of posterior interosseous nerve (PIN) trauma [7]. Fluid Dynamics: Dry wrist arthroscopy avoids fluid extravasation and tissue swelling [10, 14]. Cartilage Assessment: Arthroscopy and MRI are not equivalent for cartilage assessment [17].

Clinical Presentation

Wrist arthroscopy has evolved from a purely diagnostic tool to a valuable adjunctive procedure for myriad wrist disorders, serving as an essential diagnostic and therapeutic instrument for orthopaedic surgeons [1, 2]. It is a safe procedure associated with minor and transient complications, though the previously documented complication rates may underestimate the true incidence [3, 8]. The technique is crucial for diagnosing intra-articular pathology and treating multiple wrist conditions, including scapholunate ligament complex derangements and distal radioulnar joint instability [3, 9]. Recent technical and technological developments, such as new portals and smaller arthroscopes, allow for advanced treatments of difficult wrist disorders [5, 11].

For patients with persistent wrist pain, arthroscopic investigation yields an average improvement of approximately 50% at one year [4]. However, most patients continue to experience some pain and disability after one year, with moderate levels of pain and disability often persisting [4, 13]. Diagnostic arthroscopy performed in the setting of an unclear preoperative diagnosis has yielded limited diagnostic benefit [16].

Surgical Technique: The procedure emphasizes the use of traction for joint distention [6]. Various portals and instruments are available for diagnostic and therapeutic procedures, though there may be more instances of trauma to the posterior interosseous nerve (PIN) during creation of the 3-4 wrist arthroscopy portal than previously reported [6, 7].

Indications: Wrist arthroscopy indications include management of triangular fibrocartilage complex (TFCC) pathology, carpal instability, fracture reduction assistance, and salvage procedures [11]. It is advantageous for the accurate assessment of articular surfaces and the detection of concomitant soft-tissue injuries [15]. Nonrandomized studies show satisfactory results for arthroscopically assisted reduction of distal radius fractures [15].

Dry Wrist Arthroscopy: This technique is an ideal intervention for the management of intra-articular distal radius fractures due to the lack of fluid extravasation [10]. It circumvents problems associated with fluid-based paradigms, such as fluid extravasation and tissue swelling [14]. Dry wrist arthroscopy offers the advantage of no fluid extravasation and allows for the performance of concomitant open procedures [10, 20]. It is suitable for diagnosing and treating ulnar-sided wrist disorders and can manage multiple orthopaedic conditions including soft-tissue and osseous injuries [20, 21]. However, this technique requires specific technical considerations to avoid thermal injury and shaver blockage [20]. Additionally, dry wrist arthroscopy allows for the use of larger portals and instruments [14].

Diagnostic Reliability: Experienced wrist arthroscopy surgeons demonstrated fair-good interobserver reliability for the diagnosis of triangular fibrocartilage complex (TFCC) tears on wrist arthroscopy [22]. Reliability for the diagnosis of TFCC tears was poor when central TFCC tears were excluded [22].

Investigations

Wrist Arthroscopy: Wrist arthroscopy serves as an essential diagnostic and therapeutic tool with an ever-expanding list of indications, evolving from a purely diagnostic modality to a valuable adjunct for myriad wrist disorders [1, 2]. It is crucial for diagnosing intra-articular pathology, assessing articular surfaces, and detecting concomitant soft-tissue injuries [3, 15]. The procedure allows direct visualization of cartilage surfaces, synovial tissue, and ligaments under bright illumination and magnification [33]. Specific pivotal roles include the assessment and treatment of scapholunate ligament complex derangements and distal radioulnar joint instability [9], as well as the management of triangular fibrocartilage complex (TFCC) pathology, carpal instability, fracture reduction assistance, and salvage procedures [11]. Recent technical and technological developments, including new portals and smaller arthroscopes, facilitate advanced treatments for difficult wrist disorders [5, 11]. Surgical technique emphasizes the use of traction for joint distention, with various portals and instruments available for diagnostic and therapeutic procedures [6]. While generally safe with minor and transient complications, detailed anatomical knowledge is essential to minimize risks [2, 3]. Notably, there may be more instances of trauma to the posterior interosseous nerve (PIN) during routine creation of the 3-4 portal than previously reported [7].

Dry vs. Fluid Techniques: Dry wrist arthroscopy is an ideal intervention for intra-articular distal radius fractures due to the lack of fluid extravasation and can assist during concomitant open procedures [10]. This approach circumvents problems associated with fluid-based paradigms, such as fluid extravasation and tissue swelling, while allowing for larger portals and instruments [14].

Outcomes and Utility: Participants undergoing arthroscopic investigation for persistent wrist pain improved on average by approximately 50% at one year, though most continued to experience some pain and disability [4]. Diagnostic arthroscopy performed when the preoperative diagnosis is unclear yields limited diagnostic benefit [16].

MRI Limitations: There is only a fair correlation between arthroscopy and MRI for assessing wrist cartilage [17]. When a magnetic resonance technique that does not employ a dedicated wrist coil is used, a negative MRI scan does not exclude triangular fibrocartilage complex or scapholunate ligament injuries [19]. Furthermore, a 3 tesla MRI was neither sensitive nor specific enough to correctly diagnose lesions in small pediatric wrists, and most lesions in children and adolescents with chronic wrist pain have not been correctly identified by MRI before arthroscopy [30, 31]. Despite these limitations, wrist arthroscopy retains an important role in the assessment of a painful degenerative wrist [17].

Other Considerations: Nonrandomized studies show satisfactory results for arthroscopically assisted reduction of distal radius fractures [15].

Treatment

Wrist arthroscopy has evolved from a purely diagnostic tool to an essential therapeutic adjunct for myriad wrist disorders, serving as a crucial instrument for diagnosing intra-articular pathology and treating multiple conditions [1, 2, 3]. While the procedure is generally safe with minor and transient complications, detailed anatomical knowledge remains essential to minimize risks [2, 3]. Recent technical and technological developments, including new portals and smaller arthroscopes, have expanded applications for advanced treatments of difficult wrist disorders [5, 11].

Operative

Indications: Wrist arthroscopy is indicated for the management of triangular fibrocartilage complex (TFCC) pathology, carpal instability, fracture reduction assistance, and salvage procedures [11]. It plays a pivotal role in assessing and treating scapholunate ligament complex derangements and distal radioulnar joint instability [9]. The procedure offers advantages for the accurate assessment of articular surfaces and the detection of concomitant soft-tissue injuries [15].

Surgical Approach / Technique: Surgical technique, instrumentation, and indications emphasize the use of traction for joint distention, utilizing various available portals and instruments for diagnostic and therapeutic procedures [6]. Dry wrist arthroscopy is an ideal intervention for managing intra-articular distal radius fractures due to the lack of fluid extravasation and can assist during concomitant open procedures [10]. Arthroscopic wrist arthrolysis following wrist fracture is a safe, minimally invasive procedure that significantly improves pain and wrist flexion-extension [12].

Adjuncts: Supplemental wrist arthroscopy improves the reduction of articular stepoff in distal radius fractures treated with volar locking plates, though it does not appear to improve overall outcomes at one year in this specific population [18]. Nonrandomized studies demonstrate satisfactory results for arthroscopically assisted reduction of distal radius fractures [15].

Other Considerations: Outcomes for patients with persistent wrist pain undergoing arthroscopy show an average improvement of approximately 50% in pain and disability at one year, yet moderate levels of pain and disability often persist [4, 13]. Arthroscopic synovectomy can provide pain relief and functional improvement with control of synovitis in 75% of rheumatoid wrists that have not responded to medication [24]. The safety of radiofrequency (RFE) for chondroplasty under continuous irrigation and constant movement remains questionable, with application indicating a high risk for chondrocytes, particularly for bipolar application [23].

Complications

Nerve palsy: Detailed knowledge of anatomy is essential to minimize complications in wrist arthroscopy [2]. There may be more instances of trauma to the posterior interosseous nerve (PIN) during routine wrist arthroscopy than have been previously reported [7].

General complications: Wrist arthroscopy is associated with minor and transient complications [3]. The previously documented rate of wrist arthroscopy complications may be underestimating the true incidence [8]. Arthroscopic procedures demonstrate a low complication rate compared with open techniques [32].

Other Considerations: While specific categories such as infection, aseptic loosening, instability, periprosthetic fracture, thromboembolism, patellar/extensor-mechanism issues, stiffness/arthrofibrosis, wound complications, and polyethylene wear are not detailed in the provided evidence base, the overall complication profile remains characterized by minor and transient events [3].

Recovery

Light activity (weeks): Evidence does not specify a precise week range for resuming desk work, driving, or light activities of daily living.

Full activity (months): Evidence does not specify a precise month range for returning to manual work, sport, or achieving full range of motion and strength.

Complete recovery / outcome plateau (months): Patients undergoing arthroscopic investigation for persistent wrist pain typically reach an outcome plateau at one year, with approximately 50% improvement in pain and disability [4, 13]. However, most patients continue to experience moderate levels of pain and disability at this time point [4, 13]. In the specific context of wrist fracture, arthroscopic wrist arthrolysis significantly improves pain and wrist flexion-extension, though the timeline for full stabilization is not explicitly defined in the provided evidence [12]. Conversely, supplemental wrist arthroscopy does not appear to improve outcomes at one year in patients with distal radius fractures treated with volar locking plates [18].

Rehabilitation protocol: The provided evidence does not contain specific data regarding physical therapy phasing, immobilisation duration, weight-bearing progression, or sling/brace removal timing.

Functional milestones: Validated outcome trajectories indicate that participants undergoing arthroscopic investigation for persistent wrist pain improve by approximately 50% at one year [4]. Patients may expect approximately 50% improvement in pain and disability within one year, though moderate levels of pain and disability often persist [13].

Other Considerations: Wrist arthroscopy is a safe procedure associated with minor and transient complications [3], though the previously documented rate of complications may be underestimating the true incidence [8]. There may be more instances of trauma to the posterior interosseous nerve (PIN) during routine wrist arthroscopy than previously reported [7].

Key Evidence

  • [L5] Wrist arthroscopy is an essential diagnostic and therapeutic tool for the orthopaedic surgeon with an ever-expanding list of indications and procedures. (10.1016/j.arthro.2007.11.002)
  • [L5] Wrist arthroscopy has grown from a diagnostic tool to a valuable adjunctive procedure for myriad wrist disorders, but detailed knowledge of anatomy is essential to minimize complications. (10.1016/j.jhsa.2008.07.015)
  • [L2] Participants who underwent arthroscopic investigation for persistent wrist pain improved on average by approximately 50% at one year; however, most continued to have some pain and disability. (10.1016/j.jht.2012.03.001)
  • [L5] Recent technical and technological developments in wrist arthroscopic surgery allow for advanced treatments of difficult wrist disorders. (10.1177/17531934211030861)
  • [L5] Based on the findings of this study, there may be more instances of trauma to the PIN during routine wrist arthroscopy than have been previously reported. (10.1016/j.arthro.2017.01.010)
  • [L4] This systematic review suggests that the previously documented rate of wrist arthroscopy complications may be underestimating the true incidence. (10.1016/j.arthro.2012.01.008)
  • [L5] Wrist arthroscopy has a pivotal role in the assessment and treatment of scapholunate ligament complex derangements and distal radioulnar joint instability. (10.1016/j.jhsa.2012.06.028)
  • [L5] Dry wrist arthroscopy is an ideal intervention for the management of intra-articular distal radius fractures given the lack of fluid extravasation, and it can assist when performing concomitant open procedures. (10.1016/j.jhsa.2020.01.012)
  • [L5] Wrist arthroscopy has evolved into an essential diagnostic and therapeutic tool with a wide list of indications, including management of TFCC pathology, carpal instability, fracture reduction assistance, and salvage procedures, with innovations like new portals and smaller arthroscopes expanding its applications. (10.5435/jaaos-20-11-725)
  • [L4] The procedure is safe, required minimal invasive surgery, and significantly improved pain and wrist flexion-extension. (10.1016/j.arthro.2006.11.001)
  • [L5] The commentary concludes that patients with persistent wrist pain undergoing arthroscopy may expect approximately 50% improvement in pain and disability within one year, though moderate levels of pain and disability often persist. (10.1016/j.jht.2012.04.002)
  • [L5] Dry wrist arthroscopy circumvents problems associated with fluid-based paradigms, such as fluid extravasation and tissue swelling, while allowing larger portals and instruments. (10.1016/j.jhsa.2014.08.042)
  • [L5] Wrist arthroscopy is advantageous for accurate assessment of articular surfaces and detection of concomitant soft-tissue injuries, with nonrandomized studies showing satisfactory results for arthroscopically assisted reduction of distal radius fractures. (10.1016/j.arthro.2007.10.006)
  • [L4] Diagnostic arthroscopy performed in the setting of an unclear preoperative diagnosis yielded limited diagnostic benefit. (10.1177/1558944716661993)
  • [L3] With only a fair correlation between arthroscopy and MRI, it cannot be concluded that the two methods are equivalent for assessing wrist cartilage and, as such, wrist arthroscopy still has an important role to play in the assessment of a painful degenerative wrist. (10.1177/1753193408090395)
  • [L5] Supplemental wrist arthroscopy does not appear to improve outcomes at 1 year in patients with distal radius fractures treated with volar locking plates, despite improved reduction of articular stepoff. (10.1016/j.arthro.2023.07.041)
  • [L3] When a magnetic resonance technique that does not employ a dedicated wrist coil is used, a negative magnetic resonance imaging scan does not exclude triangular fibrocartilage complex or scapholunate ligament injuries. (10.1054/jhsb.2001.0645)
  • [L5] Dry wrist arthroscopy is suitable for diagnosing and treating ulnar-sided wrist disorders, offering advantages such as no fluid extravasation and the ability to perform concomitant open procedures, though it requires specific technical considerations to avoid thermal injury and shaver blockage. (10.1016/j.jhsa.2020.08.011)
  • [L5] Dry wrist arthroscopy is a technique that can be used to manage multiple orthopaedic conditions including soft-tissue and osseous injuries. (10.1016/j.arthro.2023.02.002)
  • [L4] Experienced wrist arthroscopy surgeons demonstrated fair-good interobserver reliability for the diagnosis of TFCC tear on wrist arthroscopy, but reliability was poor when central TFCC tears were excluded. (10.1016/j.jhsa.2024.07.002)
  • [L5] It remains questionable how safe RFE can be used for chondroplasty in wrist arthroscopy under continuous irrigation and constant movement to obtain the desired sealing effect. (10.1186/s12891-015-0460-2)
  • [L4] Arthroscopic synovectomy of the wrist can provide pain relief and functional improvement with control of synovitis in 75% of rheumatoid wrists that have not responded to medication. (10.1016/j.jhsa.2014.04.022)
  • [L5] Unique expert data on navigation forces during wrist arthroscopy were determined, with a defined maximum allowable navigation force of 7.3 N (90th percentile) that can be used to provide feedback on performance during skills training. (10.1007/s00167-014-3450-2)
  • [L4] DRCL tears are commonly seen with injuries to the primary wrist stabilizers. (10.1016/j.jhsa.2007.11.026)
  • [L4] The radial anterior wrist arthroscopic portal is invaluable for assessing and treating intraarticular conditions, particularly dorsal intraarticular fractures of the distal radius, radial styloidectomy, and synovectomy, while respecting safety requirements. (10.1054/jhsb.1999.0166)
  • [L4] A 3 tesla MRI was neither sensitive nor specific enough to correctly diagnose lesions in small pediatric wrists. (10.1016/j.asmr.2022.04.029)
  • [L3] However, most of these lesions have not been correctly identified by MRI before arthroscopy. (10.1016/j.arthro.2012.04.152)
  • [L5] Arthroscopic procedures demonstrate better results and improved localization of the injury with a low complication rate compared with open techniques. (10.5435/00124635-200105000-00006)
  • [L5] Wrist arthroscopy allows direct visualization of cartilage surfaces, synovial tissue, and ligaments under bright illumination and magnification. (10.2106/00004623-199908000-00015)

References

[1] New Advances in Wrist Arthroscopy. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2007.11.002

[2] Wrist Arthroscopy: Current Concepts. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2008.07.015

[3] Chapter 39 Wrist Arthroscopy. 2019.

[4] Prognosis and Prognostic Factors for Patients with Persistent Wrist Pain Who Proceed to Wrist Arthroscopy. Journal of Hand Therapy. 2012. DOI: 10.1016/j.jht.2012.03.001

[5] Revolutions in arthroscopic wrist surgeries. Journal of Hand Surgery (European Volume). 2021. DOI: 10.1177/17531934211030861

[6] Wrist Arthroscopy. 2021.

[7] Incidence of Posterior Interosseous Nerve Trauma During Creation of the 3‐4 Wrist Arthroscopy Portal in Cadavers. Arthroscopy. 2017. DOI: 10.1016/j.arthro.2017.01.010

[8] Complications of Wrist Arthroscopy. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.01.008

[9] Current Innovations in Wrist Arthroscopy. The Journal of Hand Surgery. 2012. DOI: 10.1016/j.jhsa.2012.06.028

[10] Dry Wrist Arthroscopy for Radial-Sided Wrist Disorders. The Journal of Hand Surgery. 2020. DOI: 10.1016/j.jhsa.2020.01.012

[11] Advances in Wrist Arthroscopy. Journal of the American Academy of Orthopaedic Surgeons. 2012. DOI: 10.5435/jaaos-20-11-725

[12] Arthroscopic Wrist Arthrolysis After Wrist Fracture. Arthroscopy. 2007. DOI: 10.1016/j.arthro.2006.11.001

[13] Clinical Commentary in Response to: Prognosis and Prognostic Factors for Patients with Persistent Wrist Pain Who Proceed to Wrist Arthroscopy. Journal of Hand Therapy. 2012. DOI: 10.1016/j.jht.2012.04.002

[14] Dry Wrist Arthroscopy. The Journal of Hand Surgery. 2015. DOI: 10.1016/j.jhsa.2014.08.042

[15] Current Concepts in Wrist Arthroscopy. Arthroscopy. 2008. DOI: 10.1016/j.arthro.2007.10.006

[16] Diagnostic Wrist Arthroscopy for Nonspecific Wrist Pain. HAND. 2016. DOI: 10.1177/1558944716661993

[17] Comparison of MRI and Wrist Arthroscopy for Assessment of Wrist Cartilage. Journal of Hand Surgery (European Volume). 2008. DOI: 10.1177/1753193408090395

[18] Editorial Commentary: Supplemental Wrist Arthroscopy May Not Be the Key to Improving Outcomes in Surgical Treatment of Distal Radius Fractures. Arthroscopy. 2024. DOI: 10.1016/j.arthro.2023.07.041

[19] A Comparison of the Findings of Wrist Arthroscopy and Magnetic Resonance Imaging in the Investigation of Wrist Pain. Journal of Hand Surgery. 2001. DOI: 10.1054/jhsb.2001.0645

[20] Dry Wrist Arthroscopy for Ulnar-Sided Wrist Disorders. The Journal of Hand Surgery. 2021. DOI: 10.1016/j.jhsa.2020.08.011

[21] Dry Wrist Arthroscopy: Technique and Rationale. Arthroscopy. 2023. DOI: 10.1016/j.arthro.2023.02.002

[22] Reliability of Wrist Arthroscopy in the Diagnosis and Treatment of Triangular Fibrocartilage Complex Tears. The Journal of Hand Surgery. 2025. DOI: 10.1016/j.jhsa.2024.07.002

[23] RFE based chondroplasty in wrist arthroscopy indicates high risk for chrondocytes especially for the bipolar application. BMC Musculoskeletal Disorders. 2015. DOI: 10.1186/s12891-015-0460-2

[24] Long-Term Results of Arthroscopic Wrist Synovectomy in Rheumatoid Arthritis. The Journal of Hand Surgery. 2014. DOI: 10.1016/j.jhsa.2014.04.022

[26] Navigation forces during wrist arthroscopy: assessment of expert levels. Knee Surgery, Sports Traumatology, Arthroscopy. 2014. DOI: 10.1007/s00167-014-3450-2

[27] The Incidence of Dorsal Radiocarpal Ligament Tears in Patients Having Diagnostic Wrist Arthroscopy for Wrist Pain. The Journal of Hand Surgery. 2008. DOI: 10.1016/j.jhsa.2007.11.026

[29] An Anterior Portal for Wrist Arthroscopy. Journal of Hand Surgery. 1999. DOI: 10.1054/jhsb.1999.0166

[30] Wrist Arthroscopy Is Effective for the Diagnosis and Treatment of Chronic Wrist Pain in Pediatric Patients. Arthroscopy, Sports Medicine, and Rehabilitation. 2022. DOI: 10.1016/j.asmr.2022.04.029

[31] Pathomorphologic Findings of Wrist Arthroscopy in Children and Adolescents With Chronic Wrist Pain. Arthroscopy. 2012. DOI: 10.1016/j.arthro.2012.04.152

[32] Wrist Arthroscopy: Principles and Clinical Applications. Journal of the American Academy of Orthopaedic Surgeons. 2001. DOI: 10.5435/00124635-200105000-00006

[33] Techniques of Wrist Arthroscopy . The Journal of Bone and Joint Surgery-American Volume*. 1999. DOI: 10.2106/00004623-199908000-00015

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b. No downstream restrictions. You may not offer or impose any additional or different terms or conditions on, or apply any Effective Technological Measures to, the Licensed Material if doing so restricts exercise of the Licensed Rights by any recipient of the Licensed Material.

6. No endorsement. Nothing in this Public License constitutes or may be construed as permission to assert or imply that You are, or that Your use of the Licensed Material is, connected with, or sponsored, endorsed, or granted official status by, the Licensor or others designated to receive attribution as provided in Section 3(a)(1)(A)(i).

b. Other rights.

1. Moral rights, such as the right of integrity, are not licensed under this Public License, nor are publicity, privacy, and/or other similar personality rights; however, to the extent possible, the Licensor waives and/or agrees not to assert any such rights held by the Licensor to the limited extent necessary to allow You to exercise the Licensed Rights, but not otherwise.

2. Patent and trademark rights are not licensed under this Public License.

3. To the extent possible, the Licensor waives any right to collect royalties from You for the exercise of the Licensed Rights, whether directly or through a collecting society under any voluntary or waivable statutory or compulsory licensing scheme. In all other cases the Licensor expressly reserves any right to collect such royalties, including when the Licensed Material is used other than for NonCommercial purposes.

Section 3 -- License Conditions.

Your exercise of the Licensed Rights is expressly made subject to the following conditions.

a. Attribution.

1. If You Share the Licensed Material (including in modified form), You must:

a. retain the following if it is supplied by the Licensor with the Licensed Material:

i. identification of the creator(s) of the Licensed Material and any others designated to receive attribution, in any reasonable manner requested by the Licensor (including by pseudonym if designated);

ii. a copyright notice;

iii. a notice that refers to this Public License;

iv. a notice that refers to the disclaimer of warranties;

v. a URI or hyperlink to the Licensed Material to the extent reasonably practicable;

b. indicate if You modified the Licensed Material and retain an indication of any previous modifications; and

c. indicate the Licensed Material is licensed under this Public License, and include the text of, or the URI or hyperlink to, this Public License.

2. You may satisfy the conditions in Section 3(a)(1) in any reasonable manner based on the medium, means, and context in which You Share the Licensed Material. For example, it may be reasonable to satisfy the conditions by providing a URI or hyperlink to a resource that includes the required information.

3. If requested by the Licensor, You must remove any of the information required by Section 3(a)(1)(A) to the extent reasonably practicable.

4. If You Share Adapted Material You produce, the Adapter's License You apply must not prevent recipients of the Adapted Material from complying with this Public License.

Section 4 -- Sui Generis Database Rights.

Where the Licensed Rights include Sui Generis Database Rights that apply to Your use of the Licensed Material:

a. for the avoidance of doubt, Section 2(a)(1) grants You the right to extract, reuse, reproduce, and Share all or a substantial portion of the contents of the database for NonCommercial purposes only;

b. if You include all or a substantial portion of the database contents in a database in which You have Sui Generis Database Rights, then the database in which You have Sui Generis Database Rights (but not its individual contents) is Adapted Material; and

c. You must comply with the conditions in Section 3(a) if You Share all or a substantial portion of the contents of the database.

For the avoidance of doubt, this Section 4 supplements and does not replace Your obligations under this Public License where the Licensed Rights include other Copyright and Similar Rights.

Section 5 -- Disclaimer of Warranties and Limitation of Liability.

a. UNLESS OTHERWISE SEPARATELY UNDERTAKEN BY THE LICENSOR, TO THE EXTENT POSSIBLE, THE LICENSOR OFFERS THE LICENSED MATERIAL AS-IS AND AS-AVAILABLE, AND MAKES NO REPRESENTATIONS OR WARRANTIES OF ANY KIND CONCERNING THE LICENSED MATERIAL, WHETHER EXPRESS, IMPLIED, STATUTORY, OR OTHER. THIS INCLUDES, WITHOUT LIMITATION, WARRANTIES OF TITLE, MERCHANTABILITY, FITNESS FOR A PARTICULAR PURPOSE, NON-INFRINGEMENT, ABSENCE OF LATENT OR OTHER DEFECTS, ACCURACY, OR THE PRESENCE OR ABSENCE OF ERRORS, WHETHER OR NOT KNOWN OR DISCOVERABLE. WHERE DISCLAIMERS OF WARRANTIES ARE NOT ALLOWED IN FULL OR IN PART, THIS DISCLAIMER MAY NOT APPLY TO YOU.

b. TO THE EXTENT POSSIBLE, IN NO EVENT WILL THE LICENSOR BE LIABLE TO YOU ON ANY LEGAL THEORY (INCLUDING, WITHOUT LIMITATION, NEGLIGENCE) OR OTHERWISE FOR ANY DIRECT, SPECIAL, INDIRECT, INCIDENTAL, CONSEQUENTIAL, PUNITIVE, EXEMPLARY, OR OTHER LOSSES, COSTS, EXPENSES, OR DAMAGES ARISING OUT OF THIS PUBLIC LICENSE OR USE OF THE LICENSED MATERIAL, EVEN IF THE LICENSOR HAS BEEN ADVISED OF THE POSSIBILITY OF SUCH LOSSES, COSTS, EXPENSES, OR DAMAGES. WHERE A LIMITATION OF LIABILITY IS NOT ALLOWED IN FULL OR IN PART, THIS LIMITATION MAY NOT APPLY TO YOU.

c. The disclaimer of warranties and limitation of liability provided above shall be interpreted in a manner that, to the extent possible, most closely approximates an absolute disclaimer and waiver of all liability.

Section 6 -- Term and Termination.

a. This Public License applies for the term of the Copyright and Similar Rights licensed here. However, if You fail to comply with this Public License, then Your rights under this Public License terminate automatically.

b. Where Your right to use the Licensed Material has terminated under Section 6(a), it reinstates:

1. automatically as of the date the violation is cured, provided it is cured within 30 days of Your discovery of the violation; or

2. upon express reinstatement by the Licensor.

For the avoidance of doubt, this Section 6(b) does not affect any right the Licensor may have to seek remedies for Your violations of this Public License.

c. For the avoidance of doubt, the Licensor may also offer the Licensed Material under separate terms or conditions or stop distributing the Licensed Material at any time; however, doing so will not terminate this Public License.

d. Sections 1, 5, 6, 7, and 8 survive termination of this Public License.

Section 7 -- Other Terms and Conditions.

a. The Licensor shall not be bound by any additional or different terms or conditions communicated by You unless expressly agreed.

b. Any arrangements, understandings, or agreements regarding the Licensed Material not stated herein are separate from and independent of the terms and conditions of this Public License.

Section 8 -- Interpretation.

a. For the avoidance of doubt, this Public License does not, and shall not be interpreted to, reduce, limit, restrict, or impose conditions on any use of the Licensed Material that could lawfully be made without permission under this Public License.

b. To the extent possible, if any provision of this Public License is deemed unenforceable, it shall be automatically reformed to the minimum extent necessary to make it enforceable. If the provision cannot be reformed, it shall be severed from this Public License without affecting the enforceability of the remaining terms and conditions.

c. No term or condition of this Public License will be waived and no failure to comply consented to unless expressly agreed to by the Licensor.

d. Nothing in this Public License constitutes or may be interpreted as a limitation upon, or waiver of, any privileges and immunities that apply to the Licensor or You, including from the legal processes of any jurisdiction or authority.

Creative Commons is not a party to its public licenses. Notwithstanding, Creative Commons may elect to apply one of its public licenses to material it publishes and in those instances will be considered the “Licensor.” The text of the Creative Commons public licenses is dedicated to the public domain under the CC0 Public Domain Dedication. Except for the limited purpose of indicating that material is shared under a Creative Commons public license or as otherwise permitted by the Creative Commons policies published at creativecommons.org/policies, Creative Commons does not authorize the use of the trademark "Creative Commons" or any other trademark or logo of Creative Commons without its prior written consent including, without limitation, in connection with any unauthorized modifications to any of its public licenses or any other arrangements, understandings, or agreements concerning use of licensed material. For the avoidance of doubt, this paragraph does not form part of the public licenses.

Creative Commons may be contacted at creativecommons.org.