Arthroscopic treatment of carpal boss: Description of an intra-articular technique.

INTRODUCTION

Carpal Boss is a bony protuberance located on the dorsal region of the wrist, at the base of the carpometacarpal joint of the second and third rays. It is a lesion of uncertain origin and, when associated with osteophytes and osteoarthritis, may be linked by a congenital change due to the presence of an accessory bone (os styloideum), which causes a change in biomechanics, thus creating instability. In symptomatic patients, surgery may be indicated and consists of resecting the sclerotic bony prominence in layers until all degenerative tissue is removed, finding healthy cancellous bone and cartilage.

PURPOSE: to describe arthroscopic surgical access portals for the treatment of carpal boss.

MATERIAL AND

METHODS

The intra-articular arthroscopic treatment of the carpal boss that is accessed through the midcarpal joint, associated with the use of one or two additional portals that are strategically located radially and ulnarly to the carpometacarpal joint and the extensor carpi radialis longus tendon.

RESULTS

These portals provide direct access to the carpal boss and allow the surgeon to maneuver the instruments with precision while avoiding injury to critical structures.

CONCLUSION

This technique lets complete and safe resection of the carpal boss, allowing the surfaces of the second and third metacarpals and the trapezoid to be flattened to create a smooth, level contour. In addition, when compared to open techniques, it provides a wide and direct view of the region with less soft tissue damage, cosmetic advantages and rapid recovery.