The influence of tenoscopic approaches on radiocarpal joint perforation during carpal sheath tenoscopy in horses.
Authors: Skov Hansen Sabrina, Tóth Tamás
Journal: Veterinary surgery : VS
Summary
# Editorial Summary Inadvertent perforation of the radiocarpal joint (RCJ) during proximolateral carpal sheath tenoscopy poses a significant risk of iatrogenic contamination, particularly when treating septic conditions. Hansen and Tóth investigated whether portal placement relative to the distal radial physeal remnant influences RCJ breach rates, using dye-leakage testing in 12 live horses and computed tomography imaging of 12 cadaver limbs to establish whether natural communication between these structures might mask perforations. Placing instrument portals at the physeal remnant level resulted in RCJ perforation in 83% of cases (10/12), compared with only 33% (4/12) when portals were positioned 2 cm proximally—a statistically significant difference (P = 0.03)—whilst CT imaging confirmed no natural anatomical communication exists between the two structures to explain unexpected fluid tracking. Practitioners should relocate tenoscopic instrument portals to >2 cm proximal to the distal radial physeal remnant to substantially reduce perforation risk, a practice modification that becomes critically important when managing septic carpal sheath cases where joint contamination could precipitate catastrophic complications.
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Practical Takeaways
- •Place carpal sheath tenoscopic instrument portals at least 2 cm proximal to the distal radial physeal remnant to significantly reduce risk of radiocarpal joint contamination
- •Be especially cautious with portal placement when treating septic carpal sheath cases, as RCJ perforation could introduce infection across the joint capsule
- •Understand that any dye or fluid leakage from RCJ into carpal sheath during your procedure indicates iatrogenic perforation, not natural communication
Key Findings
- •Instrument portal placement at the distal radial physeal remnant level resulted in RCJ perforation in 10/12 limbs (83%), compared to 4/12 (33%) when placed >2 cm proximal (P=0.03)
- •No natural anatomical communication between radiocarpal joint and carpal sheath was detected on contrast CT in any of 12 cadaver limbs
- •RCJ perforation during carpal sheath tenoscopy is iatrogenic and directly related to instrument portal positioning