If pain persists after two injections, it is often because a ligament has been partially torn and the torn part is folded into the joint. This can irritate and inflame the joint, similar to irritation due to a pebble in a shoe. Another reason for persistent joint pain is a cartilage injury, where a loose flap of the joint’s surface is similarly inflaming the joint.
Both off these problems respond extremely well to arthroscopic debridement. The torn part of the ligament, or cartilage, is simply shaved out with a small motorized shaver, often providing significant pain relief (Figures 16 & 17). If the cartilage injury is severe and early arthritis is present, arthroscopy will diagnose this condition, allowing appropriate treatment options to be considered.
Both metacarpophalangeal joint arthroscopy and proximal interphalangeal joint arthroscopy are minimally-invasive, outpatient procedures. Both arthroscopies usually use only two small ‘stab wounds’ to visualize and instrument the joint, and pain is usually minimal. Early motion is encouraged. Stiffness is uncommon, and the need for post-operative hand therapy is often short. The wounds only need to be kept dry for 24 hours, and then showering is permitted. Please do not get the wounds dirty or submerge them under water for 10 days. Heavy use and power grip are best avoided for a week or two.
In short, both metacarpophalangeal joint arthroscopy and proximal interphalangeal joint arthroscopy are minimally-invasive procedures that are helpful to both diagnose and treat many joint disorders that have failed appropriate non-operative management.