Physiotherapist undergoes career-saving arthroscopic surgery

Posted on 6 January 2017

When an old wrist injury came back to haunt physiotherapist Elané de Beer eight years after the fact, she was unable to perform the hands-on, strenuous physical therapy her job entailed. Dr Adriaan Smit, Orthopod at Mediclinic Durbanville, prescribed arthroscopic ligament repair.

What is arthroscopic surgery?

Arthroscopic surgery, also called arthroscopy, is a surgical procedure performed on a joint through a small incision. Unlike traditional, open surgery, arthroscopy is minimally invasive, requiring only two small incisions. One incision is for the endoscope (a small camera that creates an enlarged internal view), and one for the arthroscope (through which the interior of a joint is inspected or operated on).

The benefits of arthroscopic surgery include:

• Reduced recovery time as a result of the joint not having to be completely opened (which normally causes more trauma to the connective tissue).
• Limited scarring which allows for optimal mobility and dexterity.

Patient journey

Physiotherapist Elané De Beer injured her wrist eight years ago and was put in a cast. But a few months ago, she started experiencing discomfort.

‘I’ve been doing very hands-on work every day. I think the injuries flared up from overuse and the types of techniques that I use,’ says Elané.

Elané knows Dr Adriaan Smit as the practice she works for treats some of his patients. ‘He’s a very good hand and upper limb specialist, so obviously I thought to go to someone as specialised and as well recommended as possible,’ said Elané.

She’d struggled with discomfort in her wrist for some months, hoping it would dissipate. Three months prior to consulting Dr Smit, she became concerned. In the last three weeks, Elané was in immense pain. She started losing strength in her hand and struggled to do tasks that were expected of her.

A few options were discussed in consultation, from symptomatic treatment (like splinting the arm), to harvesting tendons from Elané’s forearm to reconstruct the damaged ligament, which is quite invasive. ‘We spoke about the type of work I do. My hands are my eyes. I have to be able to feel with my hands. I have to be able to treat and really have full function of all the things my hands can do. It had to be all or nothing.’

Dr Smit suggested repairing the damage as minimally invasively as possible. Elané would be the first patient to undergo arthroscopic ligament repair of the wrist at Dr Smit’s hand.

Surgery

In the weeks leading up to the surgery, Elané struggled with feelings of ‘pins and needles’ – an indication of nerve compression. Dr Smit also noticed a lot of swelling internally, evidence that the inflammatory process had been going on for a while.

A small incision was made on her wrist and through that Dr Smit used a camera to magnify his view on a monitor. He used a small tool to clear excess tissue and another tool for the internal stitches.

On the video footage, Dr Smit was able to show Elané how the structural changes in her hand were compensating for the malfunctioning [scapholunate] ligament, causing the thickening of some of the tissues that needed to be cleared.

‘He showed me where the [scaphoid and lunate] bones overlap: they’re supposed to work together, but because the ligament was torn, there was a gap between the two small [carpal] bones,’ she says, explaining that this was causing them to glide over one another. Dr Smit was able to stitch the bones back together.

Recovery

Elané’s surgery took place on 1 December 2016, and her arm was placed in a plaster back slab for 12 days to allow for neuromuscular checks and test that there’s sufficient blood flow to, and sensation in, the fingers. On 13 December, the plaster was removed, the wound was inspected and her wrist was placed in a fiberglass cast to remain immobile for the next six weeks. She’s due for another checkup and x-ray at the end of January 2017 before rehabilitation begins. Recovery is expected to take eight to 12 weeks, depending on her progress.