This is an anatomic study and a retrospective chart review to describe the neurovascular relationships of the volar radial portal in wrist arthroscopy. The author evaluates whether volar wrist arthroscopy helped to identify additional dorsal pathology not visualized using standard dorsal portals. Cadaveric dissection was used to define the neurovascular anatomy. Additionally, the author retrospectively reviewed charts of thirty patients in which the palmar radial portal was used, and documented the pathology that was identified through the volar wrist portal which was not visible through the dorsal portals. With a greater than 3mm safe zone between the portal and any other neurovascular structures, the author found that pathology was evident in 10 of 30 patients that was not visible from dorsal visualization. This included one case of hypertrophy to the dorsal capsule, 1 patient with an avulsion of the radioscapholunate ligament with an exposed palmar scapholunate cleft. One patient had a tear restricted to the palmar portion of the scapholunate ligament and 7 patients had tears to the dorsal radiocarpal ligament.
It is of note that the author actually makes an incision over the flexor carpi radialis and places a retractor under the tendon, thereby eliminating the potential for injury to both the palmar cutaneous branch of the median nerve as well as to the radial artery. Whether this portal actually provides significant data that alters the patient care is not entirely clear and will have to be answered by additional studies.