Arthroscopic Radial Styloidectomy: An All‐Dorsal Two‐Portal Surgical Technique

Abstract

Radial‐sided wrist pain and impingement are recognized sources of persistent symptoms following 4‐corner fusion, often related to radioscaphoid contact and progressive degenerative changes. Radial styloidectomy has been described as a surgical option to address this pathology while preserving carpal stability. An arthroscopic approach offers the potential advantages of improved visualization, reduced soft tissue disruption, and concomitant treatment of intra‐articular pathology. Standard wrist arthroscopy portals are established, with the 6R portal for visualization and the 3‐4 portal as the working portal. Diagnostic arthroscopy allows for evaluation of the radiocarpal joint and treatment of concomitant pathology, including synovitis, which may be addressed with arthroscopic synovectomy. The 3‐4 portal is then used for visualization and the 6R portal for working on the remainder of the case. The radial styloidectomy is performed arthroscopically using a 3.0 oval burr and a 4.0 bone cutter. Fluoroscopy confirms a 4 mm resection of the radial styloid to relieve impingement while maintaining the extrinsic ligaments and wrist stability. Patients start therapy at 2 weeks, moving on to strengthening at 6 weeks. Arthroscopic radial styloidectomy is an effective surgical approach for wrist pain and impingement in post‐4‐corner fusion patients. This minimally invasive technique provides significant pain relief and facilitates early functional recovery.