Arthroscopic examination with an ultra-thin arthroscope is an easy, minimally invasive procedure for examination of the inside of joints. However, one disadvantage of arthroscopy is the risk of scope breakage in narrow joint spaces. We describe an improved procedure for arthroscopic examination of the upper joint space and describe the findings thus obtained.
Arthroscopic examination is done with the patient under local anesthesia in the outpatient clinic. To observe the synovium in the posterior compartment, an 18-gauge needle and a trocar for a 0.8mm rod-lens fiberscope are inserted into the anterior and posterior compartments of the upper joint space, respectively. The articular cartilage of the glenoid fossa and eminence is also observed. Finally, the presence or absence of adhesion in the anterior compartment is examined. In narrowed joint spaces with severe adhesions, injection of normal saline under sufficient pressure is performed to widen the upper joint space. The fiberscope is then advanced from the posterior compartment to the anterior compartment via the lateral paradiscal groove.
This procedure enables us to observe synovitis with capillary hyperemia or hyperplasia of the synovium, cartilage changes with fibrillation or exposure of subchondral bone, and the distribution and degree of adhesion.
