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

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.