Portals in Hand Arthroscopy

Arthroscopy of the small joints of the hand has evolved with advances in arthroscopes and instruments. Arthroscopic access to trapeziometacarpal (TMJ), metacarpophalangeal (MCP), and the proximal and distal interphalangeal joints (PIP, DIP) is difficult due to the narrow joint spaces and proximity to neurovascular structures and tendons. Specialized portals for thumb and finger joints permit arthroscopic visualization of these joints and complex therapeutic procedures can be performed. Each of these joints has a unique bony, soft-tissue, and neurovascular anatomy and familiarity with anatomic landmarks and neurovascular structures is necessary for accurate and safe portal placement.