Wrist and hand arthroscopic surgery–current status and future horizons in hand surgery: a narrative review

Purpose: Wrist and hand arthroscopy has advanced significantly since its introduction in the late 20th century, evolving from a purely diagnostic procedure into a highly sophisticated therapeutic modality. Improvements in high-resolution optics, miniaturized instruments, and anatomical knowledge have broadened the indications for hand and wrist arthroscopy, enabling treatment of a diverse array of intra-articular pathologies. This review highlights key developments in arthroscopic management of triangular fibrocartilage complex (TFCC) tears, scapholunate ligament injuries, intra-articular distal radius fractures, scaphoid nonunions, and finger joint pathologies.Current Concepts: Specifically, this review discusses classifications and basic surgical techniques for TFCC repair, ulnar impaction syndrome, and arthroscopy-assisted fixation of distal radius fractures, with an emphasis on precision, minimally invasive approaches, and improved functional outcomes. In addition, the role of arthroscopy in the management of inflammatory conditions, including inflammatory arthritis, and its application to small joint procedures such as thumb carpometacarpal joint arthritis and carpal tunnel release are explored. Future perspectives address the integration of nanoscope technology, augmented and virtual reality-assisted surgery, and biologic augmentation using platelet-rich plasma and stem cell-based therapies.Discussion and Conclusion: Despite a steep learning curve and technical demands, hand and wrist arthroscopy is becoming a cornerstone of hand surgery, owing to its diagnostic accuracy, minimal soft tissue disruption, and enhanced recovery. With continued technological innovation and focused surgeon training, wrist and hand arthroscopy will further redefine standards of care and promote patient-specific treatment in upper extremity surgery.