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The first portal used in wrist arthroscopy is the 3,4 portal (number 5), which is located just distal (approximately 1cm) to Lister's tubercle. At least 11 portals have been described in wrist arthroscopy: 5 radiocarpal, 4 midcarpal, and 2 distal radioulnar portals. The five radiocarpal portals are named by their relationship to the extensor compartments. The 3-4 portal is between the third and fourth compartments and is the initial site for portal placement. It is also the workhorse for wrist arthroscopy. It is located 1 cm distal to Lister's tubercle and is not located near any significant neurovascular structures. It is just radial to the extensor digitorum communis tendons and ulnar to the extensor pollicis longus tendon. Gupta et al. performed a review on wrist arthroscopy. They report that only the deep branch of the radial artery and the superficial dorsal sensory branches of the radial, ulnar, and lateral antebrachial cutaneous nerves are located on the dorsal aspect of the wrist. This makes wrist arthroscopy a safe procedure that not only yields diagnostic information but may have therapeutic options as well. They conclude that compared with open techniques, arthroscopic procedures may have a shorter recovery time and an earlier return to work for the patient. Kiliç et al. performed a cadaveric study to determine the course of the superficial branch of the radial nerve and its location in relation to wrist arthroscopy portals. The distance of the closest nerve branch to the 3-4 portal was 9 mm. They found a large amount of anatomic variation and therefore making a superficial skin incision with use of blunt dissection prior to portal placement to avoid damage to the superficial branch of the radial nerve. Figure A is a photograph of the dorsum of the wrist with Lister's tubercle marked by the blue circle. Illustration A (Gupta et al.) demonstrates the standard wrist arthroscopy portals. Illustration B (Gupta et al.) demonstrates the standard midcarpal portals, (STT: scaphotrapeziotrapezoid; TH: triquetrohamate). Incorrect Answers: Answer 1: Number 1 corresponds to the 6U portal. Answer 2: Number 2 corresponds to the 6R portal. Answer 3: Number 3 corresponds to the 4-5 portal. Answer 4: Number 4 corresponds to the radial midcarpal portal.
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