Volar tenosynovectomy in the rheumatoid hand

Rheumatoid involvement on the flexor aspect of the hand is common, but is easily overlooked because of difficulty in clinical examination. It is our experience that this localization of the disease process is extremely important and that surgical treatment should be given high priority. In this study a series of 235 operations on the flexor aspect of the hand performed on 139 patients are presented. The results are very gratifying as far as tenosynovectomy in the carpal tunnel and the pain is concerned. When performed on the fingers, however, varying degrees of postoperative flexion contractures developed in no less than 44%. It was found that this problem arose when the synovectomy was extended beyond the level of the middle flexion crease of the finger being caused by excessive postoperative scar formation in the region volar to the proximal interphalangeal joint between the tails of the superficial tendon. It is concluded that less extensive surgery should be aimed at in this particular area.