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The rheumatoid wrist.

Steven R Papp1, George S Athwal, David R Pichora

  • 1University of Ottawa, Ottawa Civic Hospital, Ottawa, ON, Canada.

The Journal of the American Academy of Orthopaedic Surgeons
|February 10, 2006
PubMed
Summary
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Rheumatoid arthritis commonly affects the wrist, necessitating surgical intervention for persistent cases. Surgical options range from soft-tissue procedures to bony stabilization, aiming to improve function and relieve pain.

Area of Science:

  • Orthopedics
  • Rheumatology
  • Surgical Procedures

Background:

  • Rheumatoid arthritis frequently impacts the wrist joint.
  • Surgical intervention is considered for patients with persistent rheumatoid arthritis unresponsive to medical management.
  • Individualized assessment is crucial for defining functional deficits and treatment objectives.

Purpose of the Study:

  • To review surgical management strategies for wrist involvement in rheumatoid arthritis.
  • To discuss the efficacy and indications of various surgical procedures.
  • To highlight the importance of patient assessment in surgical decision-making.

Main Methods:

  • Review of surgical techniques for rheumatoid arthritis wrist involvement.
  • Discussion of soft-tissue procedures (tendon repair, transfer, grafting).

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  • Evaluation of bony procedures for stabilization (distal radioulnar joint procedures, fusions, arthroplasty).

    • Main Results:

    • Soft-tissue procedures provide short-term symptomatic relief and functional gains.
    • Tendon rupture due to synovial infiltration may necessitate tendon transfer or grafting.
    • Bony procedures are required for dislocation and end-stage arthritis, offering stability.
    • Distal radioulnar joint procedures (Darrach, Sauvé-Kapandji) are common.
    • Wrist fusion (partial or total) provides stability and pain relief, with total fusion sacrificing motion.
    • Total wrist arthroplasty is an emerging motion-sparing alternative with ongoing outcome evaluation.

    Conclusions:

    • Surgical management of rheumatoid arthritis wrist involvement is multifaceted, involving soft-tissue and bony procedures.
    • Procedure selection depends on disease progression, joint involvement, and patient-specific goals.
    • While fusion offers reliable pain relief, arthroplasty presents a motion-preserving option requiring further study.