The rheumatoid hand and preventive surgery

Preventive surgery in rheumatoid arthritis of the hand is aimed at avoiding or at least delaying deformity and disability and at alleviating symptoms, especially pain. This can be successfully accomplished only in the disease's early phases. The family physician is in a position to assess his rheumatoid patients and to develop a good sense of the disease's progression. He can therefore make timely referrals to a hand surgeon, before major deformity and disability are present and the optimum time for preventive surgery has passed. The common surgical procedures-including excision of rheumatoid nodules; release of nerve entrapments; tenosynovectomy; synovectomy, and resection and reconstruction of the ulnar head-are discussed, as are their indications.