Surgical treatment of the rheumatoid hand

Multiple involvement of joints and tendons of the hand by rheumatoid disease is frequent and may result in severe deformities. Surgery plays a major role in an integrated treatment program that considers the patient's possibilities for improvement. Extensor and flexor tenosynovitis requires an early synovectomy to prevent tendon ruptures, to restore tendon gliding and to decompress the median nerve at the wrist level. Ruptured tendons are usually widely degenerated and restoration of function is provided by end-to-side repair, tendon grafts or tendon transfers. Joint synovectomies must be preformed at an early stage to be effective. Restoration of function in eroded, dislocated or unstable joints can be attained by arthroplasty or arthrodesis. A resection arthroplasty, usually completed by a silicone implant, corrects the deformity while preserving or restoring a functional range of motion. Flexible implant arthroplasty is very often performed in the metacarpophalangeal joints, and less frequently in the wrist and interphalangeal joints. Arthrodesis is a satisfactory procedure for those joints where stability is more important than motion.