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Rheumatoid Hand and Wrist Surgery: Soft Tissue Principles and Management of Digital Pathology
Philip E Blazar1, Stephanie M Gancarczyk, Barry P Simmons
1From the Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA.
Summary
Disease-modifying drugs reduce rheumatoid arthritis surgeries, but soft tissue management remains crucial for hand and wrist function. This review details essential surgical techniques for these complex cases.
Area of Science:
- Orthopedics
- Rheumatology
- Hand Surgery
Background:
- Disease-modifying antirheumatic drugs have decreased the overall incidence of rheumatoid arthritis requiring surgical intervention.
- Despite this, a notable number of patients still present with rheumatoid arthritis necessitating hand and wrist surgery for pain and functional improvement.
- Management of soft tissue pathologies is critical, even in cases with underlying bone and joint involvement.
Purpose of the Study:
- To review the key principles and surgical techniques for managing soft tissue deformities in rheumatoid hand and wrist surgery.
- To address the declining training and practice exposure to these specific surgical procedures.
- To provide guidance for orthopedic surgeons managing rheumatoid arthritis patients with hand and wrist conditions.
Main Methods:
- Literature review focusing on soft tissue management in rheumatoid hand and wrist surgery.
- Synthesis of established and current surgical principles and techniques.
- Analysis of challenges in managing soft tissue deformities in this patient cohort.
Main Results:
- Soft tissue handling is paramount in rheumatoid hand and wrist surgery, irrespective of the primary pathology.
- Specific techniques are essential for addressing deformities such as synovitis, tenosynovitis, and joint instability.
- Effective management requires a thorough understanding of both pharmacological and surgical treatment options.
Conclusions:
- Surgical intervention for soft tissue deformities in rheumatoid hand and wrist remains important for patient function.
- A comprehensive understanding of soft tissue management principles is vital for orthopedic surgeons.
- Continued education and skill refinement in these techniques are necessary due to decreasing exposure.
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