[Rheumatic lesions of the carpus]

The wrist is frequently involved in rheumatoid arthritis. The areas where the synovial membrane is best developed are the best areas for the development of the pannus as well. Proliferation of the synovial membrane lining the joint capsules leads to loss of ligamentary support of the wrist. This is the basis for further deformation. The direction of the carpal deformation is determined by normal anatomical conditions. Destruction of the elements that are essential for the stabilization of the wrist is responsible for these deformations; these elements are described. The flexor and extensor tendons of the fingers and wrist joint are coated with synovial sheaths. These can also be infiltrated by a synovial pannus or rupture due to abrasion by osteophytes. The dislocation, elongation, or rupture of tendons also leads to deformation. In accordance with our conception of the longitudinal pillars of the carpus we classify the different possible types of rheumatic carpal deformation into three groups: deformities of the ulnar, central, and radial type. Combinations of these various types are also common in the course of the disease and lead to instability and ankylosis. Synovectomy represents the basic treatment for the rheumatic joint. It is initially performed by radiosynovectomy. If there is persistent pain and swelling, an operative synovectomy is required. The following surgical procedures are most frequently combined with synovectomy of the wrist joint: synovectomy of the extensor tendons, resection of the head of the ulna, axial realignment of the wrist joint, and reconstruction of ruptured tendons. The operative technique is described in detail. This operation is also most commonly performed in the advanced stages. This operation produces good functional results that are reliable for a prolonged period of time, so that arthrodesis or arthroplasty can be avoided. Deterioration of the radiological findings, however, is common.