Synovectomy of the hand and wrist

Synovectomy of tendons gives excellent results with rare recurrence. This is because the local environment is altered from a closed space into a decompressed area of healthy fat. The synovium can invade and destroy tendon, cartilage or bone when in a closed space and under pressure. Unfortunately, the environment can not be so altered in a joint. Joint synovectomy, however, is the only procedure available to prolong function of the patient's own joint (and relieve pain) for an "X" amount of time, which depends upon the course of the generalized disease. After two to three years, the result of a synovectomy is dependent upon the course of the general disease activity and not the surgery. It is absolutely necessary that general medical treatment be carried on before, during, and after surgery, as the surgery is only one incident, often dramatic, in total care of the patient. Chemical synovectomy of the hand has been shown to have variable results with only short-term gains being noted. Surgical synovectomy is indicated when synovitis persists in spite of adequate medical management and there is pain and early correctible deformities. Besides removing the synovium, it is necessary to reconstruct the capsular support and correct alignment. Flexor tenosynovitis in the fingers should be treated with decompression of the digital sheath, not incising the pulley system due to the possibility of accentuating the forces causing ulnar drift. Dorsal tenosynovitis in the wrist is treated by tenosynovectomy, synovectomy, resection of the distal ulna, reconstruction of the ulnar side of the wrist and transposition of the dorsal carpal ligament beneath the extensor tendons.(ABSTRACT TRUNCATED AT 250 WORDS)