Planning treatment of the rheumatoid hand

A detailed assessment of the patient as a whole is an essential pre-requisite to the successful planning and execution of surgical treatment of the rheumatoid hand. In particular the decision whether or not to operate must emerge from a careful weighing of the severity of the patient's symptoms, signs and physical disability against the benefits which are likely to accrue from surgical treatment assessed in relation to the patient's own individual requirements. The author presents his personal reflections on the relative merits of the commonly used surgical procedures with reference to their ability to relieve pain, restore function, achieve cosmetic improvement, and prevent further damage, while at the same time carrying minimal risk of further damage to the already impaired function of the hand. Finally, the philosophy which should govern the surgeon - patient relationship during the management of a chronic progressive disease is examined. That it is absolutely essential to establish a sound rapport from early in the surgical programme is strongly emphasised. Some guidelines as to the design of the programme are also provided.