Rheumatoid hand deformities: pathophysiology and treatment

Area of Science:

• Orthopedics
• Rheumatology
• Hand Surgery

Background:

• Rheumatoid disease affects the synovium of hand joints and tendon sheaths.
• Proliferating synovium leads to joint destruction, tendon gliding issues, and ligament weakening.
• This results in diverse and significant hand deformities.

Purpose of the Study:

• To outline the multifaceted nature of rheumatoid hand disease.
• To describe treatment goals: function conservation, restoration, and deformity prevention.
• To highlight the roles of rheumatologists, physical therapists, and hand surgeons.

Main Methods:

• Review of rheumatoid hand pathology and its impact on joint and tendon structures.
• Discussion of integrated treatment approaches, including medical management and physical therapy.
• Overview of surgical interventions for specific deformities: tendon ruptures, wrist issues, and metacarpophalangeal joint problems.

Main Results:

• Surgical treatment can alleviate pain, reduce deformity, and improve function in select rheumatoid hand cases.
• Specific procedures like tenorrhaphy, tendon grafting, synovectomy, and joint replacement address various deformities.
• Carpal tunnel release via median nerve decompression is a key intervention for wrist involvement.

Conclusions:

• Integrated management involving medical, therapeutic, and surgical interventions is crucial for rheumatoid hand disease.
• Surgical options are vital for restoring function and managing deformities when conservative measures are insufficient.
• Early and comprehensive treatment is essential to prevent progressive joint damage and functional loss.