The wrist in rheumatoid arthritis

In the rheumatoid wrist, cartilage loss, synovial expansion with erosive disease and ligamentous laxity, result in loss of carpal height and stability and development in varying amounts of ulnar/palmar translocation and supination of the carpus on the distal forearm. This results in a painful wrist which influences deformity development distally. The aims of surgery are relief of pain and adequate stability while retaining as much motion as possible consistent with the degree of destruction present. A variety of procedures from soft-tissue reconstruction to total arthrodesis are available to achieve these aims.