The rheumatoid thumb

The thumb frequently is involved in rheumatoid arthritis and often is a source of significant functional loss, pain, and deformity. Fortunately, much can be done to provide pain relief, improve function, enhance appearance, and slow the progression of disease. Specific surgical interventions should be based on the nature and stage of deformity as well as the status of tendons, ligaments, and adjacent joints. Treatment options, in isolation or in combination, include synovectomy, arthrodesis, arthroplasty, and tendon repair or transfer. Although most thumb deformities can be classified as one of six common types, other patterns of deformity also are seen. It therefore is imperative not to operate on pattern recognition alone, but to examine each patient carefully and individualize treatment.