You are on page 1of 20

Rheumatoid Arthritis

R. Hill

Rheumatoid Arthritis
• Auto-immune process of unknown aetiology causing a chronic inflammatory process • Primarily affects the synovium in the Hand • Epidemiology

Surgical Aims • Decrease pain • Prevent worsening deformity/function • Improve appearance/ function .

passively correctable deformity Fixed deformity. no joint changes Articular destruction .Stages of Rheumatic joint involvement Stage I II III IV Description Synovitis no deformity Synovitis.

Surgical Procedures • • • • • Synovectomy Tenosynovectomy Tendon Surgery Arthroplasty Arthrodesis .

Thumb Deformities .

arthroplasty or arthrodesis – Intermediate – late .Type 1 Boutonniere • Usually due to MCP joint synovitis • Exclude FPL rupture • Treatment – early Synovectomy + tendon reconstruction Arthrodesis or Arthroplasty ST repair.

Type III Swan-Neck Deformity • Result of CMC disease • Treatment – Early – Intermediate – Late Resection arthroplasty with tendon interposition (RATI) RATI + volar tenodesis or arthrodesis of MCPJ RATI and MCPJ arthrodesis .

.Type IV Gamekeepers Thumb • Due to synovitis of the MCPJ – NB no CMCJ disease • Treatment – Early – Late Synovectomy. adductor fascia release and repair UCL Arthrodesis/ arthroplasty + adductor fascia release.

Type II • Combination of Type I and II • Treatment – CMCJ – MCPJ – IPJ RATI Tendon reconstruction arthroplasty/arthrodesis Nil .arthrodesis .

volar capsulodesis or sesamoidesis .Type V • Due to stretching of the volar plate • Treatment Arthrodesis.

Arthritis Mutilans • Instability and joint destruction • Treatment – Early – Late Early arthrodesis Arthrodesis with bone grafting .

Boutonniere deformity .

Boutonniere • Stage I • Stage II • Stage III PIPJ lag 10-15 degrees PIPJ lag 30-40 Degrees PIPJ Fixed .

tendon tenotomy Repair central slip and bands.Treatment • Stage I • Stage II Ext. Ext Tendon tenotomy • Stage III Arthrodesis / arthroplasty .

Swan-Neck Deformity .

Types of Swan-Neck Deformity • Type I • Type II • Type III • Type IV Passive Motion at PIPJ possible Related to MCPJ and intrinsic tightness Fixed PIPJ preserved joint Fixed PIPJ and degenerate joint .

Treatment of Swan-Neck deformity • Type I DIPJ Fusion Volar Tenodesis Retinacular ligament reconstruction Dermadesis • Type II Intrinsic Release (IR) + type I or Correct MCPJ disorder .

Treatment Swan-Neck deformity • Type III Restore passive motion Correct deformity later Salvage procedure. • Type IV .

Evidence • • • • No randomised control trials Papers often retrospective over long periods Poor numbers with no controls No validated scoring systems to evaluate outcome • Results poor yet conclusion’s often positive .