Rheumatoid hand

Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania

MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika

Rheumatoid arthritis (RA) is mostly poly arthritis witch symmetrically damage hand and foot joints

Cartilage and bones damage is common for RA

As disease progress deformities and dysfunction of joints appears

RA also disturb lungs, vessels, skin and eyes

Epidemiology

Incidence is approximetly 1% of population Women:men rate 2.5 : 1

http://emedicine.medscape.com/article/1287449-overview

Because of synovitis happens:•Damage of joint cartilage•Damage of tendons (tenosynovitis, ruptures)•Damage of ligaments ( pervasive joint instability and deformities)

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2

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Predictable evaluative

pattern

1. Dorsal subluxation of the ulnar head (volar ECU dislocation)

2. Carpal ulnar translocation

3. Carpo-metacarpal radial deviation

4. Carpal supination

5. Volar carpal subluxation

1

3

1. Pain

2. R.O.M. reduced

3. Attrition tendon ruptures

4. Secondary finger deformities

Pain reduce Improvement of function Suspend the spread of disease Improvement of hand appearance

Aims of operative treatment

Synovectomy Tenosynovectomy Tendons surgery Arthroplasty Arthrodesis

Tenosynovectomy

Tendons surgery

Tendons surgery

Arthrodesis

•partial

•total

Partial arthrodesis of radiocarpal joint

Indications

•Pain syndrome

•No X-ray signs of middle wrist joint degeneration

Indications

1. Pain syndrome

2. X-ray sings of degeneration and clinically middle wrist and radiocarpal joints are damaged

Total arthrodesis of radiocarpal joint

ArthroplastyIndications

1.1. Joint damage, Joint damage, sublucsation as RA sublucsation as RA complications, traumacomplications, trauma

2.2. No effect of conservative No effect of conservative treatmenttreatment

Arthroplastics

TechniqueJoints’ surfaces resection + Implant + reconstruction of soft tissues = functional joint

MP damage After operation

Contraindications

Possibility of conservative treatment Infection Local skin damage, disturbances of blood

supply No possibility for tendon reconstruction Patients who have over workload for hands