Rheumatoid Hand Reconstruction

This chapter presents a case scenario of a 58-year-old Caucasian woman who reports a several-month history of generalized fatigue and “stiffness” of both hands that lasts through the morning. Hand surgeons use open and arthroscopic techniques to remove the infiltrative synovium to ameliorate symptoms, improve function, and halt destructive synovitis. Swelling of a patient’s joints could be an indication of proliferative synovitis. Flexor tenosynovectomy can provide functional benefit for patients with impairment of active flexion caused by synovitis. Owing to the progressive nature of rheumatoid arthritis, joint destruction can reach a stage in which a surgical salvage procedure such as metacarpophalangeal (MCP) joint arthroplasty is necessary. The MCP joint is most commonly affected in RA. MCP joint arthroplasty provides long-term improvement in subjective outcomes and should be considered in end-stage destruction of MCP joints. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.