Hospital of Lithuanian University of Health
Sciences Kaunas, Lithuania
Rheumatoid hand
MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika
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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
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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)
Predictable
evaluative
pattern
3
4
2
1
1.
2.
3.
4.
5.
Dorsal subluxation of the ulnar head
(volar ECU dislocation)
Carpal ulnar translocation
Carpo-metacarpal radial deviation
Carpal supination
Volar carpal subluxation
3
1
1.
2.
3.
4.
Pain
R.O.M. reduced
Attrition tendon ruptures
Secondary finger deformities
Aims of operative treatment
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Pain reduce
Improvement of function
Suspend the spread of disease
Improvement of hand appearance
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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
Total arthrodesis of radiocarpal joint
Indications
1. Pain syndrome
2. X-ray sings of
degeneration and
clinically middle
wrist and
radiocarpal joints
are damaged
Arthroplasty
Indications
1. Joint damage,
sublucsation as RA
complications, trauma
2. No effect of conservative
treatment
Arthroplastics
Technique
Joints’ surfaces
resection + Implant +
reconstruction of soft
tissues = functional
joint
MP damage
After operation
Contraindications
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Possibility of conservative treatment
Infection
Local skin damage, disturbances of blood
supply
No possibility for tendon reconstruction
Patients who have over workload for hands