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

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

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

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

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 damageAfter 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