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The condition is generally managed by Rheumatologists. It is usual that they make the diagnosis and treat the condition with specific anti-rheumatoid drugs. Splints may also be employed. Referral to a hand surgeon can be for various reasons.

  1. Carpal Tunnel syndrome is very common in rheumatoid arthritis and it may be that Rheumatologists ask the surgeon to decompress your carpal tunnel as part of your therapy.
  2. Trigger fingers are again common in rheumatoid arthritis
  3. Tendon rupture - tendons on the back of the hand are called extensor tendons and sometime these can rupture over the prominent bone on the little finger side of your wrist. Generally this involves the little and ring fingers which tend to drop so you cannot pull them up straight. Because of the inflammation of the tendons in the front of the hand some of the flexor tendons can also rupture and this would leave the patient with an inability to actually bend the finger. Occasionally the synovium of the tendons of the fingers gets inflamed. This can give pain in all the upper fingers and this can result in tendon rupture and this can be prevented by removing some of the lining of the tendons and this is called a synovectomy. Click here to view tendon transfer for EPL rupture, and click here to view tendon transfer for dropped fingers
Joint Deformity

This occurs quite commonly in rheumatoid arthritis, particularly the metacarpophalangeal joints where the fingers tend to drift towards the little finger side of the hand. The picture below illustrates the drifting of the fingers towards the little finger side of the hand.

This is called ulnar drift. Occasionally, if this is associated with pain in the metacarpophalangeal joint, this drift can be corrected by means of joint replacement in the hand, particularly the metacarpophalangeal joint.

Another joint deformity can happen when the fingers develop two other deformities.

One is called the Boutonniere deformity where there is a bend at the proximal interphalangeal joint and a reverse deformity at the distal interphalangeal joint. These can be helped by either joint replacement or fusion in addition to tendon surgery.

The second deformity is the Swan Neck deformity where there is an over straightening of the proximal interphalangeal joint, a bending of the distal interphalangeal joint which makes the finger look a little bit like a swan neck. This can be helped with tendon transfer surgery.

Joint Instability

Quite often joints of the fingers or thumb can become unstable in late rheumatoid which means they become floppy and for instance, pinch can be tricky if the end joint of the thumb becomes floppy. This can be treated by fusion in order to stabilise the thumb which is a very successful surgical procedure for such a deformity.

Pain

Various joints in the wrist and the hand can be helped if they become very painful.

  1. This can be done be excision of bone or part thereof
  2. Replacements of joints
  3. Joint fusions