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REVIEW - Surgery of the wrist and hand in RA

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Bull Acad Natl Med. 2009 Jan;193(1):63-78; discussion 78-9.

[surgery of the wrist and hand in rheumatoid arthritis]

Merle M.

Institut Européen de la Main, 13 rue Blaise Pascal, 54320

Maxeville- et Hôpital Kirchberg, 9 rue Steichen L-2540

Luxembourg.

Wrist and hand surgery in rheumatoid arthritis has continued to evolve

since first being tried fifty years ago. Improvements have flowed from

a better understanding of pathophysiological mechanisms, from

technical progress and from more effective medical treatment. The use

of methotrexate and the subsequent development of biological therapies

have transformed the course of the disease, increasing the chances of

positive and durable surgical results. Priority must be given to

re-alignment of the wrist in order to protect the fingers. It is

equally important to perform synovectomies of the extrinsic tendons

and to re-align extensor tendons with the metacarpophalangeal joints.

At a later stage, metacarpophalangeal arthroplasty can re-establish a

useful range of mobility in these joints. Early correction of

swan-neck deformity is essential. Arthrodesis of the

metacarpophalangeal joint of the thumb is also beneficial as it

improves finger-thumb pinch grip. These procedures are usually

performed under regional block anaesthesia. They take less than two

hours and the techniques employed are compatible with early

mobilisation. Effective surgical management of rheumatoid arthritis

requires close collaboration between surgeons, rheumatologists,

physiotherapists, orthotists and occupational therapists. There are

thought to be some 500,000 patients in France who might benefit from

such treatment but, as yet, there are too few multidisciplinary teams

equipped to manage them effectively.

PMID: 19718981

http://www.ncbi.nlm.nih.gov/pubmed/19718981

Not an MD

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