Journal of Rheumatic Diseases

Table. 1.

Summary of common procedures of the rheumatoid hand

Procedure Indications Description/Outcomes
Preventive procedures
Synovectomy and/or tenosynovectomy Persistent wrist synovitis in the early stages of the disease with moderate swelling and relatively well preserved joint motion Short-term benefits, such as pain relief and improved function
Ulnar wrist-related
Darrach procedure Pain from DRUJ disease and distal ulna impingement on the carpus Long-term improvement in pain and function/risk of potential ulnar translocation of the carpus
Sauvé-Kapandji procedure Same as above Support to ulnar carpus/unpredictable fusion of DRUJ
Dorsal wrist-related
Partial wrist arthrodesis Disease primarily localized to radiocarpal joint while sparing the midcarpal joint Preserves some range of motion of the wrist/generally reliable outcomes with low rates of nonunion
Total wrist arthrodesis Pan-carpal arthritis with poor tissue support Significant limitation of wrist motion/generally excellent clinical outcomes
Total wrist arthroplasty Pan-carpal arthritis/alternative to total arthrodesis High-risk, high-reward procedure with preservation of wrist motion but questions in durability and reliability
Ulnar drift deformity
Extensor tendon centralization Extensor subluxation with resultant ulnar drift deformity Centralization with soft-tissue balancing
Cross-intrinsic transfer Ulnar drift deformity with volar subluxation of MCP joint Transfer of intrinsic muscles to radial side to provide radial stability
Joint arthroplasty Damage of articular surface Proper joint alignment/improvement in function and aesthetics
Swan-neck deformities
FDS tenodesis Flexible hyperextension deformity of PIP joint Static volar restraint against hyperextension/Improved initiation of PIP flexion
Reconstruction of oblique retinacular ligament Same as above Dynamic tenodesis/restores DIP extension and restrains PIP hyperextension simultaneously
Volar translocation of lateral bands Early flexible SND caused by PIP synovitis Minimally invasive/effective and sustained correction
Trapeziectomy SND of the thumb Simple trapezium excision to various resection suspension arthroplasties
Boutonniere deformities
Central slip shortening and dorsal repositioning of lateral bands DIP hyperextension with preserved PIP joint cartilage Excision of redundant central slip and advancement/mobilization and dorsal repositioning of lateral bands
Arthrodesis Articular destruction or severe flexion contracture of PIP joint/thumb IP joint Simple and reliable option for managing pain and treating deformity

DIP: distal interphalangeal, DRUJ: distal radioulnar joint, FDS: flexor digitorum superficialis, MCP: metacarpophalangeal, PIP: proximal interphalangeal, SND: swan-neck deformity.

J Rheum Dis 2021;28:192~201 https://doi.org/10.4078/jrd.2021.28.4.192
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