Rheumatoid hand deformities: pathophysiology and treatment.

Rheumatoid disease, as it affects the hand, is a disease of the synovium lining the joints and sheaths of the tendon. The proliferating synovium destroys the articular surfaces of the joint, interferes with the gliding mechanism of the tendons and weakens the supporting ligaments of the joints. The degree and variety of deformities is multifold. Treatment of the rheumatoid hand is aimed at conservation and restoration of hand function, as well as prevention of future deformities. Rheumatologists, physical therapists and hand surgeons carry out important functions in the well-planned, integrated regimen. Surgical treatment of the rheumatoid hand deformity may alleviate pain, lessen deformity and improve function in selected cases. It should be integrated in the general medical management of a patient. Treatment of tendon ruptures includes tenorrhaphy, tendon grafting and arthrodesis in the case of mallet finger deformity. The wrist joint is improved by synovectomy and carpal tunnel release is accomplished by median nerve decompression. Metacarpal phalangeal joint deformities may be treated by synovectomy or silastic joint replacement when there is destruction of the articular joint surface, severe subluxation, or persistent painful motion.