Surgical management of the rheumatoid hand and wrist

Management of the patient with rheumatoid arthritis of the hand and wrist demands a methodical approach. Multidisciplinary assessment and treatment in conjunction with a rheumatologist and dedicated hand therapist are essential. Initial treatment should be conservative. However, when patients develop severe deformities refractory to medical treatment, or there is impending tendon rupture or nerve compression, surgical intervention is required. This article aims to provide a current review of the principles and common conditions in surgery for rheumatoid arthritis of the hand and wrist.     

Management of the osteoarthritic and rheumatoid wrist

Arthritis of the wrist has multiple causes, with post-traumatic being the most common non-inflammatory cause, and rheumatoid arthritis the most common inflammatory condition. Management starts with detailed history, examination and functional assessment. Surgical options include wrist denervation, correction of carpal deformities (distal radius osteotomy, ligament tenodesis), excision of the affected articulations (scaphoidectomy, styloidectomy, proximal row carpectomy), arthrodesis (four corner fusion, limited carpal fusions, total wrist arthrodesis) and total wrist arthroplasty. Similar procedures can be performed at the distal radioulnar joint. This article reviews the causes of wrist arthritis and evidence behind the management options.