Synovectomy of the proximal interphalangeal joint of the finger in rheumatoid arthritis

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RHEUMATOID arthritis, a disease that can affect every organ system in the body, is particularly likely to affect the musculoskeletal system. In the hand, progressive rheumatoid arthritis leads to rupture of either the flexor or the extensor tendons, or both, and to instability or to dislocation of the finger joints. When these complications occur, hand function declines and the patient experiences difficulty in performing many acts of daily living.

This paper concerns the proximal interphalangeal joint of the finger, a joint that is important in the actions of pinching and grasping. Preservation of function of the joint is vital, especially when the metacarpophalangeal joint is diseased and its function restricted. When both the metacarpophalangeal and proximal interphalangeal joints are destroyed, hand function is poor. At the present time, the disability caused by a destroyed or dislocated meta-carpophalangeal joint can be greatly reduced by arthroplasty (the fashioning of a new joint). However, in regard to the proximal interphalangeal joint, arthroplasty is still in the developmental stage of technic.

In the proximal interphalangeal joint, the disabilities resulting from chronic, progressive rheumatoid arthritis are the boutonniere deformity (Fig. 1), and the destruction of the joint, producing instability, pain, and angulation (Fig. 2). In the patient with rheumatoid arthritis the boutonniere deformity is due to stretching or actual rupture of the central slip of the extensor tendon at its attachment on the dorsum of the middle phalanx. The lateral bands of the extensor tendon are also stretched due to persistent synovitis in the proximal. . .



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