Abstract
Rheumatoid arthritis causes complex deformities in the thumb. Synovial hypertrophy stretches out the capsule and ligaments of the individual joints which, together with cartilage destruction and subluxation or even rupture of tendons, causes instability and imbalance of the entire thumb. In the early phase of the disease, before the thumb is destabilized or when the deformities still are passively correctable, nonoperative treatment is indicated by using antirheumatic medications, intra-articular steroid injections, splinting, and protection measures. Surgical treatment must be considered if synovitis or pain cannot be controlled by nonoperative treatment or if there are severe functional problems. The procedures used include synovectomy, reconstructive procedures at the level of the IP joint, MCP joint, or CMC joint, and reconstruction of ruptured tendons. The Nalebuff classification is helpful in understanding the deformities and in planning surgery. In this chapter, the most important surgical procedures are described: fusion of the MCP joint, rerouting of the EPL tendon for boutonniere deformity, MCP joint sesamoidesis/capsulodesis, reconstruction of the ulnar collateral ligament of the MCP joint, fusion of the IP joint, resection arthroplasty for the CMC joint, and reconstruction of the EPL and FPL tendons.
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Boeckstyns, M.E.H. (2016). The Rheumatoid Thumb. In: Chung, K. (eds) Clinical Management of the Rheumatoid Hand, Wrist, and Elbow. Springer, Cham. https://doi.org/10.1007/978-3-319-26660-2_21
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DOI: https://doi.org/10.1007/978-3-319-26660-2_21
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