The hand

Abstract

Submit your article to this journalArticle views: 57 The hand Typical deformities in rheumatoid arthritis include ulnar drift of the fingers, swan-neck and Boutonnière deformity (imbalance and malalignment of the PIP and DIP joints of the fingers), and shoemaker's thumb. These malalignments, along with pain and decreased mobility, may seriously impair hand function.The goal of surgical treatment is to: -achieve pain relief -counteract deterioration -improve function -achieve cosmetic improvement.Soft tissue surgery, eg, synovectomy in joints and tendon sheaths, for joint pain or mobility problems, tendon transfer for deviated fingers or following tendon rupture, and neurolysis to treat compression of peripheral nerves, can often improve hand function and counteract deterioration.If the joints are more or less destroyed by the rheumatic process, arthrodesis may be a suitable treatment in some joints (the MCP joint of the thumb, DIP joints of the fingers), while arthroplasty is the most appropriate surgical approach in other joints (the MCP joints of the fingers).The data in this chapter are based mainly on retrospective clinical and radiological studies of rheumatic patients. AnatomyThe bones and joints of the hand (starting from the wrist) consist of 5 carpometacarpal joints (CMC I-V) between the wrist (carpal bones) and metacarpal bones, 5 metacarpophalangeal joints (MCP I-V) between the metacarpal bones and phalangeal bones, and proximal and distal interphalangeal joints (PIP and DIP joints) between the different phalangeal bones. Mobility in CMC I (saddle joint) is good which, eg, enables the thumb to be positioned in opposition to the fingers. Other CMC joints have little or no mobility; CMC II and III are tight joints. The MCP joints have a mobility of approximately 90° from extended to flexed position, and also have the capacity to deviate to the side so the hand grip can adapt to the shape of an object. The PIP and DIP joints are hinge joints with mobility of approximately 100° (PIP) and 70° (DIP) respectively.