Rheumatoid Hand — Clinical Presentation and Management
DNB Orthopaedics • May 2024 • Paper I • 10 Marks
Introduction
Rheumatoid arthritis (RA) is a chronic systemic autoimmune inflammatory disease that commonly affects the wrist, metacarpophalangeal (MCP) joints, proximal interphalangeal (PIP) joints and tendon sheaths.
Persistent synovitis leads to capsuloligamentous attenuation, tendon imbalance, joint destruction, instability and characteristic deformities of the rheumatoid hand.
The deformities of the rheumatoid hand are not produced by bone destruction alone. They result from a combination of synovitis + ligament failure + tendon imbalance + joint erosion.
Pathogenesis of Rheumatoid Hand Deformity
Chronic synovitis
↓
Capsular distension
+ ligament attenuation
↓
Joint instability
↓
Altered tendon line of pull
↓
Muscle-tendon imbalance
↓
Subluxation / characteristic deformity
↓
Cartilage and bone destruction
↓
Fixed deformity + functional loss
A. Clinical Presentation
The clinical picture should be described under symptoms, wrist changes, MCP deformities, finger deformities, thumb deformities and tendon problems.
1. Symptoms
- Pain in wrist and small joints of the hand
- Morning stiffness
- Swelling
- Weak grip
- Difficulty with pinch
- Difficulty with fine motor tasks
- Loss of dexterity
- Fatigue and systemic features of RA
2. Synovitis
Synovial thickening may be present at:
- Radiocarpal and distal radioulnar…