PMID: 3763222Aug 1, 1986Paper

Surgical therapy of chronic polyarthritis of the hand

Der Orthopäde
B R Simmen

Abstract

Surgical therapy and the common surgical procedures for the rheumatoid hand are presented: synovectomy, boutonnière deformity, swan-neck deformity, arthroplasty, and surgical therapy of the rheumatoid thumb. The indications, early and late results, and the prophylactic value of synovectomy are discussed and compared with synoviorthesis (intra-articular injection of radioisotopic beta-emitters) in early stages of synovitis. In general, radioisotope synovectomy has reduced the need for early operative synovectomy. If synoviorthesis has no significant effect or if biomechanical factors are predominant in the affected joint (tenosynovitis, massive distension of the capsule and extensor mechanism or large masses of fibrin), then operative synovectomy is indicated. Multicenter studies have confirmed that pain can be relieved and joint swelling reduced by synovectomy for over 10 years after the operation. However, no significant preventive or retarding effects could be proven with regard to the progression of deformity or further radiologic changes. The risks in tenosynovectomy are minimal and the prognosis for improved function and prevention of ruptures is excellent. Restorative procedures on tendons are discussed in conjunction wit...Continue Reading

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