![Page 1: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/1.jpg)
Rheumatoid hand
Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania
MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika
![Page 2: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/2.jpg)
Rheumatoid arthritis (RA) is mostly poly arthritis witch symmetrically damage hand and foot joints
Cartilage and bones damage is common for RA
As disease progress deformities and dysfunction of joints appears
RA also disturb lungs, vessels, skin and eyes
![Page 3: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/3.jpg)
Epidemiology
Incidence is approximetly 1% of population Women:men rate 2.5 : 1
http://emedicine.medscape.com/article/1287449-overview
![Page 4: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/4.jpg)
Because of synovitis happens:•Damage of joint cartilage•Damage of tendons (tenosynovitis, ruptures)•Damage of ligaments ( pervasive joint instability and deformities)
![Page 5: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/5.jpg)
1
2
34
Predictable evaluative
pattern
1. Dorsal subluxation of the ulnar head (volar ECU dislocation)
2. Carpal ulnar translocation
3. Carpo-metacarpal radial deviation
4. Carpal supination
5. Volar carpal subluxation
![Page 6: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/6.jpg)
1
3
1. Pain
2. R.O.M. reduced
3. Attrition tendon ruptures
4. Secondary finger deformities
![Page 7: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/7.jpg)
Pain reduce Improvement of function Suspend the spread of disease Improvement of hand appearance
Aims of operative treatment
![Page 8: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/8.jpg)
Synovectomy Tenosynovectomy Tendons surgery Arthroplasty Arthrodesis
![Page 9: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/9.jpg)
Tenosynovectomy
![Page 10: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/10.jpg)
Tendons surgery
![Page 11: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/11.jpg)
Tendons surgery
![Page 12: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/12.jpg)
Arthrodesis
•partial
•total
![Page 13: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/13.jpg)
Partial arthrodesis of radiocarpal joint
Indications
•Pain syndrome
•No X-ray signs of middle wrist joint degeneration
![Page 14: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/14.jpg)
Indications
1. Pain syndrome
2. X-ray sings of degeneration and clinically middle wrist and radiocarpal joints are damaged
Total arthrodesis of radiocarpal joint
![Page 15: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/15.jpg)
ArthroplastyIndications
1.1. Joint damage, Joint damage, sublucsation as RA sublucsation as RA complications, traumacomplications, trauma
2.2. No effect of conservative No effect of conservative treatmenttreatment
![Page 16: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/16.jpg)
Arthroplastics
![Page 17: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/17.jpg)
TechniqueJoints’ surfaces resection + Implant + reconstruction of soft tissues = functional joint
![Page 18: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/18.jpg)
MP damage After operation
![Page 19: Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika](https://reader030.vdocument.in/reader030/viewer/2022032702/56649cd75503460f9499e945/html5/thumbnails/19.jpg)
Contraindications
Possibility of conservative treatment Infection Local skin damage, disturbances of blood
supply No possibility for tendon reconstruction Patients who have over workload for hands