Rheumatoid arthritis can threaten tendons, destabilize joints and change the mechanics of the whole hand. Reconstructive planning begins with the cause of lost function.

In this episode of Plastics in Practice, we review the rheumatoid hand, from the inflammatory-arthritis differential and deformity mechanisms to tendon rupture, joint reconstruction and perioperative planning.

Key takeaways:

• Distinguish rheumatoid arthritis from other inflammatory and degenerative conditions using the clinical pattern, systemic findings and imaging.

• Synovitis can weaken joint restraints and damage tendons; the visible finger posture may reflect a deforming force elsewhere in the hand or wrist.

• Separate flexible, reducible deformity with preserved joint surfaces from fixed deformity with advanced destruction before choosing reconstruction.

• New extension loss warrants prompt assessment. Distinguish tendon rupture from tendon subluxation or nerve dysfunction, and address the attritional source when reconstructing a rupture.

• Silicone MCP arthroplasty can improve alignment and patient-reported function without necessarily improving grip or pinch strength.

• Balance the pain, stability and motion goals of wrist reconstruction, and coordinate disease control, medications and perioperative assessment with rheumatology and anesthesia.

This content is for educational purposes only and is not medical advice.

The podcast audio is generated with Google NotebookLM using AI voices. These are synthetic discussion voices, not clinicians or accounts of their personal experience.

Apple Podcasts episode: https://podcasts.apple.com/us/podcast/rheumatoid-arthritis-when-finger-extension-fails/id1835564216?i=1000796831957

Amazon Music episode: https://music.amazon.com/podcasts/8bef056e-7c87-4224-978e-7e691b04554a/episodes/bb0a03d5-477e-467e-bad9-90fb4dd8837a/plastics-in-practice-resident-review-rheumatoid-arthritis-when-finger-extension-fails

YouTube explainer (recorded human narration): https://www.youtube.com/watch?v=S3Q4n9qksLY

Related YouTube Short: https://www.youtube.com/shorts/hLtLn0a5pgg

Instagram account: https://www.instagram.com/plasticsinpractice/

Free study guide: https://docs.google.com/document/d/1-WAk-57sUaYcorUDKGC98ajLlh4W52Yp/edit

#RheumatoidArthritis #HandSurgery #TendonReconstruction #RheumatoidHand #PlasticSurgeryEducation

References:

1. American Society for Surgery of the Hand. Rheumatoid Arthritis. https://assh.my.site.com/handcare/condition/rheumatoid-arthritis

2. McIntyre et al. Outcomes of Surgical Treatment of Vaughan-Jackson Syndrome. 2024. https://doi.org/10.1055/s-0043-1775994

3. Tailoring Tendon Transfer Surgery and Rehabilitation for a Musician: A Case Study. https://pmc.ncbi.nlm.nih.gov/articles/PMC4852048/

4. Seven-Year Outcomes of the Silicone Arthroplasty in Rheumatoid Arthritis Prospective Cohort Study. https://pubmed.ncbi.nlm.nih.gov/27696739/

5. 2021 American College of Rheumatology Guideline for the Treatment of Rheumatoid Arthritis. https://pmc.ncbi.nlm.nih.gov/articles/PMC9273041/

6. 2022 ACR/AAHKS Perioperative Guideline (elective hip and knee arthroplasty scope). https://acrjournals.onlinelibrary.wiley.com/doi/10.1002/art.42140