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Treatment of MCP Joints in the Rheumatoid Hand

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Clinical Management of the Rheumatoid Hand, Wrist, and Elbow

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Abstract

Patients with rheumatoid disease frequently suffer from hypertrophic synovitis of the metacarpophalangeal joints. The pull of the intrinsic muscles and the extrinsic digital flexor tendons will cause stretching of the collateral ligaments and secondary volar subluxation of the proximal phalanx. Weakening and subsequent elongation of the radial sagittal bands are responsible for ulnar subluxation of the extensor tendons, owing to the predominant ulnar-directed forces at this level. This will cause progressive loss of joint extension and ulnar inclination of the fingers.

When the joints are destroyed from the synovitis, an MPJ arthroplasty is indicated. Rebalancing of the deforming forces is more important than the type of joint implant used. However, flexible one-piece silicone implants are recommended to be used in severe deformities to prevent postoperative subluxation of two-component rigid implants.

MP joint arthroplasty provides pain relief, correction of deformities, and increased flexion force. The degree of active joint mobility will not be much improved, although the final arc of motion is usually displaced and changed to that of increased extension, which is more helpful for the patient.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Surgery of the Hand and Upper Extremity, Institut Kaplan, Paseo Bonanova, 9, Barcelona, Spain

    Alberto Lluch MD, PhD

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  1. Alberto Lluch MD, PhD
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Correspondence to Alberto Lluch MD, PhD .

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  1. Comp Hand Cen. Sec of PS, Dept of Surg, The University of Michigan Health System, Ann Arbor, Michigan, USA

    Kevin C. Chung

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Lluch, A. (2016). Treatment of MCP Joints in the Rheumatoid Hand. In: Chung, K. (eds) Clinical Management of the Rheumatoid Hand, Wrist, and Elbow. Springer, Cham. https://doi.org/10.1007/978-3-319-26660-2_18

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  • DOI: https://doi.org/10.1007/978-3-319-26660-2_18

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