Therapeutic Options in Arthroscopy of the Rheumatoid Wrist

Despite the increased therapeutic value of drug therapy with biologicals and small molecules for rheumatoid diseases, total synovectomy is still of outstanding importance for joint preservation in patients with persistent synovitis. Total synovectomy is well established in rheumatoid knees, shoulders, elbows, and ankle joints. Compared with these joints, arthroscopic synovectomy in the wrist is technically more difficult because three small and curved compartments, the radiocarpal, mediocarpal, and distal radioulnar joint, have to be addressed. Partial wrist fusion is an important tool for wrist stabilisation preserving some range of motion in rheumatoid wrists. Arthroscopic percutaneous wrist fusion combined with total synovectomy is indicated if periarticular surgery is not required, e. g. for tenosynovectomy of the extensor tendons. Surgeons should be well experienced with wrist arthroscopy before starting to perform these procedures.