The principles of surgery in the rheumatoid hand

The indications for surgery to the rheumatoid hand and wrist are relief of pain, improvement or preservation of function, correction of deformity, and cosmesis. The systemic, progressive and multi-articular nature of the disease makes decision-making more complex than in other areas of hand surgery Decisions about surgery should be made in a multidisciplinary clinic. Operative procedures include nerve decompression, synovectomy tenosynovectomy, tendon surgery, arthroplasty and arthrodesis. Severe nerve compression and impending tendon rupture are indications for urgent operation. (C) 2003 Elsevier Science Ltd, All rights reserved.