Arthroscopy of the proximal interphalangeal joint

Objective. Pain reduction in the affected proximal interphalangeal joint (PIP joint) by synovectomy, loose body extraction, dorsal arthrolysis. Indications. Therapy-resistant synovitis in rheumatoid arthritis (RA), early stage primary and secondary degenerative arthritis, loose bodies, capsular contracture. Contraindications. Established biomechanic changes in RA (boutonniere and swanneck deformity). Large dorsal synovial cysts. Advanced radiologic changes in degenerative arthritis. Joint instability. Fresh skin lesion near portals. Surgical technique. Vertical traction of the affected finger in a Chinese finger trap if arthroscopy of a metacarpophalangeal joint is also planned, otherwise the joint can be placed on a hand table. Fill joint with Ringer solution. A radial and ulnar dorsal portal is created at joint space level, between the lateral band of the extensor tendon and the collateral ligament. Diagnostic arthroscopy. With insufficient visibility, "blind" shaving in dorsal recess. Completion of synovectomy under vision; 1.9 mm arthroscope with 30 degrees A angle of vision; 2.0 mm shaver (aggressive cutter). Closure of portals. Soft padded dressing. Postoperative management. Immediate postoperative mobilization for full range of finger movement. Results. From 2009-2011, 91% of the patients treated with arthroscopic PIP joint synovectomy interviewed by telephone about pain reduction and satisfaction with the operation. Half of the 22 patients had RA and the other half degenerative arthritis, each with 14 joints treated. In all, 9 RA patients (11 treated joints, 79%) and only 1 patient with degenerative arthritis (2 treated joints, 14%) were content. The procedure achieves good pain reduction and functional improvement of the hand in RA. It can however not be recommended for degenerative arthritis except in selected cases.