Skip to main content

Advertisement

SpringerLink
Log in

Operative Eingriffe an Hand und Handgelenk

Hand and wrist surgery

  • Leitthema
  • Published:
Zeitschrift für Rheumatologie Aims and scope Submit manuscript

Zusammenfassung

Trotz der heute zur Verfügung stehenden Biologika bleiben das synovialitisch bedingte Karpaltunnelkompressionssyndrom, das Caput-ulnae-Syndrom oder palmar betonte Tenosynovialitiden mit drohenden Sehnenrupturen dringliche chirurgische Indikationen an der Hand. Die diagnostische und therapeutische Synovektomie zur Diagnose- und Therapieoptimierung behält ihren Stellenwert, nach Möglichkeit bevor radiologisch fassbare Destruktionen auftreten. Balance- oder gelenkstabilisierende Operationen müssen vor der Destruktion der Gelenke angeboten werden. Wird dieser Zeitpunkt verpasst, so können am Handgelenk meist nur noch Teil- oder komplette Arthrodesen, an den Grundgelenken Arthroplastiken und an den Endgelenken Arthrodesen durchgeführt werden.

Abstract

Despite improved medical treatment of rheumatoid arthritis, carpal tunnel compression, caput ulnae syndrome and palmar and dorsal tenosynovitis with potential tendon rupture represent urgent surgical indications. While diagnostic and therapeutic synovectomy may guide medical treatment, it should be performed before joint instability and destructive arthritis are established. Swan-neck and Boutonniere deformities as well as ulnar or radial drift of metacarpophalangeal (MCP) joints or the wrist can only be corrected when the involved joints are supple and intact. In the presence of destructive arthritis, partial and total wrist fusion, arthroplasties of the MCP joints and arthrodeses of the distal interphalangeal joints are recommended.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2

Notes

  1. Der Wunsch nach Verbesserung der Handerscheinung wird vom Patienten im Gespräch oft geäußert [3].

Literatur

  1. Alderman AK, Ubel PA, Kim HM et al (2003) Surgical management of the rheumatoid hand: consensus and controversy among rheumatologists and hand surgeons. J Rheumatol 30:1464–1472

    PubMed  Google Scholar 

  2. Ghattas L, Mascella F, Pomponio G (2005) Hand surgery in rheumatoid arthritis: state of the art and suggestions for research. Rheumatology 44:834–845

    Article  CAS  PubMed  Google Scholar 

  3. Chung KC, Kotsis SV, Kim HM et al (2006) Reasons why rheumatoid arthritis patients seek surgical treatment for hand deformities. J Hand Surg Am 31:289–294

    Article  PubMed  Google Scholar 

  4. Jain A, Nanchahal J, Troeberg L et al (2001) Production of cytokines, vascular endothelial growth factor, metalloproteinases, and tissue inhibitor of metalloproteinases 1 in tenosynovium demonstrates its potential for tendon destruction in rheumatoid arthritis. Arthritis Rheum 44:1754–1760

    Article  CAS  PubMed  Google Scholar 

  5. Ryu J, Saito S, Honda T, Yamamoto K (1998) Risk factors and prophylactic tenosynovectomy for extensor tendon ruptures in the rheumatoid hand. J Hand Surg Br 23:658–661

    CAS  PubMed  Google Scholar 

  6. Tolat AR, Stanley JK, Evans RA (1996) Flexor tenosynovectomy and tenolysis in longstanding rheumatoid arthritis. J Hand Surg Br 21:538–543

    Article  CAS  PubMed  Google Scholar 

  7. Nicolle FV, Holt PJL, Calnan JS (1971) Prophylactic synovectomy of the joints of the rheumatoid hand. Ann Rheum Dis 30:476–480

    Article  CAS  PubMed  Google Scholar 

  8. Wilde AH (1974) Synovectomy of the proximal interphalangeal joint of the finger in rheumatoid arthritis. J Bone Joint Surg 56:71–78

    CAS  PubMed  Google Scholar 

  9. Nakamura H, Nagashima M, Ishigami S et al (2000) The anti-rheumatic effect of multiple synovectomy in patients with refractory arthritis. Int Orthop 24:242–245

    Article  CAS  PubMed  Google Scholar 

  10. McEwen C (1988) Multicenter evaluation of synovectomy in the treatment of rheumatoid arthritis: report of results at the end of five years. J Rheumatol 15:765–769

    CAS  PubMed  Google Scholar 

  11. Weyand CM (2007) Immunopathologic aspects of rheumatoid arthritis: who is the conductor and who plays the immunologic instrument? J Rheumatol Suppl 79:9–14

    CAS  PubMed  Google Scholar 

  12. Jain A, Ball C, Freidin AJ, Nanchahal J (2010) Effects of extensor synovectomy and excision of the distal ulna in rheumatoid arthritis on long-term function. J Hand Surg Am 35:1442–1448

    Article  PubMed  Google Scholar 

  13. Ishikawa H, Murasawa A, Nakazono K (2005) Long-term follow-up study of radiocarpal arthrodesis for the rheumatoid wrist. J Hand Surg Am 30:658–666

    Article  PubMed  Google Scholar 

  14. Trail IA, Martin JA, Nuttall D, Stanely JK (2004) Seventeen-year survivorship analysis of silastic metacarpophalangeal joint replacement. J Bone Joint Surg Br 86:1002–1006

    Article  CAS  PubMed  Google Scholar 

  15. Pereira JA, Belcher HJCR (2001) A comparison of metacarpophalangeal joint silastic arthroplasty with or without crossed intrinsic transfer. J Hand Surg Br 26:229–234

    Article  CAS  PubMed  Google Scholar 

  16. Mandl LA, Galvin DH, Bosch JP et al (2002) Metacarpophalangeal arthroplasty in rheumatoid arthritis: what determines satisfaction with surgery? J Rheumatol 29:2488–2491

    PubMed  Google Scholar 

  17. Beckenbaugh RD (2003) Die Arthroplastik des Metakarpophalangealgelenkes mit Pyrocarbonimplantaten. Orthopade 32:794–797

    Article  CAS  PubMed  Google Scholar 

Download references

Interessenkonflikt

Die korrespondierende Autorin gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Universitätsklinik für Plastische und Handchirurgie,Handchirurgie und Chirurgie der peripheren Nerven, Inselspital, Freiburgstr. 10, 3010, Bern, Schweiz

    E. Vögelin

  2. Universitätsklinik für Rheumatologie, Klinische Immunologie und Allergologie, Inselspital, Bern, Schweiz

    P.M. Villiger

Authors
  1. E. Vögelin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P.M. Villiger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to E. Vögelin.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Vögelin, E., Villiger, P. Operative Eingriffe an Hand und Handgelenk. Z. Rheumatol. 70, 21–25 (2011). https://doi.org/10.1007/s00393-010-0681-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00393-010-0681-6

Schlüsselwörter

Keywords

Search

Navigation