1. Rheumatoid hand Hospital of Lithuanian University of Health Sciences Kaunas, Lithuania MD K.Braziulis, MD E.Zacharevskij, MD PhD R.Rimdeika

2. Rheumatoid arthritis (RA) is mostly poly arthritis witch symmetrically damage hand and foot joints Cartilage and bones damage is common for RA As disease progress deformities and dysfunction of joints appears RA also disturb lungs, vessels, skin and eyes

3. Epidemiology Incidence is approximetly 1% of population Women:men rate 2.5 : 1 http://emedicine.medscape.com/article/1287449-overview

4. Because of synovitis happens: Damage of joint cartilage Damage of tendons (tenosynovitis, ruptures) Damage of ligaments ( pervasive joint instability and deformities)

5. 1 2 3 4 Predictable evaluative pattern 1.Dorsal subluxation of the ulnar head (volar ECU dislocation) 2.Carpal ulnar translocation 3.Carpo-metacarpal radial deviation 4.Carpal supination 5.Volar carpal subluxation

6. 1 3 1.Pain 2.R.O.M. reduced 3.Attrition tendon ruptures 4.Secondary finger deformities

7. Pain reduce Improvement of function Suspend the spread of disease Improvement of hand appearance Aims of operative treatment

8. Synovectomy Tenosynovectomy Tendons surgery Arthroplasty Arthrodesis

9. Tenosynovectomy

10. Tendons surgery

12. Arthrodesis partial total

13. Partial arthrodesis of radiocarpal joint Indications Pain syndrome No X-ray signs of middle wrist joint degeneration

14. Indications 1.Pain syndrome 2.X-ray sings of degeneration and clinically middle wrist and radiocarpal joints are damaged Total arthrodesis of radiocarpal joint

15. Arthroplasty Indications 1.Joint damage, sublucsation as RA complications, trauma 2.No effect of conservative treatment

16. Arthroplastics

17. Technique Joints’ surfaces resection + Implant + reconstruction of soft tissues = functional joint

18. MP damageAfter operation

19. Contraindications Possibility of conservative treatment Infection Local skin damage, disturbances of blood supply No possibility for tendon reconstruction Patients who have over workload for hands