How are thumb deformities in rheumatoid arthritis (RA) treated?

Updated: Jan 11, 2019
  • Author: Michael Neumeister, MD, FRCSC, FACS; Chief Editor: Joseph A Molnar, MD, PhD, FACS  more...
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Answer

Answer

The treatment of these specific deformities depends on the severity of disease in each involved joint. Fixed joint deformities with bony destruction are usually more amenable to fusion than arthroplasty. However, in general, in an attempt to preserve motion, fusion of 2 joints in tandem is considered the last-stage effort. IP joint fusion is tolerated extremely well and maintains function. The IP joint should be fused at 0-20° of flexion. MP joint arthroplasty is recommended at the CMC joint or IP joint about to be fused. This preserves the motion of the thumb for prehensile tasks. Pathology isolated to one joint, such as in a type 4 deformity, can be surgically treated with an arthroplasty or volar plate advancement. A type 6 deformity requires fusion to regain stability. Bone grafts may be required to restore adequate bone stock.

CMC joint arthroplasties are a good option for significant deformities of the thumb if the disease initiated at the CMC joint (ie, type 3 deformities). Ligament reconstruction with tendon interposition offers a stable joint with preservation of motion. Occasionally, fusion of the CMC joint may be required if significant bone destruction is present with poor residual bone stock.


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