A collaborative team of medical professionals restoring hand function for a patient with rheumatoid arthritis, symbolizing hope and healing.

Hand Surgery for Rheumatoid Arthritis: New Advances and Proven Techniques

Samir D’Costa in Health & Wellness August 2025 • 4 min read.

"Discover how modern treatments, including biologics and innovative surgical approaches, can help maintain hand function and improve quality of life for those with rheumatoid arthritis."

Innovations in drug therapies, such as biologics and biosimilars, are decreasing the severity of destructive changes caused by rheumatoid diseases. However, targeted surgical interventions remain crucial for maintaining hand function, correcting instability, and ensuring the hand remains a useful "tool" for daily tasks.

This article highlights established and innovative surgical procedures used in the treatment of rheumatoid hand, emphasizing their role in addressing disease-related changes.

The pathobiomechanics of rheumatoid hand involves a series of changes, including destruction of the distal radioulnar joint (DRUJ), leading to palmar luxation of the extensor carpi ulnaris (ECU) tendon. This compromises wrist stability and results in ulnar translation of the carpus.

Understanding Synovialitis and Its Impact on Hand Function

A collaborative team of medical professionals restoring hand function for a patient with rheumatoid arthritis, symbolizing hope and healing.

Synovialitis, the inflammation of the synovial membrane, significantly contributes to the deterioration of hand function in rheumatoid arthritis. It manifests in two primary forms: tenosynovialitis and arthrosynovialitis.

Tenosynovialitis often leads patients to seek medical attention earlier than joint destruction. It primarily affects the ulnar side of the extensor tendons, with the ECU tendon almost always involved. While complete rupture is rare, the ECU tendon can luxate due to the swelling of the extensor retinaculum.

Ulnar shift and radial inclination: Imbalances in wrist tendons lead to the hand deviating towards the ulna (ulnar shift) and inclining towards the radius (radial inclination).
Palmar subluxation: The carpus (wrist bones) shifts towards the palm, causing the lunate bone to collapse.
Swan neck deformities: Muscle imbalances contribute to characteristic deformities in the fingers.
Kamelhöcker: Inflammatory changes lead to a loss of strength in the palmar plate, resulting in translation of the finger bones towards the palm.

Arthrosynovialitis, on the other hand, destroys cartilage and creates bone defects. The increased volume of synovial fluid causes pressure that erodes cartilage and ligament attachments. The Larsen classification is an established measure for assessing the degree of destruction.

The Multidisciplinary Approach: A Path to Better Outcomes

Managing rheumatoid hand effectively requires a multidisciplinary approach involving rheumatologists, hand surgeons, and nuclear medicine specialists. Conflicting goals, such as balancing joint mobility with stability, must be carefully considered.

The modern approach to treating rheumatoid hand combines consistent medical therapy with timely surgical intervention and the integration of nuclear medicine strategies. This comprehensive approach helps preserve hand function, enabling patients to maintain independence in their daily lives.

Ultimately, the goal of hand surgery in rheumatoid arthritis is to improve the appearance and functionality of the hand, a vital tool for interacting with the world.

About this Article -

This article was crafted using a human-AI hybrid and collaborative approach. AI assisted our team with initial drafting, research insights, identifying key questions, and image generation. Our human editors guided topic selection, defined the angle, structured the content, ensured factual accuracy and relevance, refined the tone, and conducted thorough editing to deliver helpful, high-quality information.See our About page for more information.

This article is based on research published under:

DOI-LINK: 10.1007/s00393-018-0542-2, Alternate LINK

Title: Handchirurgie An Der Rheumahand – Neues Und Bewährtes

Subject: Rheumatology

Journal: Zeitschrift für Rheumatologie

Publisher: Springer Science and Business Media LLC

Authors: B. Krieg, Z. Mascharka, G. Maderbacher, C. Baier, J. Grifka, F. Greimel

Published: 2018-09-25

Everything You Need To Know

What is the significance of the distal radioulnar joint (DRUJ) in rheumatoid arthritis?

The distal radioulnar joint (DRUJ) is the joint between the radius and ulna bones in the forearm. In the context of rheumatoid arthritis, the destruction of the DRUJ can lead to palmar luxation of the extensor carpi ulnaris (ECU) tendon, compromising wrist stability. This instability can then result in ulnar translation of the carpus, affecting hand function and causing pain. Surgical interventions are often necessary to address these changes and restore stability.

What role does synovialitis play in the context of rheumatoid arthritis?

Synovialitis is the inflammation of the synovial membrane, which lines the joints. In rheumatoid arthritis, synovialitis is a major contributor to the deterioration of hand function. It manifests in two primary forms: tenosynovialitis and arthrosynovialitis. Tenosynovialitis affects the tendons, particularly the extensor tendons on the ulnar side, potentially leading to the luxation of the ECU tendon. Arthrosynovialitis leads to cartilage destruction and bone defects. Both types of synovialitis can severely impact the hand's ability to function and are a key focus in the treatment of rheumatoid hand.

What is the extensor carpi ulnaris (ECU) tendon, and why is it important?

The extensor carpi ulnaris (ECU) tendon is a tendon located on the ulnar (outer) side of the wrist. It's crucial for wrist stability and hand movement. In rheumatoid arthritis, the ECU tendon is often affected by tenosynovialitis. The swelling of the extensor retinaculum can cause the ECU tendon to luxate, or slip out of place, affecting wrist stability and hand function. Surgical interventions may be required to address this issue, ensuring the hand remains a functional tool.

What does a multidisciplinary approach involve in the treatment of rheumatoid hand?

A multidisciplinary approach involves a team of healthcare professionals, including rheumatologists, hand surgeons, and nuclear medicine specialists. This collaborative effort is crucial for effectively managing rheumatoid hand. Rheumatologists manage the underlying disease with treatments such as biologics, hand surgeons address structural damage and restore function through surgical procedures, and nuclear medicine specialists may contribute to diagnostics or monitoring. This team approach ensures that all aspects of the condition are addressed, leading to better outcomes and improved quality of life for patients.

How do biologics and biosimilars impact the need for hand surgery?

Biologics and biosimilars are innovative drug therapies used to treat rheumatoid arthritis. They are designed to reduce the severity of destructive changes caused by the disease. While these drugs are critical in slowing disease progression, they do not always completely reverse the damage. Therefore, targeted surgical interventions remain crucial for maintaining hand function and correcting instability. Surgery can address issues such as DRUJ destruction, ECU tendon issues, and other deformities, providing a more complete approach to managing rheumatoid hand and improving a patient's ability to perform daily tasks.