The wrist is the most commonly affected joint in RA. Progression of disease destroys the articular cartilage and surrounding soft tissues, and leading to severe deformities. In general, ulnar translocation of the carpus contributes to the radial deviation of the metacarpals and accentuate the ulnar deforming force on the fingers at the MCP joints. Indications for surgical treatment of rheumatoid wrist are pain, functional disability, deformation, and deterioration of disease.
Surgical procedures involved in rheumatoid wrist including:
Preventive procedures
Synovectomy of extensor/flexor compartment
Synovectomy of RU & RC joints
Balancing of the wrist extensors
Reconstructive procedures
Distal ulnar resection
Reconstruction of extensor/flexor tendon rupture
Radiocarpal joint arthroplasty
Partial wrist fusion
Total wrist arthrodesis/Total wrist arthroplasty
The outcomes of surgery
• Dorsal synovectomy/ synovectomy of the wrist, relieves pain, prevents or delays the occurrence of extensor tendon rupture
• Distal ulna resection is the standard procedure in the treatment of DRUJ involvement in RA
• Partial wrist fusion preserves one-half to two-thirds of ROM.
• Total wrist fusion relief pain at considerable cost
• Total wrist arthroplasty is a “high risk-high reward” operation
In conclusion, a number of surgical treatments for the rheumatoid hand and careful sequential planning of the surgical procedures can maintain patients’ hand function and enhance outcomes of the rheumatoid hand by correcting existing deformities.

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