DR. MED. MARTINS KAPICKIS
Certified plastic surgeon, microsurgeon, hand surgeon
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While general arthritis is mainly treated by physicians of other specialties, the Microsurgery Center provides surgical help in the treatment of hand arthritis.
Rheumatoid arthritis is a connective tissue disease deforming the wrist and altering the tendons. Rheumatoid arthritis is treated by rheumatologists and the majority of symptoms caused by this disease can be eliminated by using specific splints or physiotherapy. However, sometimes surgical intervention is necessary, and the surgery is performed by a hand surgeon.
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What is rheumatoid arthritis
Rheumatoid arthritis (AR) is a severe disease caused by a malfunction of the immune system that can develop at any age. Usually, the body does not “see” its properly produced proteins, but “sees” and destroys only incorrectly produced or accidentally introduced foreign proteins, such as microbes or tumor cells. This is a normal defense response of the body.
In a patient with RA, the body begins to destroy its joints as if they were foreign. As a result, the joints become severely deformed, and the tendons and muscles shorten, further exacerbating the deformities. Tendon ruptures often occur. AR can also cause damage to other organs such as the heart, nerves, lungs and eyes.
How to treat and eliminate symptoms
Today, the disease is treated by rheumatologists, and many of the symptoms of the disease can be eliminated by using special orthoses or physiotherapy. The assistance of a hand surgeon is required in cases where the patient is unable to take care of himself due to joint deformities, as well as in case of severe pain and/or tendon rupture. In the classic case, the patient’s fingers bend towards the little finger and are not completely straightened. The thumb and other fingers experience severe “swan-neck deformities”. Over time, your fingers may lose sensitivity – they may become numb.
How surgery is performed
During the surgery, the diseased joints are replaced with artificial silicone joints. Ruptured and deformed tendons are sutured and put in place. Joints that have completely collapsed as a result of arthritis are subjected to surgery, during which they are made completely immobile. The goal of the surgery is to reduce the patient’s pain and improve the function of the hand. Very rarely, surgery is performed only to improve the appearance of the hand. After surgical treatment, the assistance of a rehabilitator and an orthopedic specialist is mandatory.
Duration of the surgery
Depends on the scope of the surgery.
Anesthesia
Regional or general.
Treatment
Outpatient or inpatient.
Recovery
There may be local discomfort and pain after surgery, which is well controlled with painkillers. Wounds heal in 2 weeks. The patient needs to change dressings 2-3 times a week. After two weeks, the skin sutures are removed. In the post-surgery period, the patient should wear a specially designed orthosis for up to 6 weeks, perform occupational therapy for hand and develop movements in the fingers and hand.
The result
Surgeons can prevent complications from RA, but keep in mind that surgery does not cure the underlying disease and you will need to continue regular treatment with a rheumatologist.
When should a rheumatoid arthritis patient see a wrist surgeon?
The patient is usually referred to a wrist surgeon by a rheumatologist or orthopedist to inject steroids into the small joints or to repair the torn tendons. Sometimes it is necessary to strain the ligaments and tendons to prevent deformation of the joints.
Can endoprosthesis be inserted into all wrist and finger joints?
Endoprosthesis can only be inserted if the joint has a stable ligament and tendon apparatus that will hold the joint and allow it to move in the right direction. If the joint has collapsed, the ligaments and tendons are not working well, there is a possibility that the joint will need to be immobilized to keep the finger stable and reduce pain.
Rheumatoid arthritis
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