Surgical management of rheumatoid arthritis: the upper limb

Ian McNab and Chris Little

in Rheumatoid Arthritis

Published on behalf of Oxford University Press

ISBN: 9780199556755
Published online May 2011 | e-ISBN: 9780199607334 | DOI:

Series: Oxford Rheumatology Library

Surgical management of rheumatoid arthritis: the upper limb

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• Pain from synovitis of the acromioclavicular joint localizes to the joint and responds to intra-articular steroid or arthroscopic excision of the lateral end of the clavicle • Pain from gleno-humeral disease that does not improve with articular injections is best managed by humeral head replacement, but glenoid bone loss generally makes glenoid resurfacing inadvisable • Rotator cuff impingement and tears that do not respond to injections and scapular control exercises are best treated by arthroscopic subacromial decompression and debridement • Arthroplasty will usually reduce pain and improve function, particularly in the flail elbow, but carries increased surgical risks and a higher likelihood of loosening than other large joint replacements • Nerve compression around the elbow is common, but often relatively asymptomatic • Olecranon bursal excision surgery is usually avoided due to the low but significant risks of inadequate wound healing • If hand function deteriorates and pain progresses or increases despite maximal medical therapy, surgical intervention is indicated.

Chapter.  3774 words.  Illustrated.

Subjects: Rheumatology

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