The wrist in rheumatoid arthritis.

The wrist is the key joint of the upper extremity and is frequently seriously involved in rheumatoid arthritis. Surgery is often indicated to control the effects of the synovitis which often includes rupture of both flexor and extensor tendons. Early synovectomy is indicated. Tenosynovectomy, synovectomy, distal ulnar resection and transposition of the dorsal carpal ligament beneath the extensor tendons, has been effective in preventing rupture of the extensor tendons. The wrist also has an effect on ulnar drift of the fingers. Transfer of the extensor carpi radialis longus to the extensor carpi ulnaris is recommended in patients who do not have the ability to actively ulnar deviate the wrist. Wrist fusion has proven to be effective in patients with marked destruction, deformity or pain, or where there has been a rupture of both radial wrist extensors.