Synovectomy with resection of the distal ulna in rheumatoid arthritis of the wrist.

Wrist synovectomy with resection of the distal ulna was performed in 47 cases, where rheumatoid affection in the wrist joint caused visible capsular swelling, pain and reduced range of motion. At follow-up after a mean observation time of 33 months, 31 cases had complete pain relief, eight cases had moderate pain relief. In eight cases pain during wrist motion was unchanged at follow-up and in five of these, recurrence of capsular swelling was noted. The range of motion (both supination/pronation and vola- and dorsiflection) was significantly improved, as was the subjective assessment of function. The radiographic findings showed progression in 41 cases. Deviation in the wrist was unchanged. In three cases reoperations were performed and one case had spontaneous rupture of the 4th and 5th extensor tendons 1 month postoperatively. In 15 cases dislocation of the extensor carpi ulnaris tendon in volar direction by rotational movement was noted. Stability was good in all cases and no serious postoperative complications occurred. Wrist synovectomy with resection of the distal ulna is recommended in cases where regular medical treatment has been attempted for a minimum of 6 months without successful results.