RA Finger Deformities 2

Finger Deformities 2

ring, and little fingers can be treated with extensor reconstruction and silastic implant arthroplasty; in the index finger, PIP fusion is probably better.

If Mild (up to 15 degrees PIP flexion) without fixed extension of the DIP
– release the lateral bands, and flex the DIP down (may create a mallet, which will require splinting)

If Moderate (15-40 degrees PIP flexion)
– must restore the central slip by shortening it, and correct the subluxation of the lateral bands by incising the transverse retinacular ligament and realigning the bands over the dorsal aspect of the middle phalanx. Be certain that you aren�t creating an extension deformity of the PIP

If Severe, fixed
– consider MCP arthroplasty or fusion with IP release or fusion.

ULNAR DRIFT OR DEVIATION OF FINGERS

– a number of normal anatomic factors contribute to the ulnar deviation of the fingers:
– natural ulnar deviation of the phalanges at the MCPs
– natural ulnar approach of the extensor and flexor tendons at the MCPs
– the smaller ulnar condyle of the metacarpal head
– the more ulnar deviation allowed by the radial collateral ligament in flexion

– in the rheumatoid, the additional pathological factors are:
– synovitis causing stretching out of the collateral and accessory collateral ligaments allows the FLEXOR tendons to sublux the phalanges volarly and ulnarly
– interossei contracture causing hyperextension of the PIP and flexion of the MCP
– ulnar displacement of the long extensors caused by ineffective radial sagittal bands

Treatment of Mild – Moderate Drift

– implies the absence of severely diseased articular surfaces of dislocated joints
– the pathology is usually a combination of both flexor and extensor tendon displacement ulnarly, with intrinsic tightness, and swollen joints.
– treatment is aimed at releasing the intrinsics, realigning the extensor tendons, and performing a synovectomy. No procedure has been devised yet to deal with the ulnarly displaced flexors.

– see page 3625-3626 for description of extensor realignment. Basically involves cutting the extensor hood radially, opening the joint and cleaning it out, then cutting the hood ulnarly to release it, and suturing the hood back radially.

Treatment of Severe Drift

– MCP arthroplasty