TENOSYNOVITIS AND TENDON RUPTURES IN RHEU MATOID-ARTHRITIS

Rheumatoid arthritis is basically a disease of the synovium and involv es the synovium-lined sheaths that surround many of the tendons in the hand and wrist. Proliferative synovitis affects the tendons, infiltra tes the tendons, causes formation of nodules, changes their ultrastruc ture, and eventually leads to spontaneous rupture. The three common si tes of tendon sheath involvement are the dorsal and palmar aspect of t he wrist, and the palmar aspect of the digits. Early tenosynovectomy c an prevent tendon ruptures and should therefore be the cornerstone of treatment. Once spontaneous rupture has occurred, early diagnosis and treatment are important to prevent further rupture. Reconstruction of isolated ruptures of extensor or flexor tendons gives good results. Mu tiple tendon ruptures, however, are difficult to treat and have a wors e prognosis. The severity of the patient's disease and the degree of a rticular involvement have a greater effect on the outcome of surgery t han reconstruction techniques. Our current approach to the management of this difficult problem is presented.