Extensor Carpi Radialis Longus to Extensor Carpi Ulnaris Tendon Transfer for Rheumatoid Arthritis of the Wrist

摘要

Rheumatoid arthritis (RA) is a chronic, destructive inflammatory arthritis affecting approximately 1% of the population [1]. RA is classically described as producing a symmetric polyarthritis that affects both the large and small joints of the upper and lower extremities. In the upper extremity, the wrist is involved in approximately 75% of patients and is bilateral in the vast majority of cases [1,2].Synovial inflammation, with the formation of the synovial pannus, is the hallmark of RA. Joint destruction, alteration in soft tissue function, and abnormal biomechanics ultimately lead to the classic appearance of the wrist in a patient with RA [1,3]. This "zigzag" or "Z" deformity is characterized by dorsal ulnar subluxation, carpal shortening and supination, radial shift of the metacarpals, and ulnar deviation of the fingers [4]. Surgical intervention is indicated when pain or loss of function interferes with a patient's independence or quality of life. While there are many surgical options for the treatment of RA in the wrist, the common goal is relief of pain, maintenance or restoration of function, and prevention of deformity progression.