title: Arthroscopy of the proximal interphalangeal and metacarpophalangeal joints in rheumatoid hands.
abstract: OBJECTIVE
  To describe our experience with arthroscopy of the proximal interphalangeal (PIP) and metacarpophalangeal (MP) joints and to assess the value of this technique.
  
  
  METHODS
  Case series.
  
  
  METHODS
  Arthroscopy was performed on 27 PIP joints and 16 MP joints of 21 patients with rheumatoid arthritis (mean age, 47.2 years; range, 26 to 62 years). After arthroscopic examination, 24 joints were treated with joint irrigation only and 19 were treated with arthroscopic synovectomy. All procedures were performed on an outpatient basis. The diameter of the arthroscope was 1.5 mm, and mini-forceps and a mini-shaver system with a 2.5-mm cutter were used for biopsy and synovectomy. We developed new portals for the PIP joints on the dorsal-lateral aspect, more lateral than previously reported portals.
  
  
  RESULTS
  The articular cartilage and synovial membrane of the PIP and MP joints were well visualized, and arthroscopy revealed cartilage changes and synovial proliferation. Because the PIP joint space was not wide enough to insert the arthroscope into the palmar cavity, the palmar part of the articular surfaces and the volar synovium could not be inspected. Synovial biopsy of the dorsal joint capsule was easily performed under arthroscopic visualization. Synovectomy of the dorsal joint capsule and both the radial and ulnar recesses was also possible using the 2-portal technique with a mini-shaver system. No intraoperative or postoperative complications were encountered.
  
  
  CONCLUSIONS
  Arthroscopy of the PIP and MP joints is useful in assessing articular cartilage and synovium and for synovial biopsy. Arthroscopic synovectomy can be performed safely with the 2-portal technique.
authors.affiliation: Department of Orthopaedic Surgery, Nagoya City University Medical School, Nagoya, Japan. i_sekiya@yahoo.co.jp
authors.forename: Isato
authors.initials: I
authors.lastname: Sekiya
authors.forename: Masaaki
authors.initials: M
authors.lastname: Kobayashi
authors.forename: Yoichi
authors.initials: Y
authors.lastname: Taneda
authors.forename: Nobuo
authors.initials: N
authors.lastname: Matsui
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000473:pathology / Q000601:surgery*; D001182:Arthroscopy / Q000379:methods*; D005384:Finger Joint / Q000473:pathology / Q000601:surgery*; D006225:Hand; D006801:Humans; D008662:Metacarpophalangeal Joint / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged