Functional outcome following extensor synovectomy and excision of the distal ulna in patients with rheumatoid arthritis.
We prospectively measured hand and wrist function in rheumatoid patients undergoing excision of the distal ulna. Range of motion, visual analogue pain scores and grip strength were measured in 22 wrists, and the Jebsen hand function test was administered to seven patients, preoperatively and at 3 and 12 months. At 1 year there were improvements in forearm pronation (P=0.04), supination (P=0.03) and wrist extension (P=0.02), but a reduction in flexion (P=0.009). Active radial deviation was reduced and ulnar deviation increased. There was a significant improvement in grip strength (P=0.05) and reduction in wrist pain (P=<0.0001). At 1 year the Jebsen hand function test showed improvements in simulated feeding, stacking checkers, and lifting large empty cans. Excision of the distal ulna in rheumatoid patients results in an improvement in some aspects of hand function.
Department of Musculoskeletal Surgery and the Kennedy Institute of Rheumatology, Imperial College School of Medicine, Charing Cross Hospital, Fulham Palace Road, London, UK. ajainuk@aol.com
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Jain
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Nanchahal
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018737:Hand Strength / Q000502:physiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology*; D010147:Pain Measurement; D011183:Postoperative Complications / Q000175:diagnosis* / Q000503:physiopathology; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D000074402:Synovectomy; D013583:Synovial Membrane / Q000503:physiopathology; D014457:Ulna / Q000503:physiopathology / Q000601:surgery*; D014955:Wrist Joint / Q000503:physiopathology / Q000601:surgery*