If you have moderate to severe rheumatoid arthritis (RA), there may come a time when you need to consider having hand surgery to correct deformities and damage caused by the disease process. There are factors you need to consider before deciding if surgery is right for you.
Your orthopedic surgeon will make the final judgement on whether or not your disease is adequately controlled enough for surgery to be an option. With RA, disease control can create a complex orthopedic problem. For example, damage or rupture of underlying soft tissues may necessitate repairs. Although this may temporarily fix joint instability, the problem will likely reoccur without good control over the disease process.
Further complicating the matter is that you often need to stop your medications for a couple of weeks before surgery, with no guarantee you will receive the same level of disease control upon restarting your medications. If you have struggled to find the right combination of medications and are doing well on your current regimen, you may find stopping your medications temporarily might not be worth the risk.
Typically, when someone considers hand surgery for RA, both pain and functionality are an ongoing problem. Although deformities from RA can limit both fine and gross motor skills, you may have to adjust to different functional limitations after surgery. For example, swan-neck and boutonniere's deformity are among the most common hand deformities seen in RA. They can prevent full extension of the fingers, but many people are still able to grip objects to some degree. Fusion surgery is a common surgical option to straighten the fingers. With joint fusion can come the inability to bend the fingers at all or your grasp may be limited to only moving at the metacarpophalangeal joint.
Another form of surgery that can be performed on the hands is a synovectomy. Since RA mostly affects the synovial joints, the removal of the synovium (theoretically) stops the disease process in the joint. Ideally, the surgery should be performed before complete destruction of the joints occur, as to preserve any remaining healthy joint surface. Removing the synovium can help decrease pain, but you should realize there is a difference between the types of pain you may experience.
For example, the active disease process will cause pain, but you may also experience pain from joint destruction. If you have the synovium removed, you may continue to have significant pain in your hands if damage to the joint surface and/or soft tissues has already occurred. However, the procedure may also halt the progression of damage that is directly a result of the disease.
Making the decision to have hand surgery is not always easy. Fortunately, hand surgery can afford you a better quality of life in the form of decreased pain and more independence. Consult a professional hand doctor, like Town Center Orthopaedic Associates, P.C., to learn what might be best for you.Share