Ligaments and Tendons in Rheumatoid Arthritis - Can surgery alleviate the pain associated with damage to ligaments and tendons in the wrist and hands as a result of rheumatoid arthritis?

The hand pain in rheumatoid arthritis (RA) may originate from a large variety of causes, chief amongst them are the inflammation of the synovial membranes. Synovium is specialised tissue that allows gliding to occur and  secretes the lubricant and nutrient synovial fluid essential to normal joint function and the function of some tendons. In rheumatoid arthritis this tissue becomes inflamed and instead contributes to the destruction of the joint and its adjacent ligaments (which are the stays that effectively constrain the joint and render it stable but mobile). As the joints and ligaments decay, so they may become unstable and deviate or adopt abnormal attitudes or positions, putting increased strain on the remaining ligaments. Such inflamed and swollen joints are painful in their own right, and some pain may arise from the joint surfaces or from the capsule that surrounds the joint including the ligaments that bear abnormal strains.

Surgery in this condition has several aims. Some doctors believe that in particular circumstances there is a place for “prophylactic” or preventative surgery in which the destructive diseased synovium is removed to prevent its adverse effect on adjacent tissues. Further, some feel that when the joints begin to deviate, corrective surgery to the ligaments and soft tissues (as opposed to bone) may allow realignment of the joint surfaces and prevent the erosion of those surfaces that comes from chronic malalignment. This surgery is particularly appropriate for the metacarpophalangeal joints (at the junction between fingers and palm) which commonly deviate away from the thumb side of the hand, sometimes well before the joints themselves require replacement.

It should however be borne in mind that other causes of pain occur in rheumatoid arthritis in the hand, and important amongst these are nerve compression pains from swelling of adjacent joints or tendons, and subsequent compression of the nearby nerves. A good example of this is rheumatoid arthritis associated carpal tunnel syndrome. Any one suffering from rheumatoid arthritis with any new type of hand pain should be evaluated by a hand specialist or rheumatologist where possible, and regular checks by a rheumatologist or hand surgeon are sensible; in this condition. The individual indications for surgery for pain may then be discussed in detail.