{"id":7737,"date":"2018-06-13T11:41:53","date_gmt":"2018-06-13T11:41:53","guid":{"rendered":"http:\/\/cyplasticsurgery.com\/?page_id=7737"},"modified":"2018-06-13T11:41:53","modified_gmt":"2018-06-13T11:41:53","slug":"mallet-finger","status":"publish","type":"page","link":"https:\/\/www.cyplasticsurgery.com\/ru\/mallet-finger\/","title":{"rendered":"\u03a3\u03a6\u03a5\u03a1\u039f\u0394\u0391\u039a\u03a4\u03a5\u039b\u0399\u0391 (MALLET FINGER)"},"content":{"rendered":"

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Arthritis: Rheumatoid Arthritis<\/h1>\n

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What is Arthritis?<\/strong><\/h3>\n

Arthritis means an inflamed joint.\u00a0 A joint normally consists of two cartilage-covered bone surfaces that glide smoothly against one another.\u00a0 When joints become inflamed, the joint swells and does not move smoothly.\u00a0 Over time, the gliding surface wears out.\u00a0 There are many types of arthritis.\u00a0 Rheumatoid arthritis is just one type.\u00a0\u00a0Wear and tear arthritis (osteoarthritis), gouty arthritis, and psoriatic arthritis are three other common types.\u00a0\u00a0 Rheumatoid Arthritis is considered a systemic disease.\u00a0 That is, it can affect many parts of the body.\u00a0\u00a0Patients often awaken with stiff and swollen joints.\u00a0\u00a0Early on, many patients feel tired.\u00a0\u00a0 Two thirds of patients with rheumatoid arthritis have wrist and hand problems.<\/p>\n

Rheumatoid Arthritis of the hand\u00a0<\/strong><\/h3>\n

Rheumatoid arthritis affects the cells that lubricate and line joints.\u00a0 This tissue \u2013 synovium- becomes inflamed and swollen.\u00a0 The swollen tissues stretch supporting structures of the joints such as ligaments and tendons.\u00a0\u00a0As the support structures stretch out, the joints become deformed and unstable.\u00a0 The joint cartilage and bone erode.\u00a0\u00a0Often the joints feel hot and look red.\u00a0\u00a0Rheumatoid arthritis of the hand is most common in the wrist and knuckles (see Figure 1).\u00a0 The disease is symmetric, thus what occurs in one hand usually occurs in the other.<\/p>\n

Signs and symptoms of rheumatoid arthritis of the hand<\/strong><\/h3>\n

While stiffness, swelling, and pain are symptoms common to all forms of arthritis, there are some symptoms that are classic features of rheumatoid arthritis.\u00a0 They are:<\/p>\n

\u2022\u00a0Firm nodules along fingers or the elbow
\n\u2022\u00a0Soft lump on the back of the hand that moves as the fingers straighten
\n\u2022\u00a0Angulation\u00a0 or collapse of fingers ( figure 2)
\n\u2022\u00a0Sudden inability to straighten or bend a finger because of a tendon rupture<\/p>\n

\u2022\u00a0Deformity in which the middle finger joint becomes bent ( Boutonniere deformity- figure 3)<\/p>\n

\u2022\u00a0Deformity\u00a0 where the end of the finger is bent and the middle joint over extends ( Swan-neck deformity- figure 3)<\/p>\n

\u2022\u00a0Prominent bones in the wrist<\/p>\n

In addition, patients with rheumatoid arthritis often have problems with numbness and tingling in their hand (carpal tunnel syndrome) because the swelling of the tendons causes pressure on the adjacent nerve.\u00a0 They may make a squeaky sound as they move joints (crepitus) and sometimes the joints snap or lock because of the swelling.<\/p>\n

How arthritis is diagnosed<\/strong><\/h3>\n

The diagnosis of rheumatoid arthritis is made based on clinical examination, x-rays, and lab tests.\u00a0\u00a0 Your doctor will ask questions about your symptoms and how the disease has affected your activities.\u00a0 Rheumatoid arthritis may have a hereditary component, thus your physician will ask whether other family members have had rheumatoid arthritis or symptoms similar to yours.\u00a0 Your doctor will do a detailed examination of your hands.\u00a0 The clinical appearance helps to diagnose the specific type of arthritis.\u00a0 X-rays are often helpful; certain findings are characteristic for rheumatoid arthritis.\u00a0 These findings include swelling of non-bony structures, joint space narrowing, decreased bone density, and erosions near joints.\u00a0 There are several blood tests that are often ordered to confirm the clinical diagnosis.\u00a0 These are the rheumatoid factor, sedimentation rate and sometimes the anti-CCP (cyclic citrullinated peptide).\u00a0 MRI- a special imaging study \u2013 has also been used to help confirm the diagnosis.<\/p>\n

Treatment of Rheumatoid Arthritis<\/strong><\/h3>\n

Treatment for rheumatoid arthritis aims to decrease inflammation, relieve pain and maintain function.\u00a0While there is no cure for rheumatoid arthritis, medications are available that slow the progression of the disease.\u00a0Optimal care involves a team approach among the patient, physicians, and therapists.\u00a0The care of the rheumatoid patient requires not only a hand surgeon but also a hand therapist, rheumatologist, and the patient\u2019s primary care physician.\u00a0\u00a0 The rheumatologist is often the physician that monitors and decides the specific type of medicine that is felt to be the most effective for the patient\u2019s stage in the disease process.
\nThe hand therapist will provide instruction on how to use your hands in ways that help relieve pain and protect joints.\u00a0 Therapists also can provide exercises, splints, and adaptive devices to help you cope with activities of daily living.<\/p>\n

Rheumatoid arthritis can be a progressive disease.\u00a0 Surgical interventions need to be appropriately timed in order to maximize function and minimize deformity.\u00a0In certain cases, preventive surgery may be recommended.\u00a0 Preventative surgery may include removing nodules, decreasing pressure on joints and tendons by removing inflamed tissue, or removing bone spurs that may rub on tendons or ligaments.\u00a0If a tendon ruptures, a hand surgeon may be able to repair the tendon with a tendon transfer or graft.<\/p>\n

There are several types of procedures to treat joints affected by rheumatoid arthritis, including removal of inflamed joint lining, joint replacements, and joint fusions.\u00a0The specific procedure(s) chosen depends on many factors.\u00a0These factors include the particular joints involved, the degree of damage present, and the condition of surrounding joints.<\/p>\n

One of the most important factors in deciding the most appropriate surgical procedure is the needs of the patient.\u00a0\u00a0There are often many ways to treat hand deformities in rheumatoid arthritis.\u00a0 Your hand surgeon can help you decide on the most appropriate treatment for you.<\/p>\n[vc_empty_space height=”10px”][vc_row_inner][vc_column_inner width=”1\/3″]\"\"<\/p>\n

Figure 1: Joints affected by rheumatoid arthritis<\/p>\n

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Figure 2: Drift of the fingers away from the thumb<\/p>\n

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Figure 3: Boutonni\u00e8re and swan-neck finger deformities<\/p>\n

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