How are deformities of the proximal interphalangeal joints managed surgically in patients with Rheumatoid arthritis?
Boutonnière deformities result from synovitis within the PIP joints, causing extensor tendon elongation and rupture, and leading to progressive flexion contractures. During early stages, synovectomy may be helpful.
Swan-neck deformities progress through four stages of deformity. During the first three stages, splinting, synovectomy, and surgical release of intrinsic muscle tightness and tendon adhesions are used. In the last stage, when the PIP joint is destroyed, surgical options include joint replacement or fusion.
In patients with destroyed PIP joints, total joint replacement is preferred for PIPs involved in grasping (third, fourth, and fifth PIPs), whereas fusion is used more for PIPs involved in pinch (thumb IP, second PIP).