Rheumatic hand


 *  ' Rheumatoid polyarthritis in the hand area:'  involvement synovia joint of the wrist, MCP and PIP + synovial tendon (systemic inflammatory disease affecting all synovial tissue),
 * hands deformed while inshape (ulnar deviation of fingers + volar subluxation in MCP joints, flexion contractures of the thumbs, deformities such as swan neck or button-shaped fingers), the disease was accompanied from the beginning by severe pain,
 * movement restricted gradually,
 *  'rheumatic wrist:'  pain localized to the head area ulny - local synovectomy + extirpation of the ulna head leads to the disappearance of pain,
 * involvement of tendon sheaths may precede months before symptoms of joint involvement,


 * * hypertrophic synovialis produces proteolytic enzymes → catabolic changes in the tendon,
 * * tendon sheaths most often affected on the wrist and palm side of the fingers,
 * * tendon ruptures may occur due to abrasion of the bone (mainly in the distal end of the ulna), direct invasion of the tenosynnovium on the tendon, ischemic necrosis,


 * MCP joints key to finger function


 * * the damaged MCP joint is affected by wrist deformity, forces of flexors + extensors, dysbanlation of mm

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