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Arthritis und Rheuma 2024; 44(04): 244-254
DOI: 10.1055/a-2279-6187
Schwerpunkt

Therapeutische Fenster in der Orthopädischen Rheumatologie: die ulnare Deviation der Langfinger

Wann, was, wie und dann?
Carina Eva Maria Pothmann
1   St. Josef-Stift Sendenhorst, Orthopädisches Kompetenzzentrum, Rheumatologisches Kompetenzzentrum Nordwestdeutschland, Endoprothesenzentrum Münsterland, Klinik für Rheumaorthopädie
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ZUSAMMENFASSUNG

Die Ulnardeviation der Langfinger ist eine häufige rheuma-orthopädische Herausforderung. Durch den entzündlichen, oft auch ossär destruktiven Gelenkbefall resultiert eine Instabilität mit folgender Abweichung der Finger in Richtung der Ulna. Dies führt zu einem meist schmerzhaften, konsekutiven Funktionsverlust mit deutlicher Einschränkung der Lebensqualität bis hin zur Autonomie der Betroffenen. Die Behandlung dieser Deformität ist komplex und erfordert ein tiefes Verständnis der Pathophysiologie sowie der therapeutischen Optionen. Diese Arbeit soll den Lesern als Information und Leitfaden zur Detektion des therapeutischen Fensters und somit zeit- und symptomgerechten Behandlung ihrer Patienten dienen.

Schlüsselwörter

Rheumatische Hand - Ulnardeviation - Rheuma - Arthritis - Arthroplastik


Publication History

Article published online:
06 September 2024

© 2024. Thieme. All rights reserved.

Georg Thieme Verlag KG
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  • Literatur

  • 1 Bielefeld T, Neumann DA. The unstable metacarpophalangeal joint in rheumatoid arthritis: anatomy, pathomechanics, and physical rehabilitation considerations. J Orthop Sports Phys Ther 2005; 35 (08) 502-520
    CrossrefPubMedSearch in Google Scholar
  • 2 Read GO, Solomon L, Biddulph S. Relationship between finger and wrist deformities in rheumatoid arthritis. Ann Rheum Dis 1983; 42 (06) 619-625
    CrossrefPubMedSearch in Google Scholar
  • 3 Johnsson PM, Eberhardt K. Hand deformities are important signs of disease severity in patients with early rheumatoid arthritis. Rheumatology (Oxford) 2009; 48 (11) 1398-1401
    CrossrefPubMedSearch in Google Scholar
  • 4 Horsten NC, Ursum J, Roorda LD. et al Prevalence of hand symptoms, impairments and activity limitations in rheumatoid arthritis in relation to disease duration. J Rehabil Med 2010; 42 (10) 916-921
    CrossrefPubMedSearch in Google Scholar
  • 5 Subhedar VY. A new surgical procedure for correction of ulnar deviation of fingers in rheumatoid arthritis. Rheumatol Rehabil 1973; 12 (02) 89-92
    CrossrefPubMedSearch in Google Scholar
  • 6 Lindqvist E, Jonsson K, Saxne T, Eberhardt K. Course of radiographic damage over 10 years in a cohort with early rheumatoid arthritis. Ann Rheum Dis 2003; 62 (07) 611-616
    CrossrefPubMedSearch in Google Scholar
  • 7 Wigzell FW. Ulnar deviation of the fingers as a clinical sign in the elderly. Age Ageing 1976; 05 (03) 132-140
    CrossrefPubMedSearch in Google Scholar
  • 8 Fearnley GR. Ulnar deviation of the fingers. Ann Rheum Dis 1951; 10 (02) 126-136
    CrossrefPubMedSearch in Google Scholar
  • 9 Towheed TE, Anastassiades TP. Rheumatoid hand. Practical approach to assessment and management. Can Fam Physician 1994; 40: 1303-1309
    PubMedSearch in Google Scholar
  • 10 Pothmann CEM, Koch R, Bause L.. Hilfsmittel im Alltag für die rheumatische Hand – packen wir es an! arthritis und rheuma. 2023; 43 (02) 89-99
    PubMedSearch in Google Scholar
  • 11 Smith RJ, Kaplan EB. Rheumatoid deformities at the metacarpophalangeal joints of the fingers. J Bone Joint Surg Am 1967; 49 (01) 31-47
    CrossrefPubMedSearch in Google Scholar
  • 12 Backhouse KM. The mechanics of normal digital control in the hand and an analysis of the ulnar drift of rheumatoid arthritis. Ann R Coll Surg Engl 1968; 43 (03) 154-173
    PubMedSearch in Google Scholar
  • 13 Flatt AE. Ulnar drift. J Hand Ther 1996; 09 (04) 282-292
    CrossrefPubMedSearch in Google Scholar
  • 14 Neumann DA.. Kinesiology of the musculoskeletal system : foundations for physical rehabilitation, 1st edition. St. Louis: Mosby; 2002
    Search in Google Scholar
  • 15 Shapiro JS, Heijna W, Nasatir S, Ray RD. The relationship of wrist motion to ulnar phalangeal drift in the rheumatoid patient. Hand 1971; 03 (01) 68-75
    CrossrefPubMedSearch in Google Scholar
  • 16 Rehart S, Henniger M. Veränderungen an der Hand bei Erkrankungen aus dem rheumatischen Formenkreis. In: Handchirurgie. Berlin: Springer; 2011
    Search in Google Scholar
  • 17 van Vugt RM, van Jaarsveld CH, Hofman DM. et al Patterns of disease progression in the rheumatoid wrist: a long-term followup. J Rheumatol 1999; 26 (07) 1467-1473
    PubMedSearch in Google Scholar
  • 18 Marmor L. RHEUMATOID ARTHRITIS-Operations on the Hand for Improvement of Function. Calif Med 1963; 98 (01) 35-36
    PubMedSearch in Google Scholar
  • 19 Eberhardt K, Sandqvist G, Geborek P. Hand function tests are important and sensitive tools for assessment of treatment response in patients with rheumatoid arthritis. Scand J Rheumatol 2008; 37 (02) 109-112
    CrossrefPubMedSearch in Google Scholar
  • 20 Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 1977; 18 (04) 481-491
    CrossrefPubMedSearch in Google Scholar
  • 21 Park JW, Hwang JS, Gong HS. Rheumatoid Hand Surgery in the Era of Biologic Therapy: A Rheumatologist-oriented Overview. J Rheum Dis 2021; 28 (04) 192-201
    CrossrefPubMedSearch in Google Scholar
  • 22 Rehim SA, Chung KC. Applying evidence in the care of patients with rheumatoid hand and wrist deformities. Plast Reconstr Surg 2013; 132 (04) 885-897
    CrossrefPubMedSearch in Google Scholar
  • 23 Chung KC, Pushman AG. Current concepts in the management of the rheumatoid hand. J Hand Surg Am 2011; 36 (04) 736-747 quiz 747
    CrossrefPubMedSearch in Google Scholar
  • 24 Johns Hopkins Arthritis Center. Im Internet. https://www.hopkinsarthritis.org/arthritis-info/rheumatoid-arthritis/ra-treatment/ Stand: 24. April 2024
  • 25 Gibofsky A. Combination therapy for rheumatoid arthritis in the era of biologicals. HSS Journal 2006; 02 (01) 30-41
    CrossrefPubMedSearch in Google Scholar
  • 26 Schett G, Stach C, Zwerina J. et al How antirheumatic drugs protect joints from damage in rheumatoid arthritis. Arthritis & Rheumatism 2008; 58 (10) 2936-2948
    CrossrefPubMedSearch in Google Scholar
  • 27 Lard LR, Visser H, Speyer I. et al Early versus delayed treatment in patients with recent-onset rheumatoid arthritis: comparison of two cohorts who received different treatment strategies. The Am J Med 2001; 111 (06) 446-451
    CrossrefPubMedSearch in Google Scholar
  • 28 Ghattas L, Mascella F, Pomponio G. Hand surgery in rheumatoid arthritis: state of the art and suggestions for research. Rheumatology (Oxford) 2005; 44 (07) 834-845
    CrossrefPubMedSearch in Google Scholar
  • 29 Alderman AK, Chung KC, Kim HM. et al Effectiveness of rheumatoid hand surgery: contrasting perceptions of hand surgeons and rheumatologists. J Hand Surg Am 2003; 28 (01) 3-11 discussion 12–13
    CrossrefPubMedSearch in Google Scholar
  • 30 Callinan NJ, Mathiowetz V. Soft versus hard resting hand splints in rheumatoid arthritis: pain relief, preference, and compliance. Am J Occup Ther 1996; 50 (05) 347-353
    CrossrefPubMedSearch in Google Scholar
  • 31 Stamm TA, Machold KP, Smolen JS. et al Joint protection and home hand exercises improve hand function in patients with hand osteoarthritis: a randomized controlled trial. Arthritis Rheum 2002; 47 (01) 44-49
    CrossrefPubMedSearch in Google Scholar
  • 32 Chung KC, Kotsis SV, Kim HM. et al Reasons why rheumatoid arthritis patients seek surgical treatment for hand deformities. J Hand Surg Am 2006; 31 (02) 289-294
    CrossrefPubMedSearch in Google Scholar
  • 33 Bogoch ER, Escott BG, Ronald K. Hand appearance as a patient motivation for surgery and a determinant of satisfaction with metacarpophalangeal joint arthroplasty for rheumatoid arthritis. J Hand Surg Am 2011; 36 (06) 1007–1014 e1-4
    CrossrefPubMedSearch in Google Scholar
  • 34 Pahle JA, Raunio P. The influence of wrist position on finger deviation in the rheumatoid hand. A clinical and radiological study. J Bone Joint Surg Br 1969; 51 (04) 664-676
    CrossrefPubMedSearch in Google Scholar
  • 35 Hentz VR, Chase RA. Hand Surgery: A Clinical Atlas. Philadelphia, PA: W. B. Saunders; 2001
    Search in Google Scholar
  • 36 Flatt AE. The Care of the Rheumatoid Hand. St. Louis: Mosby Comp; 1974
    Search in Google Scholar
  • 37 Wolfe SW, Pederson WC, Kozin SH, Cohen MS. Green’s Operative Hand Surgery. 8th ed. New York, NY: Elsevier; 2021
    Search in Google Scholar
  • 38 Mackin E, Callahan AD, Skirven TM. et al Rehabilitation of the Hand and Upper Extremity. St. Louis: Mosby; 2002
    Search in Google Scholar
  • 39 Ellison MR, Kelly KJ, Flatt AE. The results of surgical synovectomy of the digital joints in rheumatoid disease. J Bone Joint Surg Am 1971; 53 (06) 1041-1060
    CrossrefPubMedSearch in Google Scholar
  • 40 Towfigh H, Hierner R, Langer M, Friedel R. Handchirurgie. Berlin, Heidelberg: Springer; 2011
    CrossrefSearch in Google Scholar
  • 41 Ellison MR, Flatt AE, Kelly KJ. Ulnar drift of the fingers in rheumatoid disease. Treatment by crossed intrinsic tendon transfer. J Bone Joint Surg Am 1971; 53 (06) 1061-1082
    CrossrefPubMedSearch in Google Scholar
  • 42 Straub LR. Surgery of the arthritic hand. West J Surg Obstet Gynecol 1960; 68: 5-10
    PubMedSearch in Google Scholar
  • 43 Pechlaner S, Kerschbaumer F, Hussl H. Atlas of Hand Surgery. Stuttgart: Thieme; 2020
    Search in Google Scholar
  • 44 Trumble TE, Rayan GM, Baratz ME. et al Principles of Hand Surgery and Therapy. Philadelphia, PA: Elsevier – Health Sciences Division; 2016
    Search in Google Scholar
  • 45 Chung KC, Burns PB, Kim HM. et al Long-term followup for rheumatoid arthritis patients in a multicenter outcomes study of silicone metacarpophalangeal joint arthroplasty. Arthritis care & research 2012; 64 (09) 1292-1300
    CrossrefPubMedSearch in Google Scholar
  • 46 Swanson A, Swanson GD, Leonard J. Postoperative rehabilitation programs in flexible implant arthroplasty of the digits. Rehabilitation of the Hand: surgery and therapy 1995; 02: 1351-1376
    Search in Google Scholar
  • 47 Straub LR, Ranawat CS. The wrist in rheumatoid arthritis. Surgical treatment and results. J Bone Joint Surg Am 1969; 51 (01) 1-20
    CrossrefPubMedSearch in Google Scholar
  • 48 Taleisnik J, Ruby LK. Arthritis Deformity: Resection Arthroplasty and Fusion. In: Cooney WP, Linscheid RL, Dobyns JH, eds. The Wrist. Vol. 2. St. Louis: Mosby; 1998
    Search in Google Scholar
  • 49 Fakunle OP, DeMaio EL, Spencer CC. et al A Systematic Review of Radiolunate and Radioscapholunate Arthrodesis. J Hand Surg Glob Online 2021; 03 (02) 81-87
    CrossrefPubMedSearch in Google Scholar
  • 50 Chamay A, Della Santa D, Vilaseca A. Radiolunate arthrodesis. Factor of stability for the rheumatoid wrist. Ann Chir Main 1983; 02 (01) 5-17
    Search in Google Scholar
  • 51 Masuko T, Iwasaki N, Ishikawa J-I. et al Radiolunate fusion with distraction using corticocancellous bone graft for minimizing decrease of wrist motion in rheumatoid wrists. Hand Surg 2009; 14 (01) 15-21
    CrossrefPubMedSearch in Google Scholar
  • 52 Ishikawa H, Hanyu T, Tajima T. Rheumatoid wrists treated with synovectomy of the extensor tendons and the wrist joint combined with a Darrach procedure. J Hand Surg Am 1992; 17 (06) 1109-1117
    CrossrefPubMedSearch in Google Scholar
  • 53 Lee SK, Hausman MR. Management of the distal radioulnar joint in rheumatoid arthritis. Hand Clin 2005; 21 (04) 577-589
    CrossrefPubMedSearch in Google Scholar
  • 54 Trieb K. Arthrodesis of the wrist in rheumatoid arthritis. World J Orthop 2014; 05 (04) 512-515
    CrossrefPubMedSearch in Google Scholar
  • 55 Mannerfelt L, Malmsten M. Arthrodesis of the wrist in rheumatoid arthritis: a technique without external fixation. Scandinavian Journal of Plastic and Reconstructive Surgery 1971; 05 (02) 124-130
    CrossrefPubMedSearch in Google Scholar
  • 56 Clayton ML, Smyth CJ. Surgery for Rheumatoid Arthritis: A Comprehensive Team Approach. Edinburgh, Schottland: Churchill Livingstone; 1992
    Search in Google Scholar
  • 57 Müller ME, Schneider R, Willenegger H. Manual der Osteosynthese: AO-Technik. Berlin: Heidelberg Springer; 2013
    Search in Google Scholar
  • 58 Levignac J, Heim J, Berge M. Place and limits of surgery: development of esthetic concepts. Bulletin de L’academie Nationale de Chirurgie Dentaire (1983) 1982; 28: 53-68
    PubMedSearch in Google Scholar
  • 59 Larsson S-E. Compression Arthrodesis of the Wrist: A Consecutive Series of 23 Cases. Clinical Orthopaedics and Related Research (1976–2007) 1974; 99: 146-153
    CrossrefPubMedSearch in Google Scholar
  • 60 Brumfield RH, Champoux JA. A biomechanical study of normal functional wrist motion. Clin Orthop Rel Res 1984; 187: 23-25
    CrossrefSearch in Google Scholar
  • 61 Rayan GM, Brentlinger A, Purnell D, Garcia-Moral CA. Functional assessment of bilateral wrist arthrodeses. The Journal of hand surgery 1987; 12 (06) 1020-1024
    CrossrefPubMedSearch in Google Scholar
  • 62 Clayton ML, Ferlic DC. Arthrodesis of the arthritic wrist. Clin Orthop Rel Res 1984; 187: 89-93
    CrossrefSearch in Google Scholar