In the RA-afflicted hand, rupture of the extensor tendon is frequently seen, especially in the advanced stage of RA-afflicted wrist joints. Since 1983, this had been operated on in 22 afflicted hands of 20 patients in the author's department, and a follow-up study of these cases was performed.
All 2 0 patients had classical RA according to ARA criteria and 17 of them were female. Ages ranged from 46 to 78 years with an average of 60.3 years. The duration of the disease was from 9 months to 20 years with an average of 8 years. Rupture of the EPL tendon occurred in 3 hands, that of the Index-E.D.C., E.I.P. in 2 hands, that of the ring finger-E.D.C. in 6 hands, that of the ring finger-E.D.C. in 16 hands, and that of the little finger-E.D.C., EDM in 18 hands. The right hand was operated on in 14 patients and the left hand in 7. The interval between the time of rupture and the time of surgery was about 4 weeks in the majority of cases.
Surgical procedures included bridge tendon graft in 16 hands, tendon transfer in 4, and end-to-side suture in 3. Synovectomy of the wrist joint and the peritenon was performed together with resectioning of the distal end of the ulna in all patients except for the 3 with ruptured EPL. The palmaris longus tendon was mainly used for the tendon graft.
The follow-up period ranged from 4 months to 5 years, 5 months, with an average duration of 2 years, 5 months. At the follow-up, the range of motion of the MP joint was measured. Most patients were satisfied with post-operative results except those with end-to-side suture, in which marked limitation of the flexion of little fingers took place.
It is suggested that when the extensor tenosynovitis is remarkable with dorsal dislocation of the distal ulna end, prophylactic synovectomy of the digital extensor tendons and wrist joint, along with resectioning of the distal ulna end, is necessary to obtain satisfactory and durable postoperative results.
