Rheumatoid Hand Surgery: Reconstruction of a Musician’s Hand

Abstract

Background: Reconstructive hand surgery is well established for the management of patients with rheumatoid arthritis; however, with the advent of biologic drugs and methotrexate, disease activity, including the development of hand deformities, is well controlled. Nonetheless, many patients still need personalized surgery. Case: A 61-year-old woman with a 35-year history of rheumatoid arthritis presented with right hand deformity with unstable ulnar deviation of the metacarpophalangeal joints from the index to the little finger and hyperextension of the thumb interphalangeal joint. Her hobby was playing the erhu (a traditional two-stringed bowed Chinese instrument) and she wanted to improve her ability to hold the bow. To play the erhu, the tip of the thumb must touch the index finger to make a circle, and the other fingers must keep the bow horizontal and adjust the tension of the bow hair. We carried out thumb interphalangeal joint arthrodesis, little finger metacarpophalangeal joint arthrodesis, and transfer of the fourth dorsal interosseous muscle to the little finger. After 2 months of rehabilitation, the patient could hold the bow between the thumb and index fingers and adjust the string tension with the middle and ring fingers. Additionally, she could use chopsticks and pens more naturally. Discussion: Each patient with hand deformity resulting from burnt-out rheumatoid arthritis has a variety of demands for restoring hand function, depending on their personal needs. Individual treatment plans must be established through discussions among the patient, hand therapist, and surgeon based on the status of the hand and the patient’s needs.