HANDS IN RHEUMATOID ARTHRITIS

In all patients with rheumatoid arthritis, the wrists are affected. In fact, if the wrists do not appear to be involved, I would not diagnose a person as having RA. The knuckles and the middle finger joints are’ usually involved on both hands. Some changes that may occur in the hands include what doctors call ulnar deviation, which is the bending of the fingers toward the outer part of the arm (where the ulnar bone is located). The so-called “swan-neck deformity” is very typical in hands affected by rheumatoid arthritis. Here, the middle joint of the finger bends down and the joint nearest the tip of the finger bends up, giving the finger the appearance of a swan’s neck. This deformity is very typical of the rheumatoid hand. The hand can also have what are called “boutonniere deformities,” in which the middle finger joint pops up, resembling a boutonniere.

Swelling of the various ligaments around the wrist can result in trapped nerve syndromes like carpal tunnel syndrome, where the median nerve that goes through a closed space into the wrist is compressed. Another syndrome, also the result of nerve entrapment, is ulnar-nerve compression syndrome at the elbow. This causes extreme weakness of the pinky finger.

Sometimes rheumatoid nodules form on the tendons of the hands and may rupture. Tenosynovitis, inflammation of the tendons and the linings of the joint and tendon spaces, can also affect the hands. This can result in a rupture of the tendons and loss of mobility of fingers or, in severe cases, of the entire hand.

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