Dear Dr. Winder:
Q. My wife has rheumatoid arthritis in her hands and has been reluctant about considering surgery. She's in her late 50's and she even has trouble opening a zip-lock bag. I know we have many wonderful years ahead of us . . . what could you offer her?

A. Rheumatoid arthritis begins to affect many people in their late 40's and 50's, and gets progressively worse as they get older. The rheumatoid diseases that affect the hands all have varying degrees of symptoms; loss of mobility and function, deformity, pain and stiffness, as well as deterioration. Rheumatoid disease changes the finger joints into an aggressive, expanding, tumor-like mass of tissue. The mass is capable of penetrating tendons, ligaments or bone and the destruction of cartilage. Non-operative treatments are great during the period just after the onset of the disease. However, more often than not, depending upon the severity of the disease, surgery is recommended in order to restore some or most of the hands' mobility. The success rate for hand procedures is quite high and generally more successful than the alternative non-operative treatments. Surgery is not a "cure", but it can alleviate symptoms, correct deformities and restore function. Some of the more common procedures are joint replacement, tendon transfers and arthroplasty. Tendon transfers are common because as the tumor-like mass grows, it affects the tendons that allow mobility; this restricts movement and ultimately deforms the shape of the fingers. Joint replacement or "arthroplasty" simply means reconstruction or prosthetic replacement of a joint that is malformed. A careful assessment, by a Board Certified Plastic Surgeon with extensive hand surgery experience, of the mechanical inabilities of the hand is essential to determine the appropriate surgical course.

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