Our Summary

This research paper is about a surgical method to reduce pain in a particular joint of the finger, often affected by severe inflammation or arthritis. The method involves removing inflamed tissue and any loose bodies in the joint. This procedure is particularly recommended for cases of persistent inflammation in rheumatoid arthritis, and early stages of primary and secondary degenerative arthritis.

However, there are certain cases where this procedure is not advised, like when there are certain deformities present, large cysts, advanced arthritis changes visible through imaging, unstable joints, or fresh skin injuries near the surgical site.

The surgical technique involves stretching the affected finger, filling the joint with a saline solution, and making two small incisions on the back of the joint. A small camera is then inserted for the surgeon to view the joint, and if the visibility is poor, they perform a ‘blind’ shave in the back of the joint. Once the inflamed tissue is removed, the incisions are closed and a soft dressing is applied.

After surgery, patients are encouraged to move their finger immediately to maintain full range of movement.

The research found that between 2009-2011, 91% of patients who had this surgery reported pain reduction and satisfaction with the operation. About half of the 22 patients had rheumatoid arthritis and the other half had degenerative arthritis. In total, 79% of patients with rheumatoid arthritis and 14% of those with degenerative arthritis were satisfied with the results. The researchers concluded that this procedure is effective for reducing pain and improving hand function in rheumatoid arthritis, but it is not generally recommended for degenerative arthritis, except in selected cases.

FAQs

  1. What is the main objective of arthroscopy in the affected proximal interphalangeal joint (PIP joint)?
  2. What conditions contraindicate arthroscopic PIP joint synovectomy?
  3. How successful was the arthroscopic PIP joint synovectomy in reducing pain and improving function in patients with rheumatoid arthritis and degenerative arthritis?

Doctor’s Tip

A helpful tip a doctor might tell a patient about arthroscopy for the PIP joint is to follow postoperative management guidelines carefully, including immediate mobilization for full range of finger movement. This can help promote healing and prevent stiffness in the joint. Additionally, it is important to keep the surgical site clean and protected with a soft padded dressing to reduce the risk of infection. Following these recommendations can aid in a successful recovery and optimal outcomes from the procedure.

Suitable For

Patients with therapy-resistant synovitis in rheumatoid arthritis (RA), early stage primary and secondary degenerative arthritis, loose bodies, capsular contracture are typically recommended for arthroscopy of the proximal interphalangeal (PIP) joint. However, patients with established biomechanic changes in RA (boutonniere and swanneck deformity), large dorsal synovial cysts, advanced radiologic changes in degenerative arthritis, joint instability, or fresh skin lesions near portals are contraindicated for this procedure.

Timeline

Before arthroscopy:

  1. Patient experiences therapy-resistant synovitis in rheumatoid arthritis (RA) or early stage primary and secondary degenerative arthritis.
  2. Patient may have loose bodies, capsular contracture, or other issues in the affected proximal interphalangeal joint (PIP joint).
  3. Patient may undergo diagnostic tests to determine the need for arthroscopy.
  4. Patient may have limitations in finger movement and experience pain in the affected joint.

After arthroscopy:

  1. Vertical traction of the affected finger is done in a Chinese finger trap or placed on a hand table.
  2. Joint is filled with Ringer solution and radial and ulnar dorsal portals are created for arthroscopy.
  3. Synovectomy, loose body extraction, and dorsal arthrolysis are performed with a 1.9 mm arthroscope and 2.0 mm shaver.
  4. Portals are closed and a soft padded dressing is applied.
  5. Immediate postoperative mobilization for full range of finger movement is recommended.
  6. Patients may experience pain reduction and functional improvement in the affected hand, especially in RA patients.
  7. Follow-up appointments may be scheduled to monitor progress and address any concerns.

What to Ask Your Doctor

  1. What is the specific reason for recommending arthroscopy for my PIP joint?
  2. Are there any alternative treatments or procedures that I should consider before proceeding with arthroscopy?
  3. What are the potential risks and complications associated with arthroscopy of the PIP joint?
  4. What is the expected recovery time and rehabilitation process after arthroscopy?
  5. Will I need any additional treatments or therapies following the arthroscopy?
  6. How successful is arthroscopic PIP joint synovectomy in reducing pain and improving function, especially in cases of rheumatoid arthritis?
  7. How many arthroscopic PIP joint synovectomy procedures have you performed, and what is your success rate?
  8. Are there any specific postoperative instructions or precautions I should follow to ensure the best possible outcome?
  9. What are the long-term benefits or outcomes I can expect from arthroscopy of the PIP joint?
  10. Are there any specific factors or conditions that may affect the effectiveness of arthroscopy in my case?

Reference

Authors: Borisch N. Journal: Oper Orthop Traumatol. 2017 Aug;29(4):353-359. doi: 10.1007/s00064-017-0506-8. Epub 2017 Jun 12. PMID: 28608150