Inflammatory arthritis Discussion

In the upper extremity, systemic inflammatory arthritis results in a variety of problems. Joint problems include stiffness, instability, unnatural angulation and deformity. Tendons involvement may take the form of tendinitis, triggering and tendon rupture. Nerve compression syndromes and weakness are common. Conservative management includes medications, cortisone injections, adaptive devices and education regarding joint and skin protection. Prophylactic surgery may be indicated to prevent tendon rupture if tendinitis fails to respond to conservative management. Otherwise, surgery is indicated on a highly individualized basis to correct specific complications of the disease process. Synovectomy, joint replacement or fusion, tendon transfer and nerve decompression are all common components of reconstructive surgery for this disorder. After surgery, patients with systemic inflammatory disorders are at particular risk for problems due to poor wound healing. Postoperative therapy is essential for most procedures, often for prolonged periods. Multiple operations may be needed, and prognosis is always guarded.

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