RA- THUMB

Question 1

3 main thumb deformities in RA

Answer 1

1. Boutonniere deformity
2. Swan neck deformity
3. Adduction contracture
   - affect hand function especially pinch grips x3

Question 2

3 goals for surgical management of thumb in RA

Answer 2

1. Pain relief
2. Mobile base
3. Stable post for pinch and grip

Question 3

Classification of thumb deformity in RA

Answer 3

Modified Nalebuff classification = clinical and radiographic classification with 6 types
Type I (most common) = boutonniere deformity
Type II = boutonniere deformity with CMC arthritis
Type III (2nd most common) = swan neck deformity with CMC arthritis
Type IV = gamekeeper's thumb (unstable joint)
Type V = swan neck deformity without CMC arthritis
Type VI = arthritis mutilans

Question 4

Preferred surgical options for thumb joints in RA

Answer 4

1. IPJ = arthrodesis
2. MPJ = arthrodesis or silicone arthroplasty
   - position of arthrodesis = thumb key pinch position (palmar abduction/ flexion/ pronation)
3. CMCJ = resection arthroplasty (trapezectomy)