Surgery in patients with systemic sclerosis (scleroderma) of the hand
- Edward A Nalebuff, MD
Edward A Nalebuff, MD
- Clinical Professor of Orthopedics
- Tufts University School of Medicine
Patients with systemic sclerosis can experience significant pain and functional loss in affected hands. They are ideally treated by a team that includes a rheumatologist, a hand therapist, and a hand surgeon . Initially, every effort is made to preserve function and to regain motion nonsurgically. This is done by mobilizing tissues, using exercises to increase range of motion, and using appropriate splinting.
However, selected surgery may be helpful in relieving pain and in restoring function. Examples of problems for which surgery may be indicated, as well as the types of procedure, include the following :
●Calcinosis may be treated by excision or curettage.
●Interphalangeal (IP) joint fusions and metacarpophalangeal joint replacements may correct severe flexion deformities and may improve grasp.
●Sympathectomy or vein bypass grafting may improve circulation to ischemic digits.
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- DEFORMITY PATTERNS
- Proximal interphalangeal joint flexion contracture
- Proximal interphalangeal hyperextension
- Contracture between thumb and index finger
- SURGICAL TREATMENT
- Skin ulcerations
- - Finger tips
- - Proximal interphalangeal and metacarpophalangeal joints
- Calcinosis cutis
- Finger and thumb deformities
- - Distal interphalangeal joint
- - Proximal interphalangeal joint
- - Metacarpophalangeal joint
- - First web space
- Digital ischemia
- SUMMARY AND RECOMMENDATIONS