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Surgery in patients with systemic sclerosis (scleroderma) of the hand

Author
Edward A Nalebuff, MD
Section Editor
John S Axford, DSc, MD, FRCP, FRCPCH
Deputy Editor
Monica Ramirez Curtis, MD, MPH

INTRODUCTION

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 [1]. 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 [2]:

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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Literature review current through: Nov 2016. | This topic last updated: Tue Jul 19 00:00:00 GMT+00:00 2016.
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References
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  1. Melvin JL. Scleroderma (systemic sclerosis): Treatment of the hand. In: Rehabilitation of the Hand: Surgery and Therapy, Hunter J, Macklin E, Callahan A (Eds), Mosby, New York 1995. Vol 2, p.1385.
  2. Bogoch ER, Gross DK. Surgery of the hand in patients with systemic sclerosis: outcomes and considerations. J Rheumatol 2005; 32:642.
  3. Kimball HL, Nalebuff EA. Unusual Arthridities. In: Arthritis of the Hand and Upper Extremity, Master Skills Publication, 2011.
  4. Bennett RM. Mixed connective tissue disease and other overlap syndromes. In: Textbook of Rheumatology, 2nd, Kelley WN, Harris ED, Ruddy S, et al (Eds), WB Saunders, Philadelphia 1985. p.1115.
  5. Feldon P, Millender L, Nalebuff E. Rheumatoid arthritis in the hand and wrist. In: Operative Hand Surgery, 3rd, Green DP (Ed), Churchill Livingstone, New York 1993. p.1586.
  6. Ward WA, Van Moore A. Management of finger ulcers in scleroderma. J Hand Surg Am 1995; 20:868.
  7. Jones NF, Imbriglia JE, Steen VD, Medsger TA. Surgery for scleroderma of the hand. J Hand Surg Am 1987; 12:391.
  8. Jones NF, Raynor SC, Medsger TA. Microsurgical revascularisation of the hand in scleroderma. Br J Plast Surg 1987; 40:264.
  9. Hussmann J, Russell RC, Kucan JO, et al. Soft-tissue calcifications: differential diagnosis and therapeutic approaches. Ann Plast Surg 1995; 34:138.
  10. Lapner MA, Goetz TJ. High-speed burr debulking of digital calcinosis cutis in scleroderma patients. J Hand Surg Am 2014; 39:503.
  11. Norris RW, Brown HG. The proximal interphalangeal joint in systemic sclerosis and its surgical management. Br J Plast Surg 1985; 38:526.
  12. Lipscomb PR, Simons GW, Winkelmann RK. Surgery for sclerodactylia of the hand. Experience with six cases. J Bone Joint Surg Am 1969; 51:1112.
  13. Finch MB, Dawson J, Johnston GD. The peripheral vascular effects of nifedipine in Raynaud's syndrome associated with scleroderma: a double blind crossover study. Clin Rheumatol 1986; 5:493.
  14. Flatt AE. Digital artery sympathectomy. J Hand Surg Am 1980; 5:550.
  15. Wilgis EF. Digital sympathectomy for vascular insufficiency. Hand Clin 1985; 1:361.
  16. Melone CP Jr, McLoughlin JC, Beldner S. Surgical management of the hand in scleroderma. Curr Opin Rheumatol 1999; 11:514.
  17. Fox P, Chung L, Chang J. Management of the hand in systemic sclerosis. J Hand Surg Am 2013; 38:1012.
  18. Kotsis SV, Chung KC. A systematic review of the outcomes of digital sympathectomy for treatment of chronic digital ischemia. J Rheumatol 2003; 30:1788.