Rheumatoid Arthritis
Hand & Wrist Surgery
Jacksonville, FL
Rheumatoid arthritis destroys joint cartilage and erodes tendons over time — producing deformity, instability, and pain that medications alone cannot always address. Dr. R. David Graham at JOI manages the full spectrum of RA surgical reconstruction: synovectomy, tendon repair and transfer, MCP joint arthroplasty, and wrist fusion or arthroplasty. The rheumatologist manages the disease. Dr. Graham manages what the disease has done to the joints and tendons.
- Synovectomy — removal of inflamed synovium before joint destruction occurs
- Tendon repair and transfer — ruptured extensor tendons from synovial erosion
- MCP arthroplasty — silicone implants to restore knuckle alignment and function
- Wrist fusion or arthroplasty — for advanced RA wrist disease
- Rheumatologist manages the disease; Dr. Graham manages the reconstruction
- Timing of surgery coordinated with rheumatologist re: biologic medications
RA hand surgery is reconstructive surgery. The goal is restoring function and reducing pain in joints and tendons that have been damaged by chronic inflammation. Surgery does not treat the underlying disease — that is the rheumatologist's role.
When RA Requires Surgery
Reconstructing What Rheumatoid
Arthritis Has Damaged
Rheumatoid arthritis is a systemic autoimmune disease — the immune system attacks the synovial lining of joints, producing chronic inflammation that erodes cartilage, destroys bone, and weakens tendons over time. Modern biologic medications have dramatically slowed this progression for many patients. But even with optimal medical management, some patients develop joint destruction and tendon rupture that requires surgical correction.
The most common RA surgical problems in the hand and wrist are: tenosynovitis (inflamed tendon sheaths that restrict motion and can rupture tendons), extensor tendon ruptures from synovial erosion at the wrist (Vaughan-Jackson syndrome — ulnar extensor tendons rupture first), MCP joint destruction producing ulnar drift deformity, and wrist joint destruction producing carpal collapse and pain.
Dr. Graham manages the full surgical reconstruction spectrum for RA hand and wrist disease. The approach is always collaborative — the rheumatologist optimizes medical management, and surgery is planned with awareness of immunosuppressive medications (particularly biologics, which are typically held peri-operatively to reduce infection risk).
- ✓ Synovectomy — before tendon rupture or joint destruction; reduces synovial burden
- ✓ Extensor tendon repair/transfer — for Vaughan-Jackson ruptures; transfer from intact radial tendons
- ✓ MCP arthroplasty — silicone implants for advanced knuckle destruction and ulnar drift
- ✓ Wrist fusion — reliable pain relief for advanced RA wrist; motion sacrificed for stability
- ✓ Wrist arthroplasty — motion-preserving option in appropriate RA patients
- ✓ Distal ulna resection (Darrach) — for DRUJ synovitis and caput ulnae
Surgical Options
Staged and Prioritized Reconstruction
Scroll the table sideways to see all columns
| Problem | Timing | Dr. Graham's Approach |
|---|---|---|
| Tenosynovitis | Before rupture — proactive | Synovectomy to reduce synovial load on tendons. Prevents the rupture that requires more complex reconstruction later. |
| Extensor tendon rupture (Vaughan-Jackson) | Urgent — within weeks | Transfer intact radial-side extensor tendons (EDC, EIP) to the ruptured ulnar tendons. End-to-side or end-to-end repair depending on available donors. |
| MCP destruction + ulnar drift | When deformity limits function | MCP arthroplasty with silicone implants (Swanson or NeuFlex). Corrects ulnar drift, restores extension, improves pinch and grip. Intrinsic rebalancing performed at same setting. |
| Wrist joint destruction | When pain limits function despite medical management | Total wrist fusion (most reliable for RA) or total wrist arthroplasty (motion-preserving in appropriate patients). Distal ulna resection (Darrach) for DRUJ disease — frequently performed concurrently. |
| Caput ulnae / DRUJ synovitis | Before extensor tendon rupture | Darrach procedure (distal ulna resection) removes the bony prominence that erodes ulnar extensor tendons from below. Combined with synovectomy when tendon erosion is identified early. |
FAQs
Frequently Asked Questions
Related Conditions
Next Steps
RA deformity or tendon rupture
— surgical reconstruction is available.
RA hand surgery produces meaningful functional improvement. The evaluation starts with X-rays and a thorough exam — Dr. Graham will assess what has been damaged and discuss the options specifically tailored to your situation.
Jacksonville Beach, FL 32250
No imaging required.