Arthritic Hand and Wrist Reconstruction — Rheumatoid Arthritis, Osteoarthritis, CMC Arthritis, and Wrist Salvage

This episode reviews the core principles of arthritic hand and wrist reconstruction, focusing on the major differences between rheumatoid arthritis, osteoarthritis, inflammatory arthropathies, and surgical salvage strategies.Topics include the biology of rheumatoid arthritis as a systemic inflammatory disease of the synovium and tenosynovium, including pannus formation, ligament attenuation, marginal erosions, periarticular osteopenia, and the surgical principle that pain relief and function come before appearance. The episode also reviews perioperative RA management, including the 6-to-12 month optimization rule, coordination with rheumatology, and the principle that steroids and methotrexate usually stay while biologics take a break.Rheumatoid wrist and hand reconstruction are discussed through Caput syndrome, DRUJ instability, Vaughan-Jackson syndrome, Mannerfelt lesion, Darrach vs Sauvé-Kapandji, tendon transfers, total wrist arthrodesis, total wrist arthroplasty, silicone MCP arthroplasty, boutonnière deformity, swan-neck deformity, and rheumatoid carpal tunnel syndrome requiring open release and flexor tenosynovectomy.Osteoarthritis is reviewed as a mechanical wear problem, with emphasis on Heberden nodes, Bouchard nodes, DIP fusion, PIP arthroplasty vs fusion, thumb CMC arthritis, Eaton staging, LRTI / Burton-Pellegrini reconstruction, suspensionplasty, CMC arthrodesis, ST joint disease, and Z-deformity correction. Wrist salvage strategies include SLAC, SNAC, proximal row carpectomy, four-corner fusion, smoking-related nonunion risk, capitate cartilage quality, and the radiolunate joint as the key preserved articulation.Additional inflammatory arthropathies include psoriatic arthritis, arthritis mutilans, pencil-in-cup deformity, Jaccoud arthropathy in lupus, and scleroderma / CREST-related hand contractures, with emphasis on matching the operation to the underlying biology of the disease. Part of Dr. Lara’s Plastic Surgery Compendium — a high-yield audio reference for plastic surgery trainees and surgeons.DisclaimerThis podcast is intended for educational purposes only and is designed for medical students, residents, fellows, and practicing healthcare professionals. It is not intended to provide medical advice, diagnosis, or treatment for any individual patient. The content presented reflects general surgical principles and should not be used as a substitute for formal medical training, clinical judgment, or consultation with qualified healthcare professionals. Listening to this podcast does not establish a physician–patient relationship.SEO / Topic Keywordsarthritic hand reconstruction, rheumatoid arthritis hand, osteoarthritis hand, rheumatoid wrist, Caput syndrome, Vaughan-Jackson syndrome, Mannerfelt lesion, Darrach procedure, Sauvé-Kapandji procedure, rheumatoid tendon rupture, silicone MCP arthroplasty, boutonnière deformity, swan neck deformity, rheumatoid carpal tunnel syndrome, flexor tenosynovectomy, thumb CMC arthritis, basal joint arthritis, Eaton staging, LRTI, Burton-Pellegrini, trapeziectomy, suspensionplasty, ST joint arthritis, Z-deformity thumb, SLAC wrist, SNAC wrist, proximal row carpectomy, four-corner fusion, psoriatic arthritis hand, arthritis mutilans, Jaccoud arthropathy, scleroderma hand