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Synovitis and Tenosynovitis

Surgical tenosynovectomy is an established treatment that can increase tendon excursion and prevent extensor or flexor tendon rupture. Recurrence after tenosynovectomy is uncommon.[2]

Joint synovectomy of either the wrist or small joints of the hand may relieve symptoms, but may result in loss of motion and usually does not prevent disease progression.

Extensor Compartment Synovitis

Synovitis of the distal radioulnar joint (DRUJ) and dorsal compartment may coexist. Swelling of the DRUJ and prominence of the ulnar head has been called the caput ulnae syndrome; this can be effectively treated with resection of the distal ulna, called Darrach's procedure.[3]

As RA progresses, the carpus subluxates palmarly on the radius, resulting in a more prominent ulna dorsally (Fig. 23-17). The tendons on the dorsum of the hand are forced to glide along the more prominent and irregular ulnar head and become more attenuated, which, when combined with dorsal tenosynovitis, can lead to …