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Principles of upper limb surgery 

Principles of upper limb surgery
Principles of upper limb surgery
Oxford Textbook of Rheumatology (4 ed.)

Ian McNab

and Chris Little


Reconstructive surgery should be undertaken before the patient becomes severely incapacitated. The patient should be as fit as possible, with synovitis under good control with no evidence of sepsis. Active disease or glucocorticoid therapy are not contraindications to surgery. Shoulder surgery: Pain from synovitis of the acromioclavicular localizes to the joint and responds to intra-articular steroid or arthroscopic excision of the lateral clavicle. Pain from glenohumeral disease that does not improve with articular injections is helped by humeral head replacement, but glenoid bone loss generally makes glenoid resurfacing inadvisable. Rotator cuff impingement and tears that do not respond to injections and capsular control exercises are best treated by arthroscopic subacromial decompression and debridement. Elbow surgery: Arthroplasty will usually remove pain and improve function, particularly in the flail elbow, but carries increased surgical risks and a higher likelihood of loosening than other large-joint replacements; lifting should be restricted in the long term. Nerve compression around the elbow is common, but often relatively asymptomatic. Olecranon bursal excision surgery is usually avoided because of the low but significant risks of problems with wound healing. Hand and wrist surgery: if hand function and pain continue to deteriorate despite maximal medical therapy, surgical intervention is indicated.

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