The wrist is the key joint for hand function and is also a key area for rheumatoid arthritic involvement. The role of rheumatoid synovitis in the natural history of the disease at this level has been discussed; the indications for surgical treatment and the results in thirty-seven patients with forty-seven surgical procedures have been presented. Splinting of the wrist should not be neglected. Many patients deserve early consideration of surgical treatment since good results can be obtained and maintained by such treatment.