In nineteen hands (seventy-four fingers) of eleven women and one man
with rheumatoid arthritis there was restriction of active and passive
motion of the proximal interphalangeal joints, with signs of flexor
tenosynovitis but no clinical or roentgenographic evidence of involvement
of the joint. The nineteen hands were treated by flexor tenosynovectomy
(palm only in nine, palm and carpal tunnel in five, both palm and digits in
four, and digit, palm, and wrist in one) combined with manipulation of the
joint under regional anesthesia. After an average follow-up of twenty-one
months (range, six to thirty-six months), the average range of active
motion had increased from 40 to 84 degrees and the average range of passive
motions, from 57 to 87 degrees. Only three patients had unsatisfactory
results, one because of persistent unexplained swelling and two because of
recurrence of the tenosynovitis.