Arthroscopic Complete Synovectomy of the Proximal Interphalangeal Joint of the Finger

Abstract

Rheumatoid arthritis is characterized by hypertrophic synovitis destroying the involved joints. If medical treatment fails to control the synovitis, synovectomy is a worthwhile prophylactic procedure that might help to delay further distention of the joint capsule and ligament. Synovitis of the proximal interphalangeal joint is usually performed by an open approach. The major complication is scar development around the interphalangeal joint, leading to considerable joint contracture. Arthroscopy of the proximal interphalangeal joint is a minimally invasive technique that can eliminate the risk of joint contracture associated with open surgery. The purpose of this Technical Note is to report the technical details of arthroscopic complete synovectomy of the proximal interphalangeal joint of the finger. This procedure is indicated in patients with rheumatoid synovitis of the proximal interphalangeal joint of the finger recalcitrant to medical treatment. It is contraindicated in case of an established boutonniere or swan-neck deformity, the presence of large dorsal synovial cysts, advanced degeneration of the joint, the presence of joint instability, or a fresh skin lesion near portals.

Fig 1

Arthroscopic complete synovectomy of proximal interphalangeal joint of right middle finger. The patient is in the supine position with the operative hand on the side table. (A) The dorsal radial portal (DRP) and dorsal ulnar portal (DUP) are coaxial portals for arthroscopy of the dorsal recess of the proximal interphalangeal joint. (B) The volar radial portal (VRP) is located by a needle.

Fig 2

Arthroscopic complete synovectomy of proximal interphalangeal joint of right middle finger. The patient is in the supine position with the operative hand on the side table. (A) The dorsal radial portal (DRP) is the viewing portal, and the dorsal ulnar portal (DUP) is the working portal. (B) The inflamed synovium (IS) of the ulnar half of the dorsal recess is resected with an arthroscopic shaver (AS). (MP, middle phalanx.)

Fig 3

Arthroscopic complete synovectomy of proximal interphalangeal joint of right middle finger. The patient is in the supine position with the operative hand on the side table. (A) The dorsal ulnar portal (DUP) is the viewing portal, and the dorsal radial portal (DRP) is the working portal. (B) The inflamed synovium (IS) of the radial half of the dorsal recess is resected with the arthroscopic shaver (AS). (MP, middle phalanx; PP, proximal phalanx.)

Fig 4

Arthroscopic complete synovectomy of proximal interphalangeal joint of right middle finger. The patient is in the supine position with the operative hand on the side table. The dorsal ulnar portal is the viewing portal, and the dorsal radial portal is the working portal. The inflamed synovium (IS) of the radial recess of the proximal interphalangeal joint is resected with the shaver. (MP, middle phalanx; PP, proximal phalanx.)

Fig 5

Arthroscopic complete synovectomy of proximal interphalangeal joint of right middle finger. The patient is in the supine position with the operative hand on the side table. The dorsal radial portal is the viewing portal, and the dorsal ulnar portal is the working portal. The inflamed synovium (IS) of the ulnar recess of the proximal interphalangeal joint is resected with the shaver. (MP, middle phalanx; PP, proximal phalanx.)

Fig 6

Arthroscopic complete synovectomy of proximal interphalangeal joint of right middle finger. The patient is in the supine position with the operative hand on the side table. (A) The dorsal ulnar portal (DUP) is the viewing portal, and the volar radial portal (VRP) is the working portal. (B) The inflamed synovium (IS) of the volar recess of the proximal interphalangeal joint is resected with the arthroscopic shaver (AS). (DRP, dorsal radial portal; MP, middle phalanx; PP, proximal phalanx.)