Rheumatoid Arthritis Hand

Rheumatoid arthritis hand can result in many deformities of the fingers and thumb. These include

  • Finger deformities
    1. intrinsic plus deformity
    2. swan neck deformity
    3. boutonniere deformity
    4. mallet deformity
    5. ulnar deviation (towards the little finger) of the fingers
  • Thumb deformities
    1. Type 1 is a boutonniere deformity; it is most common
    2. Type 2 is a flexion deformity of metacarpo-phalangeal with extension of inter-phalangeal joint
    3. Type 3 is a swan neck deformity; second most common
    4. Type 4 is abduction of the proximal-phalanx and adduction of the metacarpal
  • Wrist deformities
    1. dorsal (backward) dislocation of the ulna bone
    2. ulnar shifting of the wrist bones
    3. tendon rupture
    4. radial shifting (towards the index finger) of the metacarpals

See the page on hand anatomy to get a better understanding of these deformities.

rheumatoid arthritis hand deformity

This graphic shows a mallet deformity of the index and middle fingers.

Intrinsic Plus rheumatoid arthritis hand deformity is caused by the tightness of the intrinsic muscles (interossei and lumbrical muscles) of the hand. When the metacarpo-phalangeal joint is extended it is not possible to flex the proximal inter-phalangeal joint. Treatment is by surgical release of the muscles to slacken them and correct the deformity.

rheumatoid arthritis hand deformity

This graphic shows a intrinsic plus deformity.

rheumatoid arthritis hand intrinsic plus deformity

This graphic shows the ulnar deviation of the fingers along with boutonniere deformity (arrow) of the little finger.

Ulnar Deviation of the Fingers is caused by the

  • stretching of the collateral ligaments of the metacarpo-phalangeal joints
  • stretching of the accessory ligaments causing the ulnar drifting of the flexor tendons
  • contracture of the intrinsic muscles of hand
  • ulnar deviation or rupture of the extensor tendons

Treatment is by surgery. Mild deformity is treated by

  • intrinsic muscle release
  • realignment of the extensor tendons
  • excision of synovial tissue from the metacarpo-phalangeal joint

Severe ulnar deviation deformity is treated by Interposition arthoplasty of the Metacarpo-phalangeal joint.

In interposition arthoplasty the cartilage of the joint is removed and fascia or tendon is placed between the bones. This procedure stabilizes the joint and allows adequate movement.

rheumatoid arthritis hand deformity

This graphic shows a swan neck rheumatoid arthritis hand deformity (arrow) of the left middle finger along with ulnar deviation and intrinsic plus deformities.

rheumatoid arthritis hand swan neck deformity rheumatoid arthritis hand swan neck deformity These are photographs of a woman with swan neck deformity in all fingers of the left hand.

Thumb Deformity

Type 1 Thumb Deformity (boutonniere deformity) is a hyper-extension deformity of the interphalangeal joint along with a flexion and subluxation of metacarpo-phalangeal joint. It is treated by extensor reconstruction and synovial tissue excision of the metacarpo-phalangeal joint when

  • the deformity can be passively corrected
  • cartilage is preserved

If all the three joints of the thumb are damaged then metacarpo-phalangeal joint replacement is done.

Metacarpo-phalangeal joint replacement along with inter-phalangeal arthrodesis (fusion) is done when the inter-phalangeal and metacarpo-phalangeal joints are damaged and the carpo-metacarpal joint is preserved.

If the metacarpo-phalangeal and inter-phalangeal joints are severely damaged then both the joints are fused.

Type 3 Thumb Deformity (swan neck deformity) begins in the carpo-metacarpal joint and includes

  • partial dislocation of the carpo-metacarpal joint
  • adduction contracture of the metacarpal (thumb remains close to the index finger)
  • hyper-extension of the metacarpo-phalangeal joint

Mild deformity only involving the carpo-metacarpal joint is treated by partial joint replacement.

It the metacarpo-phalangeal joint is also involved then this joint is fused.

Type 4 Thumb Deformity (abduction of the proximal-phalanx and adduction of the metacarpal) is also called gamekeeper's thumb. Mild deformities require

  • synovial tissue excision from the metacarpo-phalangeal joint
  • ligament reformation
  • loosening of the adductor muscle of thumb

Severe deformities require joint fusion or replacement.

Type 2 Thumb Deformity (flexion deformity of metacarpo-phalangeal with extension of inter-phalangeal joint) is treated along the lines of type 1 and 3 deformities.

rheumatoid arthritis hand deformity

This graphic shows a boutonniere deformity of the little finger and a Type 2 deformity of the thumb.

Mild deformities of the wrist are treated with excision of the synovial tissue. Severe deformities require joint fusion or joint replacement.

An important point to remember that most rheumatoid arthritis patients have adequate function in their hands in spite of the hand deformities. Due to this reason surgery to correct the deformity is rarely required. Surgery is the exception and not the rule. It should be also remembered that deformities can recur after surgery because the disease process continues relentlessly.

Frequently Asked Questions

What measures can be taken to prevent these rheumatoid arthritis hand deformities?

Steps you can take to prevent these deformitis include

  • The best way to prevent any deformity is to prevent inflammation by early and aggressive treatment of rheumatoid arthritis (medication to halt the disease process and put the disease in remission).
  • Stretch your joints daily as much as you can within the tolerable limits of pain by moving them through the full range of motion.
  • As pain and inflammation decreases strengthen your muscles by weight training. Lifting weights and other muscle building exercises develop your muscles and strong muscles reduce stress on joints.
  • Try to maintain a constant and if possible ideal body weight.
  • Avoid injuring your joints by doing any activity that hurts or feels uncomfortable.

I hope the information on rheumatoid arthritis hand was helpful. If you have any query you can ask me at the contact me page.

This page was last updated on 17th October 2010.


After seeing rheumatoid arthritis hand deformities you can click on the links below to know more about rheumatoid arthritis.

Rheumatoid Arthritis Cause

Rheumatoid Arthritis Pathology

Rheumatoid Arthritis Symptoms

Rheumatoid Arthritis Diagnosis

Rheumatoid Arthritis Treatment

Rheumatoid Arthritis Drugs

Rheumatoid Arthritis Prognosis

Go back from Rheumatoid Arthritis Hand to Rheumatoid Arthritis




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