Options in extensor tendon reconstruction in rheumatoid arthritis

There is a decreased incidence of extensor tendon rupture in rheumatoid arthritis due to progress in drug therapy with the consequence that destructive tenosynovitis occurs less often. However, in the long-term course of the disease, the tendons will tend to show signs of attrition at the sharp bone margins as, for example, in caput ulnae syndrome or at Lister's tubercle. Tendon rupture usually begins ulnarly, progressing over the wrist and extending radially, therefore, the causes of attrition must be remedied to prevent further ruptures. Generally, tendon reconstruction will no longer be possible by primary end-to-end suture at this stage. As the number of ruptures increases, various techniques such as side-to-side suture fixation, tendon transfers or tendon grafting are employed. These techniques will be described below.