Aetiology and Management of Adduction Contracture of the Thumb in Rheumatoid Arthritis

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Abstract
Adduction contracture of the thumb in rheumatoid arthritis is a common complication which should be diagnosed in its early stages. Fibrosis of the adductor aponeurosis seems to be the main aetiological factor in the development of adduction contracture. Release of the adductor aponeurosis in mild or moderate cases may prevent the advancement of the contracture. In advanced, long standing cases, management should follow three consequent steps: 1. (1) Release of the adductor aponeurosis, preferably combined with Z-plasty of the first web. 2. (2) Stabilisation of the metacarpophalangeal or the interphalangeal joint. 3. (3) Mobilisation by arthroplasty of the trapezio-metacarpal joint.

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