REPAIRING A HAND DEFORMED BY ARTHRITIS

Her left hand looked grotesque; she was unable to perform even the simplest of household tasks. Mrs. Roland Cesarini, 49, suffered from an advanced case of rheumatoid arthritis and, although aspirin gave occasional relief, she needed surgery if she was to regain the use of her hand and fingers.

In an operating suite at Massachusetts General Hospital in Boston, Mrs. Cesarini took a general anesthetic before Dr. Harilaos Sakellarides, an orthopedic surgeon, began a series of complicated surgical procedures. Arthritis had thickened the connective tissue in Mrs. Cesarini's hand and fingers and twisted them all out of shape. As a result, the spaces between her joints were narrowed, the main joints were dislocated, tendons and ligaments were pulled out of place. Mrs. Cesarini had what doctors call a "swanneck deformity" in her fingers.

The objective of surgery in such cases is not only to re-establish joint space by the cutting and removal of thickened tissue, but also to relocate tightened tendons so maximum flexion is obtained in the joints. Dr. Sakellarides began the operation at the joints between hand and fingers where he made an incision across the knuckles, cut through joint tissue, and removed the heads of the hand bones. Then he moved down to the finger joints where he cut out more thickened tissue, removed some ligaments, as well as the shortened tendon fibers which cause swan-neck deformity.

To make the repair complete, Dr. Sakellarides inserted tiny pieces of wire between the hand and finger bones, establishing temporary "hinges" for the joints there. He made artificial pulleys out of soft tissue so that tendons would be kept in place. Finally, after stopping the bleeding, he sutured the incisions and placed the hand and fingers in a cast.

"I'm extremely happy with it," says Mrs. Cesarini, a practical nurse. "Before, I couldn't grasp objects with my left hand--my fingers seemed frozen. Now I can touch every fingertip on that hand with my thumb."

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