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RA hand tendon rupture risk — SCE Rheumatology MCQ

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ModerateRheumatoid arthritisRA hand tendon rupture riskSCE Rheumatology

A 66-year-old woman with longstanding erosive rheumatoid arthritis develops a new inability to extend her right ring and little fingers. Passive extension is preserved. Examination shows dorsal wrist synovial swelling and ulnar deviation, without sensory disturbance. Wrist radiographs demonstrate destruction and dorsal prominence of the distal radioulnar joint. What is the most appropriate next management?

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Correct answer: D — Arrange prompt assessment by a hand surgeon

This is Vaughan-Jackson syndrome: attritional rupture of the ulnar-sided extensor tendons over a diseased, prominent distal radioulnar joint. New loss of active ring- and little-finger extension with preserved passive movement localises the deficit to the extensor mechanism rather than fixed joint deformity. Prompt hand-surgery assessment is required because reconstruction commonly needs tendon transfer together with treatment of the distal radioulnar pathology, and further sequential tendon rupture may occur. Ultrasound can confirm tendon discontinuity but should not delay referral. Splinting or hand therapy alone cannot restore a ruptured tendon. A glucocorticoid injection or increased NSAID treatment may reduce inflammatory pain or synovitis but will not restore tendon continuity.

Reference: McIntyre JL, Stirling PHC, McEachan J. Outcomes of Surgical Treatment of Vaughan-Jackson Syndrome. Journal of Wrist Surgery. 2024;13(4):328-332. https://pubmed.ncbi.nlm.nih.gov/39027023/