Tendon repair for Rheumatoid Arthritis

Overview

Rheumatoid arthritis (RA) can weaken tendons, causing tearing. You may not notice the damage at first, but it can cause pain, numbness, weakness, and joint dysfunction as it worsens. In severe cases, tendons may rupture. Tendon damage can cause deformity that some people with RA may find unsightly or embarrassing.

Tendon repair surgery can partially restore function and relieve pain. In people with rheumatoid arthritis, tendon repair is most frequently performed on the hands and wrists. Approximately 70 percent of people with RA will eventually experience symptoms in their hands and wrists. Tendon repair may also be performed on ankles, elbows, shoulders, and knees.

Tendon repair is not a cure for RA, and it does not prevent future disease activity. Tendon repair cannot fully restore function.

What does it involve?
Your doctor may order a complete physical, blood tests, or other diagnostic procedures to ensure that you are in good condition for surgery.

Once your tendon repair is scheduled, spend the weeks before surgery preparing by eating nutritious meals and staying as active as possible. Stop or cut down your smoking, and limit your consumption of alcoholic beverages to one or two per day. Being in top condition for surgery will shorten your recovery time and help prevent complications.

You will be given instructions to stop eating eight hours before surgery. When you arrive at the hospital, vital signs will be taken, and blood may be drawn. Before surgery, you will receive an intravenous (IV) line. Depending on the type of tendon repair you are receiving, you may receive medication to relax you, but remain awake during surgery, or general anesthesia to make you sleep.

The technique used during tendon repair depends on many factors, including whether or not the tendon or tendons have ruptured, and how many tendons have ruptured. Technique also depends on where the damaged tendons are located, and how damaged the surrounding bones and tissues are. Tendon repair may be prophylactic (preventative) or reconstructive. The surgeon may rebalance the joint by transferring the tendon to a different attachment location. If the tendon has ruptured, the surgeon may sew the tendon together and reattach it in its original position or in another location. If there is not enough healthy tendon left, the surgeon may harvest tendon from another part of your body to use in repairing your hand.

Some tendon repair surgeries are performed on an outpatient basis. Depending on your condition and the surgical technique used, you may spend one or more nights in the hospital recovering. The nurse or doctor will explain how to care for your wound. You will begin rehabilitation exercises early in recovery. Completing your rehabilitation program is key to a successful tendon repair.

You will not be able to drive yourself home after tendon repair surgery. It may require weeks or months to rehabilitate your new joint fully. You may only be able to use one hand for six to eight weeks. Consider asking a relative, friend, or neighbor to help you during this time, or hiring a home care provider to assist.

Intended Outcomes
Tendon repair surgery can reduce pain and restore function, making it possible to return to performing normal daily tasks.

Results
Tendon repair surgery for rheumatoid arthritis is not widely standardized, which makes it difficult to collect data on how successful the outcome is for this type of surgery. However, it is proven that tendon repair can restore function and correct deformity in people with severe RA in their hands and wrists.

Constraints
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.

Tendon repair can be painful, and you will most likely need pain medication for some weeks during recovery.

Even if your tendon repair surgery is successful, there is a chance it may cause scar tissue that will result in joint stiffness or loss of function.

Call your doctor immediately if you notice signs of infection such as swelling, redness, increased pain, or bleeding from the surgical wound.