Hand surgery an increasingly valuable option for some rheumatology patients

The refinement of surgical techniques and improved technology in recent years means modern hand surgery can offer dramatic improvements in form and function for select rheumatology patients, the Irish Society for Rheumatology (ISR) 2024 Autumn Meeting heard.

One of Ireland’s leading experts in plastic reconstructive and aesthetic hand surgery, Mr Paul Sullivan, Consultant Plastic and Reconstructive Surgeon in Beaumont and Connolly Hospitals, both in Dublin, delivered a well-received presentation on the latest surgical approaches to rheumatoid hand patients.

Mr Sullivan, who carried out Fellowships in hand surgery in the UK and New Zealand, and is now involved in specialist training nationally and internationally, pointed out that hand pathology can lead to significant disability and impairment of quality-of-life.

He noted the significant advancements in small joint replacement surgery, peripheral nerve treatments, and previously untreatable hand conditions, thanks to more advanced techniques and improvements in sutures, screws, surgical tools, imaging devices, and other technologies.

“The technology has just come on massively and that has translated into what we can do in hands.”

During his presentation, Mr Sullivan showcased a number of cases where surgery caused to a dramatic improvement in functionality and appearance of hand joints affected by rheumatological conditions. Osteoarthritis of the thumb base is the second most prevalent arthritis of the hand, and some cases can do very well from surgery (eg, trapeziectomy).

Some of these patients experience significant deformity and pain and have been told that nothing more can be done for them, even though surgery could be a viable option, he said, emphasising the need for greater awareness of hand surgery procedures.

In addition, some hand surgery procedures, such as trapeziectomy, interfere with the pain-mediating nerve fibres, and therefore can “get rid of” the patient’s disease-related pain, which is another important consideration, Mr Sullivan added.

Careful patient selection is key; however, choosing who, and when, to refer for surgery can be challenging, he acknowledged.

In addition, some surgical procedures in the area remain suboptimal in outcomes, particularly on the wrist (arthroplasty), with more evidence needed.

Mr Sullivan was critical of the lack of hand surgery skills training in Ireland during his career training pathway where he had to train abroad. While the situation has improved somewhat, there is increasing demand and a need for more resources and training exposure, he said.

Speaking to the Medical Independent (MI) during the meeting, former ISR President Prof Geraldine McCarthy said she had been very interested in Mr Sullivan’s presentation, as she has many patients with osteoarthritis with joint issues, particularly at the base of the thumb.

“We are very aware of surgery for the knees and hips, but we don’t think of surgery for the hands in the same way.

“I didn’t quite appreciate how many hand procedures could be done and [the potential pain benefits]. Often our patients ask us, ‘is there anything we can do for this?’ And I am more knowledgeable now about referring them,” she commented.

However, she acknowledged that access will be an issue.

ISR President Dr John Ryan also praised Mr Sullivan’s presentation to MI, saying it was very informative and useful.