Question
A 55 year old woman with longstanding rheumatoid arthritis has a painful wrist and has lost extension of the ring and little fingers over two weeks.
- Describe the radiograph.
- Explain the cause of the loss of finger extension.
- How would you manage the wrist and the tendons?
Answer
Radiograph
- Periarticular osteopenia
- Symmetrical joint space loss
- Marginal erosions at the ulnar styloid and MCP joints
- Carpus relatively preserved in this case
- Look for ulnar translocation and radiocarpal subluxation
Loss of finger extension
- Attritional rupture of EDM, then EDC to ring and little fingers (Vaughan-Jackson syndrome)
- Caused by the dorsally subluxed ulnar head and tenosynovitis
- Mannerfelt lesion is FPL rupture over a scaphoid spur
- Exclude PIN compression at the elbow (tenodesis intact) and extensor tendon subluxation at the MCP joints
Management
- Optimise DMARDs with the rheumatologist
- Dorsal tenosynovectomy before further ruptures
- Tendon transfer, EIP to EDC ring and little, or side to side to middle finger EDC
- Darrach excision or Sauvé-Kapandji for the distal ulna
- Partial fusion (radiolunate) for ulnar translocation with a preserved midcarpal joint
- Total wrist fusion for pancarpal destruction
- Total wrist arthroplasty for low demand bilateral disease
Related pages
Author Contributions
Orthofracs team
Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.