Rheumatoid arthritis affects the hand in 90% of patients, producing the classic deformities every clinician must recognise — ulnar drift, boutonnière, swan-neckand the Nalebuff thumb patterns. This masterclass walks you through the pathomechanics, mnemonicsand a logical proximal-to-distal surgical algorithm that corrects deforming forces from the wrist down to the fingertips. ⏱ Chapters 0:00 Intro 0:24 Essentials 0:58 Classification 1:30 Finger Deformities 2:09 Deformity Mechanics 2:40 Swan Neck 3:14 Tendon Ruptures 3:45 Algorithm 4:21 Complications 4:56 Clinical reasoning — Vj 5:27 Clinical reasoning — Mcp A comprehensive, clinically-focused masterclass on rheumatoid arthritis of the hand covering synovial pathophysiology, the 2010 ACR/EULAR diagnostic framework, characteristic deformities of the thumb, MCP joints and fingers, tendon attrition syndromes (Vaughan-Jackson and Mannerfelt), and the staged surgical reconstruction pathway from synovectomy through MCP arthroplasty to PIP arthrodesis. Designed to build a clear, structured approach for anyone managing inflammatory hand disease. 🦴 IN THIS VIDEO YOU'LL LEARN • The pathophysiology of rheumatoid pannus, synovial hypertrophy and the two-year DMARD window for preventing erosive damage • How to differentiate boutonnière deformity (PIP flexion, DIP extension) from swan-neck deformity (PIP hyperextension, DIP flexion) using the BUTTON and SWAN mnemonics • The Nalebuff classification of rheumatoid thumb deformities from Type I boutonnière through to Type VI arthritis mutilans • Staging and treatment thresholds for boutonnière and swan-neck finger deformities based on passive correction and angle of lag • Why MCP ulnar drift occurs — radial collateral ligament destruction, extensor subluxation and intrinsic pull • Vaughan-Jackson extensor tendon rupture sequence and Mannerfelt flexor pollicis longus attrition, plus the role of the Darrach procedure in caput ulnae syndrome • The proximal-to-distal surgical algorithm: medical optimisation, wrist correction first, then MCP arthroplasty with soft tissue rebalancing • The role of serology — rheumatoid factor sensitivity versus anti-CCP specificity — and key demographics including the 3:1 female predominance and HLA-DR4 association ⏱️ CHAPTERS 📌 KEY TAKEAWAYS ✔️ 90% of rheumatoid patients develop hand involvement — early DMARD therapy within 2 years is the single biggest determinant of outcome ✔️ Boutonnière arises from central slip disruption with volar lateral band migration; swan-neck from volar plate laxity, intrinsic tightness, FDS attenuation or flexor nodules ✔️ Fixed boutonnière deformity over 50° or chronic for 6–12 months is best treated with PIP arthrodesis in functional position, not arthroplasty ✔️ Vaughan-Jackson ruptures follow a predictable sequence (EDM → ring EDC → middle EDC) over a dorsally prominent ulnar head — address caput ulnae early to prevent further ruptures ✔️ Always correct the wrist before the fingers; extensor tendons must pass over a stable foundation or recurrent deformity is inevitable ✔️ Stop methotrexate two weeks before and after surgery to minimise infection riskand only achieve low disease activity before proceeding to reconstruction 👩⚕️ WHO THIS IS FOR Ideal for orthopaedic and hand surgery trainees, rheumatology clinicians, physiotherapists, medical studentsand informed patients seeking a deep understanding of how rheumatoid arthritis affects the hand and how it is reconstructed. 📚 RELATED TOPICS: Boutonnière Deformity Pathomechanics and Repair · Swan-Neck Deformity: Causes and Surgical Options · Vaughan-Jackson Syndrome and Extensor Tendon Rupture · Mannerfelt Lesion and Flexor Pollicis Longus Attrition · MCP Joint Arthroplasty in Rheumatoid Arthritis · Caput Ulnae Syndrome and the Darrach Procedure 🔗 More free orthopaedic teaching at Orthovellum.com — subscribe for weekly videos. 🎨 CREDITS • Original Orthovellum production. ⚠️ DISCLAIMER: Educational only — not individual medical advice. Always consult a qualified clinician for diagnosis and treatment. #orthopaedics #handsurgery #rheumatoidarthritis #rheumatology #handdeformity #boutonniere #swanneck #ulnardrift #DMARDs #MCParthroplasty #PIPfusion #Darrachprocedure #Nalebuffclassification #medicaleducation #orthopedics