Small interosseous bursae develop between the metacarpal heads in the interosseous spaces, beneath the deep transverse metacarpal ligament. In rheumatoid arthritis, these bursae become inflamed and distended as part of the diffuse MCP synovitis and interosseous bursitis that produces the characteristic dorsal MCP swelling and palmar pannus. These bursae can communicate with MCP joint synovitis in advanced disease.
Interosseous metacarpal bursitis is a component of rheumatoid hand disease, producing dorsal metacarpal swelling between the MCP joints that creates a characteristic boggy fullness of the dorsal hand. Ultrasound demonstrates the interosseous bursae as fluid collections between the metacarpal heads with power Doppler activity indicating active inflammation. Corticosteroid injection into the dorsal interosseous space or into the adjacent MCP joints addresses both the bursal and joint components. In rheumatoid synovectomy, the interosseous bursae are decompressed alongside the MCP joint synovectomy.
Active rheumatoid disease produces synovitis of the MCP joints and the adjacent interosseous metacarpal bursae, creating boggy dorsal hand swelling between the metacarpal heads detectable by ultrasound with power Doppler activity; treatment with disease-modifying agents and local corticosteroid injection reduces bursal and joint inflammation.
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