All surgical procedures designed to preserve or improve function in the extremities, whether in rheumatoid arthritis or not, must consider the functional emphasis of the upper extremity as compared to the lower extremity. The upper extremity has, as its primary goal, mobility and prehension, whereas in the lower extremity, stability is the most important goal, mobility the next in order of importance, and prehension the least important. For example, the feet fulfill a need for stability with very little requirement for prehension, but the hand is more an instrument for prehension and there is less need to consider stability. I have divided surgery in the upper extremity of the rheumatoid patient into the surgery of prevention and the surgery of repair--that is, those procedures designed to prevent the loss of function and those designed to restore some measure of function
