Synovectomy is the basic operation on the rheumatoid wrist. Dorsal synovectomy of the wrist is never performed in isolation. It is always combined with extensor tenosynovectomy, synovectomy of the distal radio-ulnar joint, and surgical stabilization of the wrist. Early wrist synovectomy is ideally performed when the disease is largely confined to the soft tissues and where the overall alignment of the wrist is preserved. Careful reconstruction of the soft tissues following synovectomy is paramount in maintaining or restoring wrist stability. The satisfactory long term results of early wrist synovectomy have encouraged an expansion of the indications particularly to include the more advanced cases. In such cases additional bony surgery can be combined with the synovectomy to allow the realignment and stabilization of the wrist, so avoiding, in the majority of cases, the need for arthroplasty or wrist fusion.