Intra-articular radiation synovectomy is an established and well documented therapy in rheumatology. A rare side effect is necrosis of surrounding tissue caused by leakage of the radionuclide.We describe the case of a 34-year old patient with rheumatoid arthritis who developed skin necrosis 4 weeks after an intra-articular radiation synovectomy of the left wrist. When these lesions are recognized early surgical therapy or hyperbaric oxygen therapy can be initiated.