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. 2022 Nov;17(6):1098-1103.
doi: 10.1177/1558944720975137. Epub 2020 Dec 29.

Current Management of Trigger Digit in Rheumatoid Arthritis Patients: A Survey of ASSH Members

Rebecca Bickham  1 , Logan Carr  2 , James Butterfield  1 , Brittany Behar  3 , Ann-Marie Dyer  1 , Alexander Payatakes  1
Affiliations

Current Management of Trigger Digit in Rheumatoid Arthritis Patients: A Survey of ASSH Members

Rebecca Bickham et al. Hand (N Y). 2022 Nov.

Abstract

Background: Traditional dogma regarding management of rheumatoid arthritis (RA) patients with trigger digit symptoms holds that A1 pulley release should be avoided. Surgical release was thought to further destabilize the metacarpophalangeal joint. Biologic disease modifying anti-rheumatic drugs (DMARDs) have limited the development of hand deformities. Despite advances in RA treatment, many textbooks continue to discourage release of the A1 pulley in RA patients. The aim of this study was to determine if this belief is consistent with current trends in surgical management of trigger digits in patients with RA.

Methods: Active Members of the American Society for Surgery of the Hand (ASSH) were surveyed on their training and current practices as related to RA patients with trigger digits.

Results: Five hundred three surveys were completed (16% response rate). During training, 55% of ASSH Members were taught to avoid releasing the A1 pulley in RA patients. Seventy-one percent of respondents currently release the A1 pulley in RA patients with no preexisting deformities, no tenosynovial thickening, or if tenosynovectomy and flexor digitorum superficialis slip excision fail to relieve triggering. Forty percent reported that their practice has evolved toward more frequent release of the A1 pulley in RA patients.

Conclusion: The majority of ASSH Active Members were taught during training to avoid surgical release of the A1 pulley in RA patients to prevent acceleration of finger deformities. Indications and contraindications for A1 pulley release are evolving along with the improved natural history of RA associated with the use of biologic DMARDs.

Keywords: MCP joint; biologic DMARDs; rheumatoid arthritis; stenosing flexor tenosynovitis; trigger finger.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: AP reports a research internal grant from our institution, internal grant # 51, 2017, The remaining primary authors have no conflict of interest to disclose.

Figures

Figure 1.
Figure 1.
Demonstrates how training of hand surgeons has evolved over time regarding management of the A1 pulley to correct trigger finger in RA patients. Note. RA = rheumatoid arthritis.
Figure 2.
Figure 2.
Illustrates the percentage of surgeons who had observed ulnar deviation which they attributed to A1 pulley release in patients with rheumatoid arthritis, as related to years in practice.
Figure 3.
Figure 3.
Illustrates the percentage of surgeons who had observed MCP subluxation which they attributed to A1 pulley release in patients with rheumatoid arthritis, as related to years in practice. Note. MCP = metacarpophalangeal.
See this image and copyright information in PMC

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