- See:
Rheumatoid Hand:
- Sites of Triggering in the Rheumatoid Patient:
- A1 pulley (as w/ convential
trigger finger)
-
FDS decussation (may require excising slip of sublimis or an intratendinous nodule);
- nodule in
FDP near A2 can cause finger to lock into extension;
- Non Operative Rx:
- consider more than usual 3 steroid injections;
- Surgical Treatment:
- resecting or incising A1 pulley may cause bowstringing of tendon and deviation of finger toward midline with attempts at
digital flexion, and increased tendency to anterior MCP subluxation;
- local
tenosynovectomy and early postop ROM;
- in
RA surgical synovectomy of flexor tendons (for triggering) is a rewarding procedure & one of best buys in RA hand surgery;
-
Brunner incision
- tenosynovium is removed from around the flexor tendons while care is taken to preserve the A2, A4, and
if possible the A1 pulleys (see
flexor tendon pulleys);
- if necessary resect one slip of
FDS (if necessary for gluiding), but this should be avoided if possible;
Treatment considerations in the complicated rheumatoid hand.
A Miller--Breslow.
Hand Clinics. Vol 5. 1989 p 279-289.
Flexor tenosynovitis in the rheumatoid hand.
DC Ferlic and ML Clayton.
J. Hand Surgery Vol 3. 1978. p 364-367.
Treatment of tenosynovitis in rheumatoid arthritis.
CR Stirrat.
Hand Clinics. Vol 5. 1989. p 257-278.
