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Rheumatoid Trigger Finger

- 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.

Flexor tenosynovitis in the rheumatoid hand. Ferlic DC and Clayton ML. J Hand Surg. 1978;3:364-367.

Treatment of tenosynovitis in rheumatoid arthritis.