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Current Management of Trigger Digit in Rheumatoid Arthritis Patients: A Survey of ASSH Members
Rebecca Bickham1, Logan Carr2, James Butterfield1
1Penn State Health Milton S. Hershey Medical Center, Hershey, USA.
Hand (New York, N.Y.)
|December 30, 2020
Summary
Surgeons are increasingly releasing the A1 pulley in rheumatoid arthritis (RA) patients with trigger digits, challenging traditional dogma. This shift reflects evolving practices in managing RA hand deformities with modern treatments.
Area of Science:
- Hand Surgery
- Rheumatology
- Orthopedics
Background:
- Traditional management of rheumatoid arthritis (RA) with trigger digits advised against A1 pulley release due to concerns of joint destabilization.
- Biologic disease-modifying anti-rheumatic drugs (DMARDs) have improved RA outcomes, potentially altering the need for strict contraindications.
- Despite advances, many medical texts still discourage A1 pulley release in RA patients.
Purpose of the Study:
- To evaluate current surgical trends regarding A1 pulley release in rheumatoid arthritis (RA) patients.
- To determine if traditional dogma aligns with contemporary surgical practices for trigger digits in RA.
Main Methods:
- A survey was distributed to Active Members of the American Society for Surgery of the Hand (ASSH).
- The survey assessed training and current practices concerning trigger digits in RA patients.
Main Results:
- A 16% response rate yielded 503 completed surveys.
- Initially, 55% of surgeons were trained to avoid A1 pulley release in RA patients.
- Currently, 71% release the A1 pulley under specific conditions, and 40% report increased frequency of this procedure.
Conclusions:
- Surgical practices for A1 pulley release in RA patients are evolving.
- Improved RA management with biologic DMARDs influences the indications and contraindications for A1 pulley release.
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