Flexor Tendon Ruptures in Rheumatoid Arthritis

Ertel, Alan N.

doi:10.1016/s0749-0712(21)00805-2

Cited by 49 publications

(5 citation statements)

References 13 publications

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“…carpi ulnaris) (13). Někteří autoři (10,30) radí transponovat šlachu m. flexor digitorum superficialis otvorem v membrana interossea dorzálně k přerušenému extenzoru.…”

Section: Tab 2 Příčiny Spontánních šLachových Ruptur U Raunclassified

“…Ve flexorové skupině jsou ruptury šlachy m. flexor pollicis longus a ruptury flexorů pro druhý, třetí a čtvrtý prst, které jsou nejčastější, standardně reparovány volným štěpem odebraným z m. palmaris longus (10), někdy dvoudobou technikou za užití tunelizačního implantátu nebo transpozicí šlachy intaktního povrchního flexoru. Dlaňová krajina je prostornější a je pro flexorovou rekonstrukci výhodnější než volární krajina prstu.…”

Section: Tab 2 Příčiny Spontánních šLachových Ruptur U Raunclassified

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Current Options of Rheumatosurgery of the Hand and Wrist

Pech¹,

Vlček²,

Landor³

2019

Acta Chir. orthop. Traum. Cech.

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Rheumatosurgery is a discipline managing the symptoms of rheumatoid arthritis of the musculoskeletal system. In a vast number of patients this disease starts in the wrist and hand. The portfolio of surgical procedures performed on the skeleton and soft tissues in these regions can be divided into two groups that, however, often times overlap in practice. Commonly, a combination of these surgical interventions is used. The surgical management should commence with prophylactic interventions that aim to slow down the development of rheumatoid deformities. These are followed by reconstructive surgery which shall manage the already developed rheumatoid deformities and their complications. The prophylactic interventions include early and late synovectomy, peritenosynovectomy, tenodeses, tendon transpositions and limited arthrodeses. The reconstructive surgery procedures comprise osteotomy, resection procedures, alloplasties, total arthrodesis and tendon reconstructions.

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“…carpi ulnaris) (13). Někteří autoři (10,30) radí transponovat šlachu m. flexor digitorum superficialis otvorem v membrana interossea dorzálně k přerušenému extenzoru.…”

Section: Tab 2 Příčiny Spontánních šLachových Ruptur U Raunclassified

Current Options of Rheumatosurgery of the Hand and Wrist

Pech¹,

Vlček²,

Landor³

2019

Acta Chir. orthop. Traum. Cech.

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“…Funkčně významné jsou u nemocného s revmatoidní artritidou ovšem pouze léze hlubokého flexoru, které podstatně omezují úchopovou schopnost ruky. Ve shodě s našimi zkušenostmi je proto všeobecně doporučováno chirurgicky reparovat pouze léze flexoru hlubokého (9,10,41,44).…”

Section: Příčiny a Příznaky Spontánních Rupturunclassified

Spontaneous Tendon Ruptures in the Rheumatoid Hand

Pech¹,

Veigl²,

Vlček³

2016

Acta Chir. orthop. Traum. Cech.

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A spontaneous tendon rupture is a direct consequence of rheumatoid inflammation and can appear without any noticeable impact, often during sleep. The patient then presents with inability to flex or extend metacarpophalageal or interphalangeal joints. Multiple ruptures resulting in impaired function of several fingers can also occur and markedly limit the hand's grip strength. A tear may arise from either mechanical injury to the tendon along its course over bone or connective tissues, or by biochemical action of lysosomal enzymes, released during the inflammation process, on the connective tissue of the tendon. Ischaemic damage to a part of the tendon due to constriction of vessels supplying the peritenonium is found in hypertrophic peri-tenosynovitis. Spontaneous ruptures can be prevented, in the first place, by early synovectomy and then by a number of prophylactic procedures on soft tissues and carpal bones, which can stop or at least slow down the development of severe axial deformities of the wrist and hand. Simple end-to-end suture of the stumps is usually not possible; tendon repair surgery using free grafts or, more often, intact tendon transfer is necessary. In the flexor part, transfer of the superficial flexor tendon to a stump of the deep flexor tendon is frequently performed; a free graft can also be used at a two-stage tendon reconstruction. The repair of flexor tendons is technically more demanding and the results are less satisfactory compared to repair surgery on the extensor tendon.

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“…For these reasons, literature has discouraged release of the A1 pulley in favor of limited tenosynovectomy in RA patients with symptomatic triggering. [17][18][19][20][21][22][23][24][25][26][27][28] The implementation of early, aggressive medical therapy has drastically changed the natural history of RA and prevents the onset of debilitating hand deformities. 2,29 Despite these remarkable outcomes with medical treatment alone, the dogma of A1 pulley preservation persists in recent hand surgery textbooks.…”

Section: Introductionmentioning

confidence: 99%

“…For these reasons, literature has discouraged release of the A1 pulley in favor of limited tenosynovectomy in RA patients with symptomatic triggering. 17-28…”

Section: Introductionmentioning

confidence: 99%

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

Bickham

Carr

Butterfield

et al. 2020

Hand (New York, N,Y.)

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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.

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Flexor Tendon Ruptures in Rheumatoid Arthritis

Cited by 49 publications

References 13 publications

Current Options of Rheumatosurgery of the Hand and Wrist

Current Options of Rheumatosurgery of the Hand and Wrist

Spontaneous Tendon Ruptures in the Rheumatoid Hand

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

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