Thirtyone thumbs in 24 children received splinting for a mean of 11. Multiple congenital bilateral trigger digits in a 2year. Therefore, the treatment should combine shortening arthrodesis, deepening of the. Trigger thumb and fingers congenital hand and arm differences. Complications after pediatric trigger thumb release are rare and seldom reported. Failure to treat the deformity may result in compensatory hyperextension deformity of the thumb mp joint. Trigger finger is one of the most common causes of hand pain in adults. Triggering, clicking or snapping is observed by flexion or extension of the interphalangeal joint ipj. In ptt, a tendon cannot slide back and forth through the ligament and the thumb gets stuck in a bent flexed position. Trigger finger is a rare condition in children, affecting mainly the thumb.
Trigger finger and trigger thumb causes the tendons to catch or get stuck when the fingers or thumb bend. Present with digits in a position of flexionpresent at birth but not appreciated until months lateranomaly is secondary to either sheath stenosis or tendon noduleor bothperiod of observation with or without splinting is recommended ifchild is less than 6 months of agecondition is less likely to resolve. Pdf congenital hand deformities are common but most of these conditions are minor. Pain and swelling with the formation of a bump at the base of the thumb are its visible signs which passes through mild to severe stages affecting the flexion of the thumb, dr. Trigger thumb in children is an uncommon condition. Trigger finger is a condition that causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger. The other 31 thumbs in 26 children were only observed. Congenital clasped thumb describes an anomaly which is characterized by a fixed thumb into the palm at the metacarpophalangeal joint in one or both hands.
While treating a trigger thumb in a child or adult requires a similar surgery, trigger finger surgery can be quite different. Jul 10, 2014 tf tend to develop earlier in life than trigger thumb and the spontaneous recovery rate was higher in former. Trigger finger is much less common compared to trigger thumb. There is some controversy as to whether trigger thumb is a con genital or. Present with digits in a position of flexion present at birth but not appreciated until months later anomaly is secondary to either sheath stenosis or tendon nodule or both period of observation with or without splinting is recommended if child is less than 6 months of age condition is less likely to resolve in older. Corticosteroids are thought to work by reducing swelling of the tendon, allowing the tendon to move freely again. The aetiology has been suggested to be genetic though other identifiable causes may be occasionally present 3 and it is still controversial as to whether the congenital trigger digit is truly congenital or an early acquired condition 4. The problem is that the tendon which bends the thumb is locked or triggering in the tendon sheath and prevents the thumb from fully extending. Conservative treatment is recommended for six months to two years, according to the age of the patient. Guided injection and aspiration of joints and related structures view in chinese. Trigger thumb is a condition that can result in your thumb being bent inwards, toward your palm, or straightened with a snapping movement. Pediatric trigger thumb appears to be a different entity than pediatric trigger finger. Management strategy for congenital thumb differences in paediatric. With greater constriction, the tendon suddenly sticks proximal to.
In the pediatric population, the locked trigger thumb can be observed for 36 months to determine if resolution may occur. Surgical treatment of pediatric trigger thumb with. There are various fractures that can lead to trigger finger. Trigger thumb genetic and rare diseases information. Trigger finger can recur but the condition generally corrects itself after a short while. The inflammation and swelling may cause pain in the palm and in the base of the finger, especially when the finger is flexed. About europe pmc funders joining europe pmc governance roadmap outreach tools. The prognosis is also very good for congenital trigger thumb that is treated with resection of the tendon nodule. When i see a child with congenital trigger thumb, we discuss different treatment options. Sometimes, the trigger finger locks, and the thumb cannot straighten at that last joint.
In this paper, we report on a 2yearold boy with multiple congenital bilateral trigger digits. In patients with congenital trigger thumb, the a1 pulley must be released if the interphalangeal joint remains in fixed flexion. More severe cases may become locked in the bent position and require surgery to correct it. Congenital trigger thumb is easily deducible in infants as they find it difficult to extend their thumb in the early stages and then later on impossible.
Evidence based data in hand surgery and therapy eurohand. Trigger finger and trigger thumb vermont orthopaedic. Trigger thumb in infants j bone joint surg am 1949. Pdf common congenital hand conditions researchgate.
Pediatric trigger thumb nationwide childrens hospital. The condition is also known as stenosing tenosynovitis. In severe cases, such as this one, it can cause a fixed flexion deformity of the thumb. Nov 22, 2019 trigger thumb in an adult not responding to corticosteroid tendon sheath injection needs surgery. Congenital triggering of a digit other than the thumb is a rare. Conservative treatment is not appropriate for older children who present with a locked digit that cannot be passively extended. Patients with trigger finger initially describe snapping, catching, or locking musculoskeletal ultrasonography.
This condition makes it difficult to straighten the fingers and thumb back out. In children less than two years old, a congenital narrowing of the tendon sheath known as the pulley may be present, resulting in congenital trigger digit, most commonly the thumb. For claims with a date of service on or after october 1, 2015, use an equivalent icd10cm code or codes. The ring finger and thumb are most often affected by trigger finger, but it can occur in the other fingers, as well. Nov 22, 2019 the prognosis is also very good for congenital trigger thumb that is treated with resection of the tendon nodule. Aug 23, 2016 after 2 years of age, only 10% of trigger thumbs will resolve without surgery. Congenital, multiple, bilateral, trigger digits in a child. No hereditary cause triggers congenital trigger thumb, it is the inflamed tendon at the base of the thumb which fails to glide smoothly that causes it. In the furthest stage, no extension is possible and there is a fixed flexion deformity of the thumb in the ipj.
Surgery is straightforward and involves release of the tight area in the tendon which. Sometimes, the thumb locks intermittently and straightens sometimes. In this study, treatment outcomes of 47 trigger thumbs of. This condition has been referred to as congenital trigger. Congenital trigger thumb page 2 of 2 approach to treatment and generally results in normal thumb function. Trigger finger thumb is a condition of the tendon and tendon sheath in the affected digit. Open and not percutaneous surgery is the norm for trigger thumb in children and adults alike, since the neurovascular bundles in the thumb are closer to the midline than in other digits. Conservative management can be attempted in children but is historically unsuccessful. It is yet unascertainable how common trigger thumb is but it constitutes almost 2% of hand problems present in children, asserts dr. Triggering was most constant in the middle and ring fingers and observed only. The aim of this study was to evaluate the functional results and complications of surgical treatment of.
My parents say that i was born with congenital trigger thumb in both hands, so i am unsure when it developed. In cases of trigger finger, liquid corticosteroids are injected into the tendon sheath the membrane that the tendon slides through, at the base of the affected finger or thumb. Two of these digits were seen when the patient was very young. In trigger finger, a finger becomes locked in a bent position.
If the condition is allowed to progress, the nodule may swell to the point where it gets caught and. The finger locks when one of the tendons that flex the finger becomes inflamed and swollen, often with a noticeable round, raised area nodule in the palm. However, most congenital trigger digits present sometime after the neonatal period. May 01, 2020 if you have problems viewing pdf files, download the latest version of adobe reader for language access assistance, contact the ncats public information officer genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. According to, rheumatoid arthritis, partial tendon lacerations, repeated trauma from pistolgripped power tools, or long hours grasping a steering wheel can cause the flexor tendons to tighten, resulting in trigger thumb or finger.
In children, it is often first seen when the child is older than 1 year of age. While trigger thumb in the pediatric population is a common pathological condition 14, trigger finger is rare. Delayed case of congenital bilateral trigger thumb. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Although the current accepted approach to the treatment of congenital trigger thumbs. In children, pediatric trigger thumb is an acquired condition which means it is not present at birth congenital. Trigger thumb released with a satisfactory outcome. The most straightforward way to begin is with a course of therapy, which includes splinting and stretching. Trigger thumb of childhood, termed congenital trigger thumb, is a pathology of the flexor pollicis longus tendon with an unknown etiology. Introduction trigger finger or stenosing tenosynovitis of finger is caused by a nodule or thickening of flexor tendon which catches on the proximal edge of a1 pulley when the finger is actively flexed. Trigger fingerthumb in kids childrens hospital colorado.
May 03, 2010 trigger thumb released with a satisfactory outcome. After 2 years of age, only 10% of trigger thumbs will resolve without surgery. Trigger thumb is rare one estimate is that for every babies born, three of them may be affected by trigger thumb at one year of age. Infants persistent thumbclutched hand, flexionadduction deformity of the thumb, pollex varus, thumb in the hand deformity. This video gives description of the congenital trigger thumb regarding pathology, clinical presentation, prognosis and treatment options. Wait and see is ok if the finger is clicking sometimes, but not staying in a. When the condition occurs in children as young by the time they are one year of age, the condition is known as congenital trigger finger. A trigger finger or thumb happens when trying to bend or straighten the finger or thumb. Multiple congenital bilateral trigger digits in a 2yearold. With greater constriction, the tendon suddenly sticks proximal to the sheath, causing the. Trigger finger bone, joint, and muscle disorders merck. Congenital, multiple, bilateral, trigger digits in a child int orthop 1993. Congenital trigger thumb triggering normally occurs when localized swelling of the flexor tendon sheath at the level of the metacarpophalangeal mp joint it causes the tendon to get caught under the a1 pulley of the flexor tendon sheath.
Most often the thumb is stuck in the bent position. Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p. Triggering can be associated with pain, swelling, and loss of function. It can be helped with therapy and splinting but occasionally surgery is required. One third of patients with congenital trigger thumb have a positive family history of trigger thumbs, and 20 30% of cases are bilateral. A nine year old boy has been treated for congenital, multiple trigger digits in addition to the thumb. Pediatric trigger thumb ptt is also called a flexion contracture of the ip joint. Furthermore, multiple congenital bilateral trigger finger in children is an extremely rare condition 57, sometimes associated to genetic disorders 8, 9.
The operative findings were only slight thickening of the flexor pulley and noticeable fusiform swelling of the flexor tendons. Trigger thumb is a common hand problem,5, 11, 14, 16, 17, 18 characterized by clicking or locking of the interphalangeal joint upon flexion and or extension. Congenital trigger thumb is caused by a snagging of the tendon that bends the thumb when the thumb straightens. Other specified congenital anomalies of muscle tendon fascia and connective tissue short description. The procedure is open tenolysis of flexor sheath of right thumb. While trigger thumb in the pediatric population is a common pathological condition 1 sprecher ee. Intraoperatively, the radial digital nerve is at risk due to its superficial crossing location.
Congenital malformation of upper extremities may affect an individual. Congenital trigger thumb is thought to occur due to thickening of the flexor pollicis longus tendon. Doctor answers on symptoms, diagnosis, treatment, and more. To make matters worse, the sheath itself might also become irritated and thickened. But most often, the trigger thumb doesnt resolve, and therefore the next step is surgery. I am responding to this as both a hand surgeon and a mom. A trigger fingerthumb happens because the sheath tunnel of tissue that the tendon moves through isnt wide enough or gets swollen.
Congenital trigger thumb is a trigger thumb in infants and young children. Seven articles reporting on 118 trigger fingers were identified. A six year old girl presented with fixed flexion deformity of interphalangeal joints of both thumbs and nottas nodules. Congenital trigger thumb page 1 of 2 congenital trigger thumb overview your child has been diagnosed with a congenital trigger thumb. Trigger thumb genetic and rare diseases information center. Percutaneous release for trigger thumbs in children. About 30% of children with trigger thumb have it on both sides. Jan 24, 2017 trigger finger adult and congenital 1. Treatment can be conservative with finger stretching exercises, or surgical. Trigger thumb is an uncommon condition in children and can be treated successfully with the release of the a1 pulley alone when conservative treatments fail 2, 4, 8, 15.
Pediatric trigger thumb ptt is also called a flexion contracture of the ip joint picture 1. Trigger thumb trigger finger congenital hand and arm. Indications discuss indications and more general concerns. Tf tend to develop earlier in life than trigger thumb and the spontaneous recovery rate was higher in former. If you have problems viewing pdf files, download the latest version of adobe reader for language access assistance, contact the ncats public information officer genetic and rare diseases information center gard po box 8126, gaithersburg, md 208988126 tollfree. Usually a palpable click can be felt as the nodule snaps under the first finger pulley. Think about combining different materials in one orthosis.
Several explanations exist for pediatric trigger thumb. Pediatric trigger thumb is 10 times more common than pediatric trigger finger. The tendon becomes irritated and thickened, impeding its smooth movement through the sheath. It is a condition that affects the movement of the thumb in children. Pediatric trigger thumb is not the same condition seen in adults, but they are similar. A contracture means that the thumb can no longer stretch or straighten. Pediatric trigger thumb pediatric trigger thumb ptt is also called a flexion contracture of the ip joint picture 1. Over time, this may also cause a small bump to form at the base of the fingerthumb where it meets the palm of the hand. The diagnosis of trigger finger and thumb is usually quite obvious on physical examination.