Malady Wise

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Trigger Thumb

Maladywise

SUMMARY: Overview of Paediatric Trigger Thumb

Background

  • Flexion deformity of the interphalangeal joint.

  • The cause is unknown and it does not present at birth.

  • 60% of trigger thumbs resolve spontaneously by 12 months of age.

  • Trigger thumbs do not impede the early use of the hand.

  • Approximately 1:300 kids by the age of 12 months

  • 25% are bilateral

  • Note: Trigger finger is rare and is generally associated with other disorders. A referral to a Paediatric Orthopaedic Specialist is required.

Cause

  • ? Thickening of flexion tendon > nodule forming

  • Different cause to adult trigger thumb, anti-inflammatory not helpful in kids

  • Most are idiopathic, not obviously linked to other MSK conditions

Assessment

  1. History:

    • Age

    • Trauma to the hand or fingers

    • Appropriate developmental milestones

    • Family history of trigger fingers or hand deformities

  2. Examination:

    • Weight, height, and percentile for age

    • Flexed position of thumb

    • A palpable nodule may be present on the tendon of the metacarpal joint on the palmer side

    • An audible pop or click on extension

    • A palpable click on extension

    • Examine both hands

  3. X-ray is not required but is safe if there is a traumatic dislocation-type history

Management

  • Splinting or other therapies are of no benefit in the first 12 months.

  • Observation is a recommended first-line treatment and spontaneous recovery more likely in under age of 2

  • Gentle stretching and massage

  • Night time splinting

  • Ask the parents to keep a photographic diary.

  • Surgery is ideally attended between 2 to 3 years of age.

  • Successful surgical correction after 3 years may still have residual contracture.

Referral

Consider referral to paediatric orthopaedic specialist, or a specialist hand surgeon, if:

  • the trigger thumb persists past 18 months of age.

  • the child complains of pain, or is not using the hand efficiently.

  • Attach a photograph, if possible.

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