Only nine 5% of the children were associated with congenital diseases and none had a positive family history of trigger thumb. Radial clubhand radial deficiency hand orthobullets. Surgical approach to delayed case of congenital trigger thumb introduction case report congenital trigger thumb is a rare anomaly found in children. Pdf although numerous studies have been performed on congenital trigger thumb ctt, the pathogenesis is still unknown. Lynn bassini, mukund patel, in fundamentals of hand therapy, 2007. Flexion deformity was the major presenting feature, other than triggering or pain. Pediatric trigger thumb nationwide childrens hospital. Congenital hand anomalies an overview occupational therapy department. Congenital trigger thumb overview your child has been diagnosed with a trigger thumb. Triggering, clicking or snapping is observed by flexion or extension of the interphalangeal joint ipj. Concomitant congenital trigger thumb and thumb aplasia. Even though it is termed a trigger thumb or trigger finger, this act of triggering is seen infrequently. Symptoms occur when there is a size mismatch between the tendon and the sheath that surrounds the tendon. The condition is also known as stenosing tenosynovitis.
Moon sang chung, seung baik kang, young ho lee and hyun sik gong the natural history of pediatric trigger thumb this information is current as of december 23, 2009 reprints and permissions. Congenital clasped thumb thumbinpalm deformity congenital clasped thumb refers to a spectrum of thumb anomalies that range from mild deficiencies of the thumb extensor mechanism to severe abnormalities of the extrinsic and intrinsic muscles, web space, and soft tissue and joint. While uncommon in the general population, for hand surgeons who treat children, trigger thumb is quite common. Success of conservative treatment of trigger thumb in children after. This condition has been referred to as congenital trigger thumb, although it usually presents after infancy. During this maneuver, the nodule in the flexor pollicis longus will also vanish, as in surgery of a1 pulley release. Editorial case report delayed case of congenital bilateral. Quality of life following surgery for congenital or acquired. Even though congenital means at birth, trigger thumb is evident only after the child is 2 years or so. A contracture means that the thumb can no longer stretch or straighten.
Pediatric trigger finger raleigh hand center raleigh. Although there is evidence for a genetic predisposition to the condition, trigger digits in children develop after birth. Omim190410 is characterized by fixed flexion at the interphalangeal joint ipj. Trigger thumb is a condition that can result in your thumb being bent inwards, toward your palm, or straightened with a snapping movement. In the printed or pdf version of this article, author affiliations can be found at the. The theory of a congenital predisposition to trigger finger is based upon its presence at birth, its occurrence in mono zygotic twins, and its common bilateral occurrence in children. Trigger thumb is due to stenosing tenosynovitis of flexor pollicis longus at the level of first annular pulley.
Case report a six year old girl presented with fixed flexion deformity of interphalangeal joints of. 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. One third of patients with congenital trigger thumb have a positive family history of trigger thumbs, and 20 30% of cases are bilateral. Children with trigger thumb rarely complain of pain.
The etiology has been attributed to congenital factors58 or traumatic factors9. Trigger thumb released with a satisfactory outcome. Pdf congenital trigger thumb in children researchgate. And, thankfully, kids do quite well with this condition. Although trigger finger is a condition commonly treated by orthopedic surgeons, we have not found sufficient studies in the literature addressing the treatment of trigger finger that persists. Indications discuss indications and more general concerns.
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. Functional outcome of surgical management of congenital. Pollex flexus congenitus congenital trigger thumb springerlink. The best sleeping position for back pain, neck pain, and sciatica tips from a physical therapist. Pdf quality of life following surgery for congenital or. Pediatric trigger finger, also known as congenital trigger finger, is a condition affecting the flexor tendon of the finger or thumb. An audible snap is appreciated when the finger is passively extended using the contralateral hand. Cytocontractile proteins and myofibroblasts are present during softtissue contraction, and they may have a role in ctt. Congenital hand differences lisa lattanza, md chief division of hand and upper extremity surgery. Although numerous studies have been performed on congenital trigger thumb ctt, the pathogenesis is still unknown. The most straightforward way to begin is with a course of therapy, which includes splinting and stretching. A 10 monthold child presents with the deformity shown in figures 1 and 2. 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. Bilateral congenital trigger thumb is a relatively uncommon condition, with few well documented cases in literature.
Congenital trigger thumb is thought to occur due to thickening of the flexor pollicis longus tendon. Pediatric trigger thumb presents not at birth but early in childhood. When i see a child with congenital trigger thumb, we discuss different treatment options. Twentyseven children with persistent ctt were operated between 2000 and 2004. There is also controversy surrounding its aetiology, natural course, ideal treatment and the age for. My parents say that i was born with congenital trigger thumb in both hands, so i am unsure when it developed. With greater constriction, the tendon suddenly sticks proximal to the sheath, causing the. The procedure is open tenolysis of flexor sheath of right thumb. Family will often recognize limited motion and initiate. Congenital trigger thumb is a painful condition present in infants in which the thumb is bent towards the palm. Release of congenital trigger thumb orthopaedicsone.
Include any exams preformed under anesthesia positioning describe and provide or photos to illustrate p. Regarding treatment, many authors have recommended early surgical. Trigger thumb refers to a thumb that clicks, catches, or locks as the tip of the thumb moves from a flexed bent to extended straight position. Trigger finger in pediatric patients is not as commonly seen as it is in adults. Its management is controversial, ranging from observation to extensive surgical release. We strongly recommend that you talk with a trusted. As a result of this inflammation, there is impairment of the natural movements of the thumb, as well as pain with any attempts at bending the thumb. The aim of the study is to clarify the immunohistochemical and. Trigger thumb genetic and rare diseases information.
In severe cases, such as this one, it can cause a fixed flexion deformity of the thumb. The patient has a classic presentation of stenosing flexor tenosynovitis, commonly known as trigger finger. Pdf trigger thumb and finger in pediatric patients researchgate. But in children, the explanation for congenital trigger thumb is that the sheath is developing too narrow for the tendon to glide easily through. Trigger finger tf is a rare disorder in paediatric age group 1 though tf is relatively common but the two represent distinct conditions 2. In the furthest stage, no extension is possible and there is a fixed flexion deformity of the thumb in the ipj. I do know that i had surgery on my left thumb around my 6 month old mark i still have the scar on my thumb but for some reason they never did the surgery on my right hand. The common involvement of the thumb and the equal occurrence. Pediatric trigger thumb ptt is also called a flexion contracture of the ip joint picture 1. Trigger thumb occurs when the tendon sheath of the thumb gets irritated resulting in inflammation.
Miscellaneous constriction ring syndrome congenital dislocation of. Thumb malformation an overview sciencedirect topics. A congenital flexion contracture of the thumb at its ip joint is caused by a constriction of the anular ligament of the mp joint at the level of the sesamoid bones in. 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. The recognized treatment of persistent congenital trigger thumb ctt is surgical release of the flexor pollicis longus fpl tendon by transection of the first annular a1 pulley at the thumb metacarpal head. Lack of awareness and mode of presentation creates diagnostic confusion to a majority of physicians who are not familiar with this condition. The pdf of the article you requested follows this cover page. That is when the thumb is stuck in a position of flexion. Quality of life following surgery for congenital or acquired trigger finger. Congenital trigger thumb is a rare anomaly found in children. The ring finger and thumb are most often affected by trigger finger, but it can occur in the other fingers, as well. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Introduction congenital trigger thumb is an uncommon anomaly of children. The inflammation that causes trigger finger can lead to pain, tenderness, and limited mobility other symptoms include. This causes a locking or catching of the finger with attempted. Bilateral involvement is present approximately 2530% of children. Surgical treatment of pediatric trigger thumb with. The term congenital trigger thumb is thought to be a misnomer by many surgeons, as the. 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. 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. Treatment can be conservative with finger stretching exercises, or surgical. Thumb pain, trigger thumb, bilateral everything you need to know. Trigger finger is a condition that causes pain, stiffness, and a sensation of locking or catching when you bend and straighten your finger. All babies born with these problems should have a complete assessment by a hand specialist who treats these conditions. Alternatively, trigger finger in a child is 10 times less likely to be seen than trigger thumb. Trigger thumb trigger finger congenital hand and arm.
Pediatric trigger thumb appears to be a different entity than pediatric trigger finger. Sometimes the remaining finger or thumb requires surgery for reconstruction. It is a condition that affects the movement of the thumb in children. Tf tend to develop earlier in life than trigger thumb and the spontaneous recovery rate was higher in former. Trigger thumb is one of the more common reasons for kids to present to my office.
The aim of this study was to evaluate the functional results and complications of surgical treatment of. Trigger develops as the sheath around the tendon that. Sinniah from the departments of orthopaedic surgery and pathology, national university of singapore we report triggering of the thumb in a 2yearold female child caused by intratendinous granulation tissue after trauma to the thumb. One of the most common abnormalities i see in children is a congenital trigger thumb. As in the case of adults, the primary trigger thumb symptoms are the catching or locking sensation. The aetiology has been suggested to be genetic though other. In this video, we show the open surgical release of the a1proximal transverse pulley in the thumb to restore movement in a patient with a thumb interphalangeal joint flexion deformity consistent with pediatric trigger thumb. A six year old girl presented with fixed flexion deformity of interphalangeal joints of both thumbs and nottas nodules. Yenidunya 1999 classification watanabe 2001 sugimoto 1989 instrumental diagnosis.