Saturday, July 21, 2018

Trigger Thumb and Fingers

Trigger thumb is one of the more common reasons for kids to present to my office.  While uncommon in the general population, for hand surgeons who treat children, trigger thumb is quite common.  And, thankfully, kids do quite well with this condition.  Some will improve on their own without surgical intervention and others require surgery and do well.   I have other posts on this topic which can be found HERE.  Most trigger thumbs in kids are locked (the thumb is stuck in a position of flexion).

Surgery is quite reliable for trigger thumb.  95% or more are cured with a straightforward, 5- minute surgery.  My personal protocol is a small, 1-cm incision closed with dissolving stitches.  We put numbing medicine in at the time of surgery and most kids never require pain medication.  The most common complication is a superficial infection treated with antibiotics by mouth.  Other complications are incredibly uncommon.

Unfortunately, there can be a less than perfect outcome.  This patient is a 5 year old female who was treated surgically for bilateral trigger thumbs at another hospital.  Unfortunately, her symptoms did not improve.  This video demonstrates that her thumb catches when she tries to bend it.  We performed a revision surgery to correct the residual catching.

Pediatric Trigger Thumb


Trigger finger is much less common compared to trigger thumb.  It can be helped with therapy and splinting but occasionally surgery is required.  This video shows the finger catching with bending.  While treating a trigger thumb in a child or adult requires a similar surgery, trigger finger surgery can be quite different.  A pediatric trigger finger surgery can be more complex and requires a step-wise approach to care.
Pediatric Trigger Finger Video demonstrating catching.




Charles A. Goldfarb, MD
My Bio at Washington University
congenitalhand@wudosis.wustl.edu

Sunday, July 15, 2018

Extra Thumb Reconstruction

I have posted a number of times on radial polydactyly- aka split thumb, extra thumb, etc- HERE.  This is a common birth anomaly and the decision for surgery is usually straightforward.  Sometimes surgery is also straightforward while other times the reconstruction can be quite challenging.  And, about one out of three patients with radial polydactyly will need a second surgery at some point down the road.

I wanted to briefly share images of one patient who recently came back for repeat assessment after reconstruction for a somewhat complex radial polydactyly reconstruction.  Here is one picture before surgery in the clinic.  Note that the inner thumb is larger, clearly the dominant thumb.

Radial polydactyly

Here are other pictures before surgery from top and bottom.
Radial polydactyly from the palm view.

Radial polydactyly from top view

In surgery, we removed the outer, smaller thumb and realigned the remaining thumb with a cutting of the bone.  We also created a new ligament to support the thumb.  The metal pin is left in place for about 6 weeks with a cast.

The thumb after reconstruction for radial polydactyly.

Another view after reconstruction for radial polydactyly

Here is the patient/ thumb about 6 months after surgery.  He has fully incorporated the thumb into daily use. The thumb is stable and has reasonable motion.  Importantly, despite a very successful surgery for radial polydactyly, when we compare the thumbs, the smaller size of the new thumb is clear.  That is why some of us prefer the term 'split thumb' which emphasizes that even after surgery, the thumb will be smaller.  However, the thumbs will typically look great and unless directly compared as in the pictures, this size difference does not affect function and does not dramatically affect appearance.
Smaller thumb after radial polydactyly reconstruction.

Thumb after reconstruction for radial polydactyly

I typically follow patients for a few years after surgery to assure no early problems develop and, of course, welcome families to come back anytime if issues are noted.  Overall, reconstruction for radial polydactyly is usually a very successful surgery providing a highly functional thumb which works well and looks near normal.

Charles A. Goldfarb, MD
My Bio at Washington University
congenitalhand@wudosis.wustl.edu