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

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