There are multiple websites which detail trigger finger diagnosis and treatment. The AAOS (American Academy of Orthopaedic Surgeons) is a great site and the following link is as good as any.
Trigger digits in kids are very different and again, we don’t know why. A couple of thoughts.
1) Most importantly, it is almost always a trigger thumb. Trigger fingers are rare in kids but trigger thumbs are “common,” at least in my world.
2) The term congenital (meaning present at birth) is often used in describing trigger digits/ thumbs in kids. This is not accurate. There are several (at least 3) studies which look at a large number of newborns and trigger thumbs just don’t exist. The appear later. So the best term is pediatric trigger thumb.
3) Kids almost always present with the thumb in a bent or flexed position at the distal joint- the IP joint. Typically it is stuck in that position. Occasionally, kids can straighten the thumb but usually it is just stuck.
4) It doesn’t hurt. Because it is stuck, there is no pain.
5) Function is usually pretty good but we worry about function over time- in school with writing and scissorts, etc.
For those who see kids with trigger thumbs or fingers, the diagnosis is clear. The thumb is stuck in a bent position and sometimes there is swelling at the base of the thumb (MCP joint). We call this a “Notta’s node” and it is where the tendon gets stuck in the sheath. We don’t need x-rays or MRIs.
Treatment for trigger thumbs or fingers.
There are 3 options for treatment.
1) Ignore it as it might get better. This is not unreasonable given that it doesn’t hurt but in our experience, rarely does this go away on its own. But, a 6- month trial of watchful waiting is certainly a reasonable plan. This is the recommendation from Korea with a good study supporting that it will help. Dr Baek is an extremely well respected surgeon who has written on many topics in kids hand surgeries. In his study, 4 years after the first visit, about 60% of kids had resolved and another 20% were improved. http://www.ncbi.nlm.nih.gov/pubmed/18451388 These are impressive numbers but obviously require some patience from the patient, family, and surgeon.
2) Stretch and splint. There is little data to support splinting of the thumb but there is actually good data to support considering a splint and/ or stretching for trigger finger. http://www.ncbi.nlm.nih.gov/pubmed/22624785
3) Surgery. Surgery works for pediatric trigger thumb. It is a small surgery, it is outpatient and takes less than 10 minutes. Patients have little pain after and most heal uneventfully with a cure. Complications are rare and include a risk of infection (likely around 1/200) and scarring. It does require a general anesthetic but again, minimal risks. Trigger finger surgery may be more complicated as it can require a more extensive operation compared to trigger thumb. It is just less predictable. Still effective and reliable.
The decision of when to go to surgery is not easy. It depends on the family perspective, the time that the trigger finger has been present, and the surgeon’s beliefs. For me, a conversation between the family and myself helps to bring all the issues out and guide the decision. In the USA, we tend to be more aggressive than our Asian counterparts about the decision of when to go to surgery.
This is a case of a pediatric trigger finger. Again, much less common than trigger thumbs. This case had a swelling or “Notta’s node” at the A1 pulley which limited extension. At surgery, the A1 pulley was released and the finger extended. Additional surgical dissection was not required and the patient’s condition resolved.
|Pediatric trigger finger which is more rare than trigger thumb. Not the flexed position of the finger. It could not be straightened.
|I am trying to straighten the finger but it is blocked in this pediatric trigger finger.
|Bilateral trigger thumb. Photos courtesy of my partner, Dr Wall.
|Trigger thumb. We are trying to straighten the thumb but it is locked. Photo courtesy of Dr Wall.