Trigger Thumb in Children: Causes, Treatments, and Surgery Risks

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Hello Doctor: I would like to ask about a 2-year-and-1-month-old child who was hospitalized for gastroenteritis and received IV fluids.
On the second day of hospitalization, the child began to complain of pain in the right hand, and it was discovered that the right thumb could not move upward, only downward.
Upon examination, there was a protrusion below the thumb.
The physician diagnosed it as congenital trigger thumb and recommended surgery.
However, the child did not exhibit this symptom upon admission (thus making it hard to accept the diagnosis as congenital).
Is there a possibility that the condition developed due to the use of a splint while receiving IV fluids? Additionally, aside from surgery, are there any other treatment options available, such as medications? What are the risks and success rates associated with the surgery? Thank you.

Eugene, 0~9 year old female. Ask Date: 2008/09/21

Dr. Chen Xingyuan reply Orthopedics

Dear Readers,
Trigger finger, also known as stenosing tenosynovitis, occurs when the flexor tendon in the finger forms a nodule at the base of the finger, causing the finger to catch or lock when trying to straighten it.
This results in an inability to fully extend the finger or resistance when straightening, resembling the action of a trigger, hence the name "trigger finger." Many children are born with this condition, which is considered congenital; however, many patients develop it later in life, thus it is termed acquired.
Congenital trigger finger is often part of a compression phenomenon, as the fingers are continuously compressed in a bent position, leading to increased stiffness and severity.
Acquired trigger finger is more commonly associated with injury, blood clot formation, or repetitive use causing inflammation, which allows for a greater chance of reversible changes, making it generally milder.
While any finger can be affected, the thumb has the highest incidence of trigger finger, especially in children, where it almost exclusively occurs in the thumb.
Congenital trigger finger is typically identified at birth or within the first 1-2 years of life, with most cases presenting as an inability to straighten the thumb.
It is mostly non-hereditary, and about 30% of patients may resolve spontaneously before the age of one.
If it does not resolve on its own, surgical intervention is recommended by age two, and should not exceed age three to prevent excessive contracture of the finger, which can complicate correction and affect normal hand function development.
Most children can recover to normal function through rehabilitation treatments such as massage and stretching exercises.
For adults, localized injections yield relatively better results; however, injections are generally not suitable for children with trigger finger and tend to be ineffective.
If the finger is completely locked or there is persistent pain, and various conservative treatments fail, surgical intervention may be necessary.
The goal of surgery is to release the constricted pulley that is trapping the nodule, and the procedure typically takes only about 10 minutes with significant results.
However, surgery in children requires general anesthesia, and due to the small size of their nerves and blood vessels, there is a higher risk of tissue damage during the procedure.
Therefore, it is recommended to observe for three months and undergo rehabilitation treatment; if no improvement is seen, surgery is the best option.
Wishing you health and safety!
Sincerely,
Dr.
Chen

Reply Date: 2008/09/21

More Info

Trigger thumb, also known as stenosing tenosynovitis, is a condition that can affect children, particularly those under the age of 5. It occurs when the tendons that control the movement of the thumb become inflamed and thickened, leading to a locking or catching sensation when the thumb is moved. In your case, your 2-year-old daughter developed this condition after being hospitalized for gastroenteritis, which raises some important considerations regarding the potential causes and treatment options.

Causes of Trigger Thumb in Children
While trigger thumb can be congenital (present at birth), it can also develop due to various factors, including repetitive motion or trauma. In your daughter's case, the timing of her symptoms following hospitalization raises the question of whether her condition could have been influenced by the immobilization of her hand during the IV treatment. Although it is less common, prolonged immobilization can lead to stiffness and inflammation in the tendons, potentially contributing to the development of trigger thumb.

Treatment Options
1. Non-Surgical Treatments:
- Rest and Activity Modification: Allowing the thumb to rest and avoiding activities that may exacerbate the condition can be beneficial.
- Splinting: A splint may be used to keep the thumb in a neutral position, which can help reduce inflammation and allow the tendon to heal.

- Physical Therapy: Gentle stretching and strengthening exercises may be recommended to improve mobility and function of the thumb.

- Medications: Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help reduce pain and inflammation.

2. Surgical Treatment:
- If conservative measures do not provide relief, surgery may be considered. The procedure typically involves releasing the constricted tendon sheath to allow for smoother movement of the tendon.
- The success rate for surgery is generally high, with many children experiencing significant improvement in thumb function post-operatively. However, as with any surgical procedure, there are risks involved, including infection, nerve injury, and the possibility of recurrence.

Risks and Considerations
When considering surgery, it is essential to weigh the potential benefits against the risks. The surgical procedure for trigger thumb is usually straightforward and performed on an outpatient basis. However, complications, while rare, can occur. It is crucial to discuss these risks with your child's surgeon, who can provide detailed information based on your daughter's specific case.

Conclusion
In summary, while your daughter's trigger thumb may have been diagnosed as congenital, it is essential to consider the context of her recent hospitalization and treatment. Non-surgical options should be explored first, and if these do not yield satisfactory results, surgery may be warranted. It is advisable to follow up with a pediatric orthopedic specialist who can provide a comprehensive evaluation and discuss the most appropriate treatment plan tailored to your daughter's needs. Regular monitoring and communication with healthcare providers will ensure that any changes in her condition are addressed promptly.

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