Pediatric Trigger Finger Surgery: Options and Concerns

Surgical procedure for pediatric trigger finger?

Hello, my child is currently 2 years and 3 months old and has trigger thumb in both hands! We have been undergoing rehabilitation for almost two months now, but he is unwilling to cooperate with wearing the splint for stabilization, so the effectiveness seems limited! If we consider surgery for pediatric trigger thumb, I have come across two methods:
1.
Traditional open surgery to release the pulley, which, although the incision is small, requires keeping the wound dry for ten days along with bandaging.
It is nearly impossible to expect a child to patiently endure this, and I have also heard that it requires general anesthesia, which is quite concerning!
2.
Percutaneous ligament release surgery—reportedly, it has a smaller incision and does not require anesthesia, but a child will not stay still for the procedure!
Currently, I hope to have my child undergo "percutaneous ligament release surgery," but I have several questions:
Q1: Is the method for percutaneous ligament release surgery to use a needle to incise the pulley? Is it similar to traditional surgery, just with different tools?
Q2: Can "percutaneous ligament release surgery" effectively resolve trigger thumb in children?
Q3: Is it possible to perform "percutaneous ligament release surgery" while the child is asleep, considering the surgery duration is at most 10 minutes?
Q4: Is it feasible to use a small amount of medication to sedate the child for the surgery?
Q5: Which hospitals north of Hsinchu can perform "percutaneous ligament release surgery" for children, preferably with successful case recommendations?
Q6: If trigger thumb is left untreated, what impact could it have on the future growth of the child's hand?

danxin, 30~39 year old female. Ask Date: 2009/08/26

Dr. Shi Qiming reply Orthopedics

1.
Percutaneous tenotomy of the pulley is performed using a needle incision, while traditional surgery involves a scalpel incision.

2.
For pediatric trigger finger, due to the small size of the tendon sheath, percutaneous surgery is not recommended.
Our hospital has not performed percutaneous procedures for pediatric trigger finger; it is advisable to consult Professor Chou Yi-Ming at Cheng Kung University Hospital.

3.
Trigger finger varies in severity; if it interferes with the ability to pinch or grasp, surgical intervention is recommended.
It is advisable to take your child to a pediatric orthopedic outpatient clinic for further evaluation and treatment.

Reply Date: 2009/08/26

More Info

Pediatric trigger finger, or "板機指," is a condition where the finger gets stuck in a bent position due to a thickening of the tendon sheath. In young children, this condition often affects the thumb and can lead to difficulties in hand function. Given your child's age of 2 years and 3 months, it is understandable that you have concerns about treatment options, particularly regarding surgery.

Understanding Surgical Options
1. Traditional Surgery: This involves making an incision to release the pulley that is constricting the tendon. While this method is effective, it does require general anesthesia, and the recovery process can be challenging for young children. Keeping the wound dry and properly bandaged for about ten days can be difficult, especially with a toddler who may not understand the need to keep the area protected.

2. Percutaneous Release: This technique involves using a needle to cut the constricted area of the tendon sheath. It is less invasive, typically results in a smaller wound, and may not require general anesthesia. However, the challenge lies in keeping the child still during the procedure, which can be difficult for young children.

Addressing Your Questions
Q1: The percutaneous release does involve using a needle to cut the pulley, but it is not identical to traditional surgery. The tools differ, and the approach is less invasive, which can lead to quicker recovery times.

Q2: While percutaneous release can be effective for trigger finger in adults, its application in young children is less common due to the small size of their tendon sheaths. Many pediatric orthopedic specialists may prefer traditional surgery for better outcomes.

Q3: Performing the procedure while the child is asleep is possible, especially if sedation is used. However, the method of sedation would need to be discussed with the anesthesiologist and the surgeon to ensure safety and effectiveness.

Q4: Using a small amount of medication to sedate the child for the procedure is a viable option, but it must be done under medical supervision. The anesthesiologist will determine the appropriate type and dosage of sedation based on the child's health and the specifics of the procedure.

Q5: For hospitals that perform percutaneous release in children, you may want to consult with pediatric orthopedic specialists in larger medical centers in northern Taiwan, such as National Taiwan University Hospital or Chang Gung Memorial Hospital. It is essential to inquire about their experience with this specific procedure in children.

Q6: If trigger finger is left untreated, it can lead to long-term issues with hand function. The child may develop compensatory patterns that could affect the growth and development of the hand. Early intervention is crucial to prevent potential complications, including stiffness or permanent deformity.

Conclusion
In summary, while both surgical options exist for treating pediatric trigger finger, the choice largely depends on the specific circumstances of your child's condition, including the severity of the trigger finger and the child's overall health. Consulting with a pediatric orthopedic specialist who has experience with both methods will provide you with the best guidance tailored to your child's needs. Early intervention is key to ensuring optimal hand function and preventing long-term complications.

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