Quantitative Measurements of the Cross-sectional Configuration of the Flexor Pollicis Longus Tendon Using Ultrasonography in Patients With Pediatric Trigger Thumb

Kim, Jihyeung; Gong, Hyun Sik; Seok, Hyun Sik; Choi, Young Hun; Oh, Sohee; Baek, Goo Hyun

doi:10.1016/j.jhsa.2017.08.011

Cited by 13 publications

(14 citation statements)

References 20 publications

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“…Although pediatric trigger thumb and digit have been well described in the literature, the exact cause of the condition has been debated by many authors. A basic size discrepancy between the tendon sheath and its contents, which impedes tendon motion, is well accepted as the mechanism for the restriction of digit motion 9 ; however, the exact underlying pathology leading to this mismatch is still unproven. Twin studies have been performed and reviewed by Brinkman et al, 10 who examined 7 cases of trigger digits in twins, suggesting an inherent congenital predisposition of this condition.…”

Section: Discussionmentioning

confidence: 99%

Pediatric Trigger Digit Presenting in the Setting of Trauma

et al. 2021

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Background Pediatric trigger digit is a relatively rare condition with incompletely understood etiology. In our practice, we noted a series of children presenting with pediatric trigger digit after an associated local trauma to the hand, which has not been previously described. The aim of this study was to analyze the nature of presentation of trigger digits, the accuracy of initial diagnosis, and the impact on treatment strategies used. Methods An institutional review board–approved retrospective review of our institution's experience with pediatric trigger finger from 2001 to 2015 was performed. Results Twenty-two patients with 26 affected digits were identified. Eighty-eight percent of patients were diagnosed with trigger thumb, whereas 3 patients (12%) had small finger triggering. Thirteen patients (59%) presented as outpatients, whereas 9 (41%) presented through the emergency department. All patients presenting to the emergency department were in the setting of recent minor trauma. Of this subset of patients, 67% had an incorrect initial diagnosis, leading to an average delay in treatment of 60 days. Ten patients (45% of total) were initially treated with immobilization versus surgical release of the A1 pulley. However, all but 2 of these patients required eventual A1 pulley release for persistent or recurrent triggering (88%). Conclusions The cause of trigger digit in children remains incompletely understood and may be multifactorial. In this series, a traumatic component to presentation was found in a significant number of patients. This association with minor trauma may contribute to misdiagnosis and delay in definitive treatment. Although initial treatment with immobilization does not seem to impact surgical outcome, we found a high rate of failure with initial immobilization. Most patients required eventual surgical management, regardless of whether or not the initial presentation was associated with trauma. When performed, we found that A1 pulley release alone has safe, reliable results.

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Section: Discussionmentioning

confidence: 99%

Pediatric Trigger Digit Presenting in the Setting of Trauma

et al. 2021

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“…Recently, clinical assessments using ultrasonography were reported [26,27]. These results showed that focal enlargement of the FPL and the inner dimensional area under the A1 pulley was larger in trigger thumb cases.…”

Section: Discussionmentioning

confidence: 99%

Clinical results of splinting versus observation for pediatric trigger thumb

Yano¹,

Ikeda

Yoneda³

et al. 2020

Journal of Pediatric Orthopaedics B

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Patients with pediatric trigger thumb present with fixed contracture of the interphalangeal joint (IPJ) or snapping of the thumb. We applied a hand-based dynamic splint using coils at the IPJ. The aim of this study was to report the clinical outcomes of splint therapy versus observation. One hundred twenty-nine thumbs (112 patients and 57 boys) were examined retrospectively. At initial presentation, parents selected the treatment after explanation of pathology and consents were obtained. Treatment was concluded when full extension or resolution of the involved IPJ was achieved; alternatively, surgical treatment was offered for patients who failed to improve. Improvement in extension loss to 0º and hyperextension was defined as resolution of the IPJ. Surgery was not selected as a first-line treatment strategy in any of the cases in this study. The rate of resolution was 59% at 31 months of follow-up in the splint group (99 thumbs) and 43% at 30 months in observation group (30 thumbs); there was no significant difference between the groups (P = 0.15). Twenty-one thumbs showed locking of the IPJ in the extended position during splint therapy, but all recovered with a 71% rate of resolution. The splint group showed a higher rate of resolution than the observation group; however, there was no significant difference between therapies. Our study showed that 55% of patients with pediatric trigger thumb showed resolution following conservative treatment for an average of 30 months until surgery could be performed under local anesthesia. Splint therapy and observation are viable treatment options prior to surgery.

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“…Some have theorized a congenital predisposition of stenosis of the proximal pulley, and others have attributed it to posttraumatic changes from repeated injury to the flexor tendon 7,10,11 . Ultrasound has identified a larger-than-normal size of the FPL compared with the size of the contralateral, uninvolved FPL tendon and no identifiable abnormality of the A1 pulley 12,13 . Sugimoto classified pediatric trigger thumb into 4 stages (Table I) 14,15 .…”

Section: Pediatric Trigger Thumbmentioning

confidence: 97%

Congenital Disorders of the Pediatric Thumb

Nguyen

2022

JBJS Reviews

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» Surgical timing for pediatric trigger thumb treatment is controversial for numerous reasons including the potential for spontaneous resolution, the possibility of bilateral involvement, and anesthesia concerns regarding the developing brain. Hence, a reasonable approach is to delay the surgical procedure until the patient is ≥3 years of age.» Preaxial polydactyly is usually unilateral and sporadic, with the most common reconstruction method consisting of excision of the diminutive thumb with preservation and soft-tissue reconstruction of the dominant thumb. The surgical procedure is typically performed around the patient age of 1 year to decrease the risks of anesthesia but allow reconstruction prior to the development of a tip-to-tip pinch.» Triphalangeal thumb and thumb hypoplasia are often found in the setting of systemic anomalies such as Holt-Oram syndrome, thrombocytopenia absent radius syndrome, Fanconi anemia, VACTERL (vertebral anomalies, anal atresia, cardiac anomalies, tracheoesophageal fistula, renal defects, and limb anomalies), and/or Blackfan-Diamond anemia. As such, patients should receive adequate workup for these entities. A surgical procedure should be performed only once patients have been medically cleared.» The status of the carpometacarpal joint in thumb hypoplasia determines whether reconstruction with first web space deepening, collateral ligament stabilization, and opponensplasty compared with index pollicization is performed.

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Quantitative Measurements of the Cross-sectional Configuration of the Flexor Pollicis Longus Tendon Using Ultrasonography in Patients With Pediatric Trigger Thumb

Cited by 13 publications

References 20 publications

Pediatric Trigger Digit Presenting in the Setting of Trauma

Pediatric Trigger Digit Presenting in the Setting of Trauma

Clinical results of splinting versus observation for pediatric trigger thumb

Congenital Disorders of the Pediatric Thumb

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