Article

Pediatric trigger thumb

Department of Orthopaedic Surgery, Children's Hospital, Boston, MA 02115, USA.
The Journal of hand surgery (Impact Factor: 1.66). 10/2008; 33(7):1189-91. DOI: 10.1016/j.jhsa.2008.04.017
Source: PubMed
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    ABSTRACT: Introduction: Trigger finger is a rare condition in children, affecting mainly the thumb. The aim of this study was to evaluate the functional results and complications of surgical treatment of trigger thumb in children. Methods: We retrospectively evaluated all patients with surgically treated between January 2002 and August 2011. We evaluated interphalangeal range of motion and complications such as infection or sensory deficit. A satisfactory result indicated no triggering and full range of motion. Parents were asked about satisfaction of the procedure. Results: We performed 45 surgeries in the evaluated period; 31 patients (38 thumbs) could be located and evaluated (17 female and 14 male). Average age at time of surgery was 2.4 years (range: 1.7 to 7.2 years). Average follow-up was 4.7 years (range: 1-9 years). Three cases (8%) had recurrence and required subsequent release. All patients recovered full range of motion. There were no residual flexion contractures or sensory deficit. Two patients (5%) had superficial wound infection. Both responded favorably to oral antibiotic therapy. Parents reported satisfaction with the treatment. Conclusion: Open release of the A1 pulley is a safe and effective procedure for the treatment of trigger thumb in the pediatric population, with a low rate of recurrence and complications. Level evidence: IV
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    ABSTRACT: Although percutaneous trigger thumb release has been extensively used in adults, the technique is not widespread in children. The purpose of this study was to evaluate the efficacy and safety of percutaneous trigger thumb release in the pediatric age group. Twenty consecutive thumbs of 15 patients scheduled for surgical release of the A1 pulley were included in this cohort. Each patient received first the percutaneous release (PR) followed by an open release (OR) and served as self-controls. Thumb extension was assessed immediately before PR, after PR, and finally after OR, using a goniometer. Extent of the A1 pulley release, iatrogenic injury to the digital nerve and vessels, and flexor tendon laceration was assessed after PR. The distance between the PR and the digital nerve was measured in millimeters. Comparison between thumb extension after PR and OR was made using a paired t test. Preoperative range of motion averaged -45.2±21.7 degrees loss of extension (range, -80 to -10 degrees), decreased to -4±8 degrees loss of extension (range, -25 to 0 degrees) after PR, and to 0 degrees after OR. Clinically, release was complete in 14 cases (70%) and partial in 6 cases (30%). Once the thumb was approached, we confirmed that A1 pulley was completely cut in 4 cases (20%), to >75% in 2 cases (10%), and between 50% and 75% in the remaining 14 cases (70%). There were no neurovascular iatrogenic injuries. Mean distance between the needle and the digital nerve was 2.45±0.9 mm (range, 1 to 4 mm). Lacerations to the flexor tendons were observed in 80% of the cases. We do not recommend PR in the pediatric thumb given the risk of neurovascular iatrogenic injury or incomplete A1 pulley release. Level II therapeutic study-prospective comparative study.
    Journal of pediatric orthopedics 12/2013; 34(5). DOI:10.1097/BPO.0000000000000119 · 1.43 Impact Factor
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    ABSTRACT: Although it can be reasonably assumed that trigger digits occur as the result of a size mismatch in the pulley-tendon system, it is unclear whether locking, histological changes, and nodule formation occur owing to an intrinsically too small pulley or an enlarged digital flexor tendon. Our purposes in this feasibility study were to (1) create a model of trigger digit by pulley constriction in nonpreserved human tissue, (2) measure the change in work of flexion as the force of pulley constriction increased, (3) compare the work of flexion between nontriggering and triggering conditions, and (4) determine whether triggering can occur at the A2, A3, and A4 pulleys under similar conditions. Using a tensiometer, we studied the work of flexion in 4 fingers (thumb, index, middle, and ring) in a human cadaveric hand. The load of flexion was measured as the A1 to A4 pulleys were incrementally constricted in order to induce triggering. Work of flexion was analyzed for differences among trial conditions. Triggering was successfully induced in all 4 digits through constriction of the A1 pulley. No triggering occurred in any of the A2, A3, or A4 pulley systems in this model. We successfully created a trigger model in a human cadaveric hand. Our results demonstrate that the A1 pulley can cause triggering from manual constriction of the pulley alone. A trigger model such as this may allow investigations of pathophysiology, and this may result in novel treatment strategies and modalities.
    The Journal of hand surgery 08/2013; 38A(10). DOI:10.1016/j.jhsa.2013.06.033 · 1.66 Impact Factor