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The natural history of pediatric trigger thumb
Goo Hyun Baek1, Ji Hyeung Kim, Moon Sang Chung
1Department of Orthopedic Surgery, Seoul National University College of Medicine, 28 Yongon-dong, Chongno-gu, Seoul 110-744, South Korea. ghbaek@snu.ac.kr
Insights
Over 60% of pediatric trigger thumbs resolve spontaneously without intervention. Even in cases without full resolution, the thumb
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Developmental Pediatrics
Background:
- Pediatric trigger thumb involves interphalangeal joint flexion deformity in children.
- Current nonoperative treatment indications are unclear despite satisfactory surgical outcomes.
Purpose of the Study:
- To determine the spontaneous resolution rate of untreated pediatric trigger thumb.
Main Methods:
- Prospective data collection from 53 children (71 thumbs) diagnosed with trigger thumb.
- No passive stretching or splinting interventions were applied.
- Interphalangeal joint flexion deformity was measured every six months for at least two years.
Main Results:
- Spontaneous resolution occurred in 45 out of 71 thumbs (63%).
- Median time to resolution was 48 months.
- Flexion deformities improved in 22 of the 26 non-resolved thumbs.
Conclusions:
- Pediatric trigger thumb resolves without treatment in over 60% of cases.
- Improving deformity patterns are expected in non-resolved cases.
- Findings aid treatment decisions for parents and surgeons.
Background:
Pediatric trigger thumb is a condition of flexion deformity of the interphalangeal joint in children. Although the surgical outcome is satisfactory, the indications for nonoperative treatment for this condition are not clear. The aim of the present study was to determine the rate of resolution of untreated pediatric trigger thumb.
Methods:
Data on seventy-one thumbs in fifty-three children were collected prospectively. The dates of the first visits ranged from April 1994 to March 2004. Patients were diagnosed with pediatric trigger thumb during initial outpatient department visits. During the present study, no treatment such as passive stretching or splinting was applied. The amount of flexion deformity at the thumb interphalangeal joint was measured at every six-month follow-up visit, and the duration of follow-up was at least two years after diagnosis. The end point of follow-up was when the deformity caused pain or secondary deformity or prevented normal use of the hand. The median duration of follow-up was forty-eight months.
Results:
Of the seventy-one trigger thumbs, forty-five (63%) resolved spontaneously. The median time from the initial visit to resolution was forty-eight months. There was no significant difference in the pattern of resolution between patients with unilateral and bilateral trigger thumb. Although resolution was not observed in the remaining twenty-six thumbs, flexion deformities improved in twenty-two thumbs. For the first two years after the initial visit, the mean flexion deformity significantly decreased over the one-year intervals (p < 0.05).
Conclusions:
Pediatric trigger thumb can be expected to resolve without treatment in >60% of patients. Moreover, the flexion deformity can be expected to show an improving pattern in patients who do not have resolution. This information may help both parents and surgeons to make decisions regarding the treatment of pediatric trigger thumb.
