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The natural history of pediatric trigger thumb: a study with a minimum of five years follow-up
1Department of Orthopedic Surgery, Seoul National University College of Medicine, Korea. ghbaek@snu.ac.kr
Insights
Pediatric trigger thumb often resolves spontaneously, with over 75% of cases showing improvement after a 5-year follow-up. This suggests delaying surgery for pediatric trigger thumb may be beneficial.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Developmental Pediatrics
Background:
- Pediatric trigger thumb involves interphalangeal joint flexion deformity.
- Previous studies indicated spontaneous resolution in over 60% of cases within 48 months.
- Long-term natural history requires further investigation.
Purpose of the Study:
- To assess spontaneous resolution rates of pediatric trigger thumb with follow-up exceeding 5 years.
- To identify any residual deformities after extended follow-up.
- To confirm the natural history and inform treatment decisions.
Main Methods:
- Prospective follow-up of 87 thumbs in 67 pediatric patients.
- No active treatments (stretching, splinting, surgery) were administered.
- Median follow-up duration was 87.3 months (range: 60-156 months).
Main Results:
- Spontaneous resolution occurred in 66 of 87 thumbs (75.9%).
- Median resolution time was 49.0 months; no residual deformities were noted beyond 48 months.
- Flexion deformities improved in all non-resolved thumbs; no gender-based differences observed.
Conclusions:
- Over 75% of pediatric trigger thumb cases resolve spontaneously by 5 years.
- Surgery can likely be delayed or avoided in many instances.
- Findings aid families and surgeons in making informed treatment choices for pediatric trigger thumb.
Background:
Pediatric trigger thumb is due to deformed flexion of the interphalangeal joint. We previously reported that pediatric trigger thumb can spontaneously resolve in > 60% of patients at the median follow-up of 48 months. The purpose of this study was to determine whether there were any more cases of resolution with a follow-up of more than 5 years and whether any residual deformities remain, and so to confirm the natural history of pediatric trigger thumb.
Methods:
We prospectively followed 87 thumbs in 67 patients with pediatric trigger thumb and these patients didn't receive any treatment such as passive stretching, splinting or surgery. The date of the first visit ranged from April 1994 to March 2005. The patients were evaluated every six-months prior to resolution and annually after resolution. The median duration of follow-up was 87.3 months (range, 60 to 156 months).
Results:
Of the 87 trigger thumbs, 66 (75.9%) resolved spontaneously. The median time from the initial visit to resolution was 49.0 months (95% confidence interval, 41.1 to 56.9). There were no residual deformities that resolved beyond 48 months. Although complete resolution did not occur in the remaining 21 thumbs, the flexion deformities did improve in all 21 thumbs. There were no other differences between the two groups besides the average duration of follow-up. There was no difference in resolution based on gender.
Conclusions:
Pediatric trigger thumb can spontaneously resolve in > 75% of the cases after a follow-up period of at least 5 years. An operation may be delayed or avoided in the majority of cases. This may help both the families and the surgeons make decisions regarding the proper treatment of pediatric trigger thumb.