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Results of surgical release in pediatric trigger thumb
Insights
Surgical release of pediatric trigger thumb offers good outcomes. Some cases require partial oblique pulley release for full finger joint extension, ensuring high patient satisfaction.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Musculoskeletal Disorders
Background:
- Pediatric trigger thumb, or congenital stenosing tenosynovitis, affects the thumb's interphalangeal (IP) joint.
- Surgical release of the annular ligament is a common treatment, but some cases require further intervention.
Purpose of the Study:
- To evaluate the treatment outcomes of pediatric trigger thumb surgery.
- To assess the efficacy of partial oblique pulley release when initial surgery is insufficient for full IP joint extension.
Main Methods:
- A retrospective review of 21 thumbs in 17 pediatric patients treated between 2003 and 2010.
- Surgical release of the annular ligament, with 50% oblique pulley release performed if full IP joint extension was not achieved.
- Outcome measures included bowstringing, IP joint range of motion (ROM), Notta's node resolution, and patient/parent satisfaction.
Main Results:
- No significant complications like infection, neurovascular injury, or bowstringing were reported.
- Notta's node resolved in all cases, and all patients achieved improved IP joint motion without flexion contracture.
- One case of recurrent triggering occurred after 60 months; overall patient and parent satisfaction was high.
Conclusions:
- Surgical release is a recommended treatment for pediatric trigger thumb in children over one year old.
- The procedure yields satisfactory results with minimal complications.
- Partial oblique pulley release may be necessary in some cases to ensure full flexion and extension of the thumb.
Objective:
To observe and evaluate the treatment outcome of pediatric trigger thumb in patients who had undergone surgical release of the annular ligament with the oblique pulley partially released in patients who did not achieve full IP joint extension.
Material And Method:
From 2003 to 2010, 21 surgically operated thumbs in 17 patients were reviewed. Bowstringing, range of motion (ROM) of thumb interphalangeal joint, Notta's node resolution and assessment of patient/parent satisfaction were used as outcome parameters. The pulley pathology system was observed intra-operatively. The annular ligament was completely released, and in patients who were notfully corrected, a further procedure in which 50% of the oblique pulley was released was undertaken.
Results:
One thumb had recurrent triggering after 60 months of follow-up. No infection, neurovascular injury, excessive scarring, or bowstringing were detected. Notta's node was fully resolved in all operated thumbs. Mean follow-up was 64 months. Improved IP joint motion without flexion contracture was observed in all patients. The procedure was well tolerated by patients and both the patients and parents of patients expressed satisfaction with the results of the procedure.
Conclusion:
Surgical release is recommended for children aged more than one year that are afflicted with trigger thumb. This procedure delivers satisfactory results with minimal complications. To achieve full FPL excursion, some patients need to release 50% of the oblique pulley after the first procedure.
