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The "Trigger" Thumb Locked in Extension - An Unusual Presentation of a Common Paediatric Condition
Bruce R Johnstone1, L J Currie1, Edmund W Ek1
11 Department of Plastic Surgery and Maxillofacial Surgery, Royal Children's Hospital, Melbourne, Australia.
Insights
This study describes an unusual form of paediatric trigger thumb, presenting with the thumb locked in extension. This extended trigger thumb variant, though rare, requires consideration in pediatric cases of thumb immobility.
Area of Science:
- Paediatric Orthopaedics
- Hand Surgery
- Congenital Hand Anomalies
Background:
- Presents a rare variant of paediatric trigger thumb.
- Characterized by the thumb being locked in extension, unlike the typical presentation of flexion contracture.
Purpose of the Study:
- To describe the clinical features, treatment, and outcomes of paediatric trigger thumbs locked in extension.
- To determine the incidence of this extended variant compared to the typical flexed form.
Main Methods:
- Retrospective review of 11 children (14 thumbs) with extended trigger thumb over 12 years.
- Comparison with the incidence of flexed trigger thumbs from the operating room database.
- Surgical treatment involved A1 pulley release; some cases required additional dorsal capsulotomy.
Main Results:
- Extended trigger thumb accounted for approximately 1% of surgically treated trigger thumbs.
- Most children (9/11) achieved full interphalangeal joint motion after A1 pulley release.
- One child needed bilateral dorsal capsulotomy for bilateral extended trigger thumbs; another experienced temporary flexion triggering.
Conclusions:
- Trigger thumb locked in extension is a distinct clinical entity.
- It should be considered in the differential diagnosis of paediatric thumb extension limitation.
- Surgical release of the A1 pulley is effective, with potential need for capsulotomy in complex cases.
Background:
We report a variant of paediatric trigger thumb which is locked in extension rather than flexion.
Methods:
Eleven children with 14 trigger thumbs (three bilateral) locked in extension were reviewed retrospectively over a 12-year period. The number of flexed trigger thumbs encountered over this period was established from the operating room database.
Results:
All children were treated with release of the A1 pulley. Nine children achieved a full range of motion at the interphalangeal joint. One child with bilateral extended trigger thumbs required bilateral dorsal capsulotomy and another child developed temporary mild triggering in flexion.
Conclusions:
Approximately 1% of trigger thumbs treated operatively at this institution presented as the extended variant. Trigger thumb locked in extension should be considered in a child presenting with inability to flex the thumb.
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