[THE CONGENITAL TRIGGER THUMB - CLINICAL PRESENTATION AND TREATMENT]

Congenital trigger thumb is found in 0.3% of all children. There is an ongoing debate whether the finding of a congenital trigger thumb is truly congenital or is developmental, although the current tendency in the literature is to see it as a developmental finding. When a toddler is found to have a thumb with the interphalangeal joint locked in flexion there are a number of differential diagnoses to be considered. Absence or aberrance of the extensor mechanism, arthrogryposis, spasticity and the clasped thumb deformity all may explain this finding. The most common diagnosis of a toddler found with his thumb locked in flexion or extension is the congenital trigger thumb. Clinical inspection will reveal, in most cases, a distinct nodule at the base of the thumb named Notta's Node, and a thumb fixed in either flexion or extension at the interphalangeal joint. A trial of conservative treatment extending for at least six months should be made, but once this fails, surgical intervention is the rule of thumb. Surgical intervention consists of ligation of the A1 pulley while preserving structures in its vicinity.