[THE CONGENITAL TRIGGER THUMB - CLINICAL PRESENTATION AND TREATMENT]
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Published on: May 26, 2023
Hagay Amster Kahn1, Sveta Terletzky1, Niv Netser1
1Department of Orthopedic Surgery, Kaplan Medical Center, Rehovot, Israel.
Insights
Congenital trigger thumb, a common developmental issue in children, often presents with a locked interphalangeal joint. Surgical intervention is typically recommended if conservative treatments fail.
Area of Science:
- Pediatric Orthopedics
- Developmental Biology
Background:
- Congenital trigger thumb affects 0.3% of children, often viewed as a developmental rather than congenital condition.
- Differential diagnoses include extensor mechanism issues, arthrogryposis, spasticity, and clasped thumb deformity.
- The condition typically presents with a nodule (Notta's Node) and a fixed interphalangeal joint.
Purpose of the Study:
- To summarize the understanding and management of congenital trigger thumb in toddlers.
- To highlight the diagnostic features and treatment pathways for this condition.
Main Methods:
- Review of current literature on congenital trigger thumb.
- Clinical diagnostic criteria and treatment outcomes analysis.
Main Results:
- Congenital trigger thumb is the most common diagnosis for toddlers with a locked thumb.
- Conservative treatment for at least six months is recommended.
- Surgical intervention, involving A1 pulley ligation, is indicated if conservative measures fail.
Conclusions:
- Congenital trigger thumb is a prevalent developmental condition requiring timely diagnosis.
- A structured approach involving conservative management followed by surgical release is effective.
Introduction:
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.
