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The association between trauma and paediatric trigger thumb deformity; experience from a single tertiary referral
Nadia L Salloum1, Pauline McGee1, Wee L Lam1
1Department of Plastic, Reconstructive and Hand Surgery, St John's Hospital, Livingston, UK.
Insights
Trauma may expedite trigger thumb development in predisposed children, but a single injury is unlikely to be the sole cause. This study reviewed 75 pediatric trigger thumb cases, finding trauma in 28%.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Developmental Pediatrics
Background:
- The etiology of trigger thumb (stenosing tenosynovitis) in children is not well understood.
- While management is established, the underlying causes, whether congenital or acquired, require further investigation.
- A history of trauma is frequently reported in some trigger thumb cases.
Purpose of the Study:
- To investigate the role of trauma in the etiology of trigger thumb in pediatric patients.
- To analyze the clinical presentation and timing of onset in children with trigger thumb following a traumatic event.
- To determine if trauma is a causative factor or a precipitating event in trigger thumb development.
Main Methods:
- Retrospective review of 75 trigger thumb cases in 65 consecutive pediatric surgical patients.
- Analysis of patient history for traumatic events preceding trigger thumb presentation.
- Comparison of age at presentation and time to presentation between traumatic and atraumatic groups.
Main Results:
- 28% of affected digits had a reported history of thumb trauma.
- Of those with trauma, 90% presented with immediate post-injury flexion deformity.
- Children with a traumatic history were younger (median 27 months vs. 37.5 months) and presented earlier (1 day vs. 12.17 months).
Conclusions:
- A single traumatic event is unlikely to be the sole cause of trigger thumb in children.
- Trauma may act as a precipitating factor in children genetically predisposed to trigger thumb.
- Early presentation with flexion deformity post-trauma suggests a potential link in susceptible individuals.
Abstract:
Whilst the natural history and management of trigger thumb have been thoroughly investigated, the aetiology of the condition remains poorly understood. There are suggestions that this could be a congenital or acquired condition, but evidence remains limited. A history of trauma has repeatedly been noted in a proportion of patients presenting with trigger thumb. This retrospective study reviewed the presentations of 75 cases of trigger thumb in 65 consecutive children who underwent surgery for trigger thumb. We found that 28% of affected digits presented with a traumatic history to the thumb, of those 90% presented immediately post-injury with a flexion deformity. Those who presented with a traumatic history were typically younger at presentation (median age 27.0 months compared to 37.5 months for traumatic and atraumatic presentations respectively) but also tended to present earlier than the atraumatic group (one day compared to 12.17 months respectively). We conclude that a single traumatic event is unlikely to be the causative factor in the development of trigger thumb in children but it may expediate the development of individuals who are predisposed.
