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Paediatric Trigger-Locked Thumb
Carlton Fernandes1, Katherine Dong2, Ghazi Rayan3
1Department of Orthopedic Surgery, University of Oklahoma Health Sciences, Oklahoma City, Oklahoma, US.
Insights
Paediatric trigger-locked thumb (PT-LT) is a common condition causing thumb flexion deformity. Treatment varies based on age, presentation, and type, including observation, splinting, therapy, or surgery.
Area of Science:
- Orthopedics
- Pediatric Hand Surgery
Background:
- Paediatric trigger-locked thumb (PT-LT) is a frequent pediatric thumb condition.
- It involves an acquired flexion deformity of the interphalangeal joint due to tendon-pulley size discrepancy.
Purpose of the Study:
- To describe the clinical presentation, classification, and treatment of paediatric trigger-locked thumb.
- To provide an overview of management strategies for this condition.
Main Methods:
- Classification of paediatric locked thumb into Type I (no MCPJ hyperextension) and Type II (with MCPJ hyperextension).
- Review of treatment modalities including observation, splinting, therapy, and surgical intervention.
Main Results:
- PT-LT can present as a locked or trigger thumb.
- Surgical treatment involves pulley release, specifically the A1 and oblique pulleys.
Conclusions:
- Treatment decisions for PT-LT are individualized based on patient factors and condition type.
- Effective management strategies range from conservative measures to surgical release of the affected pulleys.
Abstract:
Paediatric trigger-locked thumb (PT-LT) is a common paediatric thumb condition. It is an acquired flexion deformity of the interphalangeal joint because of a size mismatch between an enlarged flexor pollicis longus tendon and a stenotic oblique pulley. It may present clinically as paediatric locked thumb which is more common or infrequently as paediatric trigger thumb. Paediatric locked thumb is classified into two types based on the presence of metacarpophalangeal joint (MCPJ) hyperextension. Type I does not have MCPJ hyperextension, whereas type II is associated with MCPJ hyperextension. The treatment of PT-LT is determined by the patient's age, time of onset, presentation, and type. Treatment modalities are observation, splinting, therapy, or surgery. Surgery involves dividing the A1 pulley and, most importantly, part of the oblique pulley. Level of Evidence: V (Therapeutic).
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