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Paediatric trigger thumb: Diagnostic pearls.

Nicholas L Hudock1, Michael W Girgis1, Gabriel D Glaun1

  • 1Department of Orthopaedics and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States.

Journal of Paediatrics and Child Health
|September 3, 2024
PubMed
Summary
This summary is machine-generated.

Paediatric trigger thumbs often present with a volar nodule and fixed flexion contracture, leading to misdiagnosis. Surgical treatment offers excellent outcomes for children aged 2-8 years.

Keywords:
Notta's nodeflexor pollicis longus tendonmisdiagnosispaediatrictrigger thumb

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Area of Science:

  • Paediatric Orthopaedics
  • Hand Surgery
  • Musculoskeletal Imaging

Background:

  • Trigger thumb (stenosing tenosynovitis) is a common condition in children.
  • Misdiagnosis as fracture or dislocation can occur due to similar presenting symptoms.
  • Early recognition and appropriate management are crucial for optimal outcomes.

Purpose of the Study:

  • To identify diagnostic pearls for paediatric trigger thumbs.
  • To review the clinical presentation and outcomes of surgical treatment.
  • To improve diagnostic accuracy and reduce misdiagnosis rates.

Main Methods:

  • Retrospective review of medical records and imaging studies.
  • Analysis of 64 trigger thumbs in 52 paediatric patients (January 2009 - December 2019).
  • Evaluation of clinical presentation, physical exam findings, and surgical outcomes.

Main Results:

  • Average age at referral was 2.5 years; average age at surgery was 3.2 years.
  • Common findings included volar nodule (100%), fixed flexion deformity (73%), and triggering (27%).
  • 46% of patients initially received hand x-rays and were misdiagnosed; surgery provided complete symptom relief without complications.

Conclusions:

  • Distinct physical exam findings (volar nodule, fixed flexion contracture) aid in diagnosing paediatric trigger thumbs.
  • Enhanced musculoskeletal education for primary care physicians can minimize misdiagnosis.
  • Surgical outcomes are excellent for children aged 2-8 years with trigger thumbs.