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The natural history of paediatric trigger thumbs. A prospective cohort study

Ee Ming Chew1,2, Noah Yu Ting Sim3, Nicole Kim Luan Lee4

  • 1Department of Orthopaedic Surgery, KK Women's and Children's Hospital, Singapore, Republic of Singapore.

The Journal of Hand Surgery, European Volume
|November 13, 2024
PubMed

Insights

Paediatric trigger thumb often resolves spontaneously within 8 years. Early presentation with a less than 30° interphalangeal joint angle predicts resolution, suggesting observation as a primary management strategy.

Area of Science:

  • Paediatric Orthopaedics
  • Developmental Paediatrics

Background:

  • Paediatric trigger thumb, a condition causing thumb flexion contracture, impacts children's hand function.
  • Understanding its natural history and predictors of spontaneous resolution is crucial for effective management.

Purpose of the Study:

  • To determine the rate and predictive factors for spontaneous resolution of paediatric trigger thumb.
  • To evaluate the long-term outcomes of observation versus surgical intervention.

Main Methods:

  • Prospective observational study of 62 patients (79 thumbs) with paediatric trigger thumb.
  • Mean follow-up of 4.2 years, with assessment of spontaneous resolution and surgical intervention rates.
  • Analysis of interphalangeal joint angle at presentation as a predictive factor.

Main Results:

  • Spontaneous resolution occurred in 37% of thumbs by 5 years and 50% by 8 years.
  • Thumbs with an interphalangeal joint angle < 30° showed a higher likelihood of spontaneous resolution (sensitivity 0.50, specificity 0.82).
  • Surgery was performed on 27% of thumbs by 5 years and 48% by 8 years.

Conclusions:

  • Observation alone for 4-5 years is a reasonable first-line management for paediatric trigger thumb.
  • Early interphalangeal joint angle is a valuable predictor for conservative management success.
  • This approach can potentially reduce surgical interventions in paediatric trigger thumb cases.

Keywords:
Paediatric triggerconservative managementnatural historytrigger thumb

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