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Spontaneous Resolution of Early-Onset Pediatric Trigger Thumb: A Case Study
Simonne M Jones1, Brett F Shannon2, Chabelly Gomez3
1Surgery, St. George's University School of Medicine, St. George's, GRD.
Insights
Pediatric trigger thumb (PTT) may resolve without surgery beyond 24 months. Non-invasive treatments like splinting and observation could be effective, even for fixed deformities.
Area of Science:
- Orthopedics
- Pediatric Surgery
Background:
- Pediatric trigger thumb (PTT) is a common condition characterized by thumb flexion deformity.
- Surgical intervention is typically recommended for fixed PTT after 24 months of age.
Observation:
- A case study of a 4-year-old female with congenital PTT, presenting from infancy.
- The patient exhibited a fixed thumb flexion deformity that resolved spontaneously at 40 months without surgical treatment.
Findings:
- Emerging evidence suggests non-surgical management may resolve PTT beyond 24 months.
- Spontaneous resolution might involve tissue remodeling, tendon adaptation, and gradual A1 pulley release.
Implications:
- Non-invasive treatments, including splinting and observation, warrant consideration for fixed PTT beyond 24 months.
- Conservative management may offer a successful alternative to surgery in select PTT cases.
Abstract:
Pediatric trigger thumb (PTT) is a deformity in the flexion of the thumb due to stenosing tenosynovitis. Surgery is the standard treatment protocol when the thumb is held in fixed flexion after 24 months of age. However, emerging research provides evidence that cases with a fixed deformity can be resolved without surgical management beyond 24 months. The patient, in this case, was a four-year-old female diagnosed with congenital pediatric trigger thumb with early onset in infancy starting at four months. She displayed complete resolution and release of the flexion deformity without surgical treatment at 40 months. It is possible that non-invasive treatment on fixed flexion, such as splinting and observation, extending beyond 24 months before proceeding with surgical intervention should be considered. While the mechanism is only hypothesized, resolution may occur through a combination of tissue remodeling, tendon adaptation, and gradual reduction of the entrapment. Waiting for the potential release of the A1 pulley to occur spontaneously, even in patients with a fixed deformity, may be a successful treatment modality.
