Bilateral multiple trigger fingers in a pediatric patient: A rare case report
Maha D Hanawi1, Rakan H Alelyani2, Kayan F Alotaibi3
1Department of Plastic & Reconstructive Surgery, King Fahad Medical City, Riyadh, Saudi Arabia.
Insights
This case study highlights a rare instance of bilateral trigger fingers in a 5-year-old boy. Surgical release was successful, emphasizing the need for thorough evaluation in pediatric cases of stenosing flexor tenosynovitis.
Area of Science:
- Pediatric Orthopedics
- Hand Surgery
- Musculoskeletal Conditions
Background:
- Trigger finger, or stenosing flexor tenosynovitis, involves a tendon-sheath mismatch at the A1 pulley.
- Pediatric trigger finger is less common than trigger thumb, with bilateral involvement being exceptionally rare.
Observation:
- A 5-year-old boy presented with a year-long history of bilateral index and ring finger triggering.
- Physical examination revealed nodules and active triggering in the affected fingers.
- Initial conservative management including physiotherapy yielded no improvement.
Findings:
- Surgical release of the trigger fingers was performed in staged procedures.
- Post-operative follow-up confirmed full range of motion and successful resolution of symptoms.
- The case underscores the rarity of multiple bilateral trigger fingers in children.
Implications:
- Bilateral trigger fingers in pediatric patients may indicate underlying conditions requiring investigation.
- Thorough clinical assessment, including history and physical examination, is crucial before surgical intervention.
- Understanding the distinct pathophysiology in children is vital for effective management, as spontaneous resolution may occur after addressing underlying causes.
Introduction And Importance:
Trigger finger, or stenosing flexor tenosynovitis, is a condition characterized by a mismatch between the flexor tendon and its surrounding sheath at the A1 pulley, which facilitates smooth movement. We are presenting a rare case of bilateral index and ring fingers triggering in a 5-year-old boy, which necessitates surgical release, and a brief literature review.
Case Presentation:
We report a case of 5-year-old boy who presented to our clinic with his mother with 1 year history of bilateral hands multiple fingers triggering. Mother reported on and off bilateral index and ring fingers triggering that is passively correctable. Patient examined and found to have nodules over the index and ring fingers with active triggering. After exclusion of underlying causes, patient was referred initially for physiotherapy and have been followed up with no improvement. Surgical release of trigger fingers was planned as staged procedures starting with the left hand then the right. Patient followed up post-op, has full range of motion of his fingers with no issues.
Clinical Discussion:
We believe that multiple trigger fingers in bilateral hands of pediatric cases are rare, and they may be associated with some underlying diseases that should be addressed and managed before any surgical management.
Conclusion:
Unlike trigger thumb which is very common in pediatrics, trigger finger is considered rare, and its bilateral hands involvement is the rarest. The pathophysiology of trigger finger in pediatrics differs that in adults, so detailed history, physical exam, and work-up must be done before any surgical intervention plan as it may be resolved spontaneously after managing the underlying cause.
Related Concept Videos
01:43Sex-linked Disorders
01:43Sex Linked Disorders