What to Do About Trigger Thumb in Children

Trigger finger is a well-known condition in adults. More rarely infants present with a trigger thumb. The thumb is locked in a flexed position. It can't be pulled straight out by the parents or the doctor. It's not clear what treatment is best. This study explores the benefit of surgery in children over the age of three.

Most doctors advise splinting or physical therapy for a child 12 months or less who has a trigger thumb. Surgical release is an option when they're older. But surgery always has risks and possible problems. In this study, surgeons use a percutaneous release of the A1 pulley mechanism instead of an open incision and release. Percutaneous means a needle is inserted into the skin and used to cut the pulley.

The benefits of percutaneous release are that it can be done in the office. Children recover right away and there's no scar. There can be nerve damage if the surgeon inserts the needle in too far. The results of this study show it works well with very few problems even after several years follow-up.

The authors say there are two key ingredients to a successful percutaneous trigger thumb release. The first is surgeon experience. Only surgeons who have treated many adults with trigger finger should try doing this operation on children. The second is parental cooperation. Parents must move the thumb often every day for good results. The problem can come back if there isn't enough movement in the early healing phase.