2. DEFINITION
• Pediatric trigger thumb is a condition of flexion deformity of the interphalangeal joint of
thumb.
• Idiopathic
• It is an acquired lesion, flexion contracture develop over the interphalangeal joint which produces
snapping phenomenon( sudden impingement between anatomical and/or heterotypical
structures with subsequent abrupt movement and noise). In passive extension of thumb.
3. Causes
• Due to prolonged inflammation, irritation may happens in tendon
sheath, which forms nodules in the tendon which impinge tendon or
block its movement
RISK
Repeated gripping
Sex-common in women's
Carpal tunnel syndrome surgery
5. CONTINUED
• A1 pulley anatomy
1. An outer, vascularized, convex layer
2. An inner, concave, flexor tendon gliding layer(FRICTION IS
MORE).
6. Cause
1.Thickening of the A1 pulley which causes pain and decreased function
2. Narrowing of the flexor tendon
3. Overuse and repeated gripping maneuver
4. Diabetes mellitus(prenatal history) , amyloidosis, and rheumatoid arthritis
7. Symptoms
• Stiffness of thumb, more in morning
• A popping sensation and clicking sound on movement of thumb
• Catching and locking of thumb
• Difficulty in straightening of thumb
• Fixed flexion deformity of metacarpophalangeal joint
8. On palpation
• Palpable nodule in flexor pollicis longus at the level of the
metacarpophalangeal joint
9. Trigger thumb can be classified based on Quinnell grading system for
flexion and extension.(1)
0- Normal movement
I -Uneven movement
II -Actively correctable
III -Passively correctable
IV -Fixed deformity
(1) Pencle FJ, Harberger S, Molnar JA. Trigger Thumb. [Updated 2020 Aug 24]. In: StatPearls. Treasure
Island (FL): StatPearls Publishing; 2021
10. Medical intervention
• Rest –kept thumb under padded gloves.
• Splinting -Mueller Reversible Thumb Stabilizer
• NSAIDS
• Steroid injection
11. SURGICAL INTERVENTION
Under general anaesthesia
1cm transverse incision is created MCP joint of thumb up to the A1
pulley
Flexor tendon sheath is exposed
A1 pulley incising, along with excision of notta nodule
FLP gliding 1
Skin closure
• 1.Management of Pediatric Trigger Thumb and Trigger Finger,Shah, Apurva S. MD, MBA; Bae, Donald S. MD
April 2020 - Volume 20 - Issue 4 - p 206-213
