Abstract
Trigger thumb, or stenosing tenovaginitis, is a relatively uncommon condition affecting the flexor pollicis longus tendon of children. The condition is characterized by the formation of a nodule within the tendon and thickening of the tendon sheath as it passes through the flexor pulley of the thumb at the level of the metacarpo-phalangeal joint. The optimum age for surgical intervention continues to be discussed. The aim of this study is to establish the temporal relationship and surgical variables to determine factors that may contribute to recurrence of the condition. A retrospective analysis of the entire surgical logbook and patient notes of a stand-alone consultant paediatric orthopaedic practice was scrutinized. 94 patients, 107 thumbs, over a 13-year period were operated on for trigger thumb. The recurrence rate was found to be 5.61 %. The average age of patients at primary release who went on to recurrence was 2.8 years, which is significantly younger than those that did not recur (p = 0.044). Sensitivity analysis revealed that the primary procedure at an age of less than 2.5 years confers a higher risk of recurrence. The data presented here advocate surgical release of trigger thumb after 2½ years of age, a senior surgeon as lead operator and a transverse skin incision at the level of the nodule or a more extensive “zig-zag” one to clearly see the structures to be released. We recommend that the surgeon ensures the stenosing pulley and sheath are released in their entirety.
Similar content being viewed by others
References
Eyres KS, McLaren MI (1991) Trigger thumb in children: results of surgical correction. J R Coll Surg Edinburgh 36(3):197–198
Slakey JB, Hennrikus WL (1996) Acquired thumb flexion contracture in children: congenital trigger thumb. J Bone Joint Surg Br 78(3):481–483
Dunsmuir RA, Sherlock DA (2000) The outcome of treatment of trigger thumb in children. J Bone Joint Surg Br 82(5):736–738
Ger E, Kupcha P, Ger D (1991) The management of trigger thumb in children. J Hand Surg Am 16(5):944–947
Tan AH, Lam KS, Lee EH (2002) The treatment outcome of trigger thumb in children. J Pediatr Orthop B 11(3):256–259
Dinham JM, Meggitt BF (1974) Trigger thumbs in children. A review of the natural history and indications for treatment in 105 patients. J Bone Joint Surg Br 56(1):153–155
Han SH, Yoon HK, Shin DE, Song DG (2010) Trigger thumb in children: results of surgical treatment in children above 5 years of age. J Pediatr Orthop 30(7):710–714. doi:10.1097/BPO.0b013e3181edef8d
Canale ST, Daugherty K, Jones L, Burns B (2003) Campbell's Operative Orthopaedics, 10th edn. Mosby, Philadelphia
Morrissy RT, Weinstein SL (eds) (2006) Atlas of pediatric orthopaedic surgery. Lippincott Williams & Wilkins
Acknowledgments
Mr. Michael Delaney is thanked for the drawing and provision of original artwork.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
Author DSE declares that he has no conflict of interest. Author RHR declares that he has no conflict of interest.
Ethical approval
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
Informed consent
Consent was obtained from all patients and their parent/guardian for the treatment/procedure described in this retrospective audit of practice. Treatments and procedures described are recognized management for the condition described.
Rights and permissions
About this article
Cite this article
Edwards, D.S., Richards, R.H. Risk stratification for the recurrence of trigger thumb after surgical release in the paediatric patient. Eur J Orthop Surg Traumatol 26, 587–590 (2016). https://doi.org/10.1007/s00590-016-1802-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00590-016-1802-y