Pediatric Orthopedic Surgeons treating a Trigger Thumb

TRIGGER THUMB

 

Trigger thumb is usually caused by swelling affecting of the tendons that run along your fingers and thumbs, although the exact reason why this occurs is not fully understood.

If your child needs surgery or casting, our Fracture Care Clinic opens every day and you do not need an appointment. Surgery rooms get scheduled every morning, so your child receives the care and attention they need right away.

Trigger Thumb

Trigger ThumbTrigger thumb, aka Stenosing Tenosynovitis, occurs when the space within the sheath surrounding the tendon in that finger narrows. If this condition worsens, the finger may also get locked in a bent position. Also, the affected thumb may straighten or bend with a snap just like pulling and releasing a trigger.

The pediatric trigger thumb is not present at birth. However, it is most common in children younger than five years old. Even though the trigger thumb also appears in adults, it is distinctly different from that seen in children.

CAUSES OF A TRIGGER FINGER/THUMB

In children, a trigger thumb is not a result of an injury or medical issues. The condition occurs when the tendons responsible for moving the thumb enlarge and consequently; do not slide smoothly through the tendon tunnel. As a result, it limits or interrupts the mobility of the affected thumb. Over time, this condition may also form a small bump at the base of the thumb closer to the palm. Usually, it is not painful. Pediatric trigger thumb occurs by chance and is not associated with other disorders.

SYMPTOMS OF TRIGGER THUMB 

When your child has this condition, you may notice that he cannot give you a thumbs up. Also, you may feel a bump formed in the palm right at the bottom of the thumb.

Some children who have a trigger thumb may extend their affected fingers. But, it may be painful and can cause swelling. Also, there might be a noticeable popping or clicking sound.

  • A clicking/popping sensation while moving the finger
  • Bump or tenderness at the base of the finger
  • Pain in the palm
  • The thumb may be stuck in a crooked position and then pop straight all of a sudden

QUESTIONS AND ANSWERS

What causes trigger thumb in children, and is it a serious condition?

Trigger thumb, also known as pediatric trigger thumb or congenital trigger thumb, is often caused by a mismatch in the size of the tendon and the tendon sheath in the thumb. The tendon, which helps the thumb bend and straighten, may be too large for the sheath, leading to difficulty in smooth movement. While the exact cause may not always be clear, there may be a genetic predisposition. In many cases, trigger thumb is not considered a serious condition and may resolve on its own. However, if the triggering is causing discomfort or if the thumb remains stuck, medical intervention may be recommended.

What are the treatment options for my child's trigger thumb, and when is intervention necessary?

Treatment options for trigger thumb depend on the severity of the condition. In mild cases, where the thumb is not causing significant discomfort or limitation of movement, observation and monitoring may be recommended. If the condition persists or worsens, non-surgical treatments may include:

  • Physical Therapy: Gentle exercises and stretching may be prescribed to improve thumb movement.
  • Splinting: Wearing a splint to keep the thumb in an extended position may help in mild cases. If these non-surgical interventions are not successful or if the trigger thumb is causing significant impairment, a doctor may recommend a simple outpatient procedure called a trigger thumb release. This surgery involves releasing the tight portion of the tendon sheath, allowing for smoother movement of the thumb.
What is the long-term outlook for my child with a trigger thumb, and will it affect their hand function?

The long-term outlook for a child with a trigger thumb is generally positive. Many cases resolve on their own or respond well to non-surgical interventions. In cases where surgery is required, the procedure is typically straightforward with a low risk of complications. With appropriate treatment, most children can achieve normal thumb function, and the triggering is alleviated. Regular follow-up with a healthcare provider is important to monitor the child’s progress and address any concerns. In the majority of cases, trigger thumb does not have a lasting impact on a child’s hand function or overall development.

If your child suffers from trigger thumb, please give our office a call to make an appointment with one of our children’s specialists who will fix your child’s problem.

WHEN TO SEE A DOCTOR 

Medical care is necessary to prevent permanent damage. Therefore, see a doctor when the thumb is stuck in the bent position and cannot be straight. Opt for immediate medical attention if the finger joint of your child feels warm or looks red and swollen. A condition like this indicates the swollen area might be infected.

DIAGNOSIS 

Our doctors usually diagnose this condition through a thorough medical history checkup and physical exam. X-rays are not necessary for the diagnosis of the trigger thumb. Most children with this condition are at least six months old. Parents may notice the bent thumb while checking for any other injury to the hand. There might be painful snapping, locking, or clicking of the thumb. However, usually, the thumb is locked in a bent position. Often, parents or kids do not remember an injury that could lead to a flexed thumb. Also, the child may not complain of discomfort or pain at all.

Our doctors generally do not use X-rays to diagnose PTT. Since this is not a problem related to bones or joints in the thumb, the affected tendon would not show on regular X-rays. Experts may recommend x-rays if the diagnosis is vague even after thoroughly examining the child.

TREATMENT

Sometimes, a trigger thumb gets better on its own, without any treatment. However, this chance decreases as a child gets older. In such cases, our orthopedic surgeons recommend surgery for this condition in children older than 2. The surgery usually takes about 30 minutes under general anesthesia. During the surgery, the surgeon makes a small incision in the tendon sheath to make the tendon move smoothly.

Basically, when it comes to treating trigger thumb, experts recommend three things:

Wait and Watch

In younger children, PTT sometimes disappears without any treatment. It may take many months or years. Therefore, you can keep an eye on the affected area to see if the flexion contracture recovers on its own.

Thumb Stretching and Splinting 

The doctor will teach you how to stretch and massage your child’s thumb. After the stretch, keep the thumb straight in a splint. Your child may have to wear the splint at all times or at certain times, such as while sleeping. It can relieve the swelling. However, splinting may be painful when a Notta’s nodule presses nonstop against the ligament. In other words, stretching and splinting may not always be a solution. Sometimes, movement may improve even though it might be hard to achieve full motion.

Surgery

Surgery is the cure if the Pediatric Trigger Thumb does not go away naturally, and stretching and splinting do not help either. The operation might take place in an outpatient setting. The surgeons will make a small incision at the base of the thumb and then cut through the ligament to free the tendon. They only cut the A1 pulley ligament but no oblique pulley ligament.

They won’t cut the tendon, and neither will they remove Notta’s Nodule. Cutting the A1 pulley takes off the pressure on the tendon. Thus, it can glide smoothly.

Post-Surgery 

After surgery, there will be no restrictions on using the thumb. Children can use it without worrying about damaging the surgical repair. The child will have to wear a bandage for three days.

Home Remedies

Thankfully, the trigger thumb has a wide variety of natural remedies. For treating children, doctors highly recommend using conservative treatment options first. Take a look:

Trigger thumb Splinting

Wearing a brace, specifically on the trigger thumb, is an effective way to relieve and heal the pain. Many specialists recommend wearing a brace at night to avoid any problems in the daytime. It is helpful, especially at a very young age. Having a rigid splint offers maximum support. Also, splinting after surgery is often suitable to keep the operated finger protected and isolated.

Top Trigger Thumb Exercises

Gentle finger workouts often help improve mobility in your child’s trigger thumb. During exercise, your child might require your help. Trigger Thumb workouts that specifically work on the abduction muscles are helpful for treatment.

Tennis Ball Exercise: Have your child grab a tennis ball or a stress ball. Ask him to hold it and squeeze the ball for a couple of seconds. 

Resistance Exercise: Take a rubber band that provides enough resistance and wear it around your child’s fingers and thumb. Then, have your child start moving his or her fingers and thumb inwards and outwards. It should be conducted in a repeated motion.

Fingers to Palm Stretch: Follow the same resistance exercise without a rubber band.

Bent Finger Exercise: Have your child bend the thumb inwards to touch the other fingertips in order. Holding the thumb at each fingertip for at least 10 seconds will help strengthen the tendon muscle.

Extensor Exercise: Place your child’s hand flat on a surface and have him or her raise each finger without lifting the palm. It might be painful initially. However, with practice, the pain level will decrease.

Consult our Doctors First

Practicing these exercises three to four times every day ensures fast recovery without surgical treatments. However, consult a doctor to ensure these exercises will be safe and effective for your child. They can help your kids exercise correctly. Our doctors may also recommend Trigger Thumb Physical Therapy. A physical therapist will use various exercises to work out and stretch your child’s fingers.

Why Choose Medical City Children’s Orthopedics and Spine Specialists

Pediatric orthopedics is a specialty of our doctors and surgeons at Medical City Children’s Orthopedics and Spine Specialists. Moreover, they understand your concerns, can answer your questions regarding your child’s condition, and know how to use their specialized knowledge to assist you. Doctors Shyam Kishan, Richard Hostin, and Kathryn Wiesman have many years of training and experience in bone, joint, and muscle care for children and young adults and can help your child get back to the best of health.

For the convenience of our patients, we have five offices in Arlington, Dallas, Flower Mound, Frisco, and McKinney, TX.

The following are just a few of the many reasons why patients might choose Medical City Children’s Orthopedics and Spine Specialists.

  • Expertise in pediatric orthopedics and spine: The team of specialists at Medical City Children’s Orthopedics and Spine Specialists are experts.  They specialize in the diagnosis and treatment of pediatric orthopedic and spinal conditions, ensuring the best possible care for children.
  • Cutting-edge technology: Our practice uses the latest technology and techniques to diagnose and treat a wide range of conditions.  In addition, we use minimally invasive procedures that reduce pain and promote faster recovery.
  • Comprehensive care: Our practice offers a full range of services, from diagnostic imaging and physical therapy to surgery.  Also, we ensure that patients receive complete, seamless care for their orthopedic and spinal conditions.
  • Dedicated pediatric facilities: Medical City Children’s Orthopedics and Spine Specialists are dedicated to providing children with a safe and comfortable environment.

Finally, our board-certified physicians and fellowship-trained orthopedic surgeons use the full range of treatments to treat growth plate fractures and return kids to the activities they enjoy. Get in touch with us today at 214-556-0590 to schedule an appointment.

____________________

Footnote:

National Institute of Health: Trigger Thumb

Call 214-556-0590 to make an appointment.

Comprehensive services for children from birth through adolescence at five convenient locations: Arlington, Dallas, Flower Mound, Frisco and McKinney.