Congenital Trigger Thumb
Hi, my name is Charles Goldfarb. I'm an orthopedic surgeon at Washington University in St. Louis. I see patients at the Orthopedic Center in Chesterfield, St. Louis Children's Hospital, and the Shriner's Hospital For Children. Kids born with hand and upper extremity abnormalities often come to these sites to see me for evaluation and treatment.
One of the most common abnormalities I see in children is a congenital trigger thumb. That is when the thumb is stuck in a position of flexion. The interesting thing is this is probably not something a child is born with, but rather something that develops between one and two years of age. It doesn't cause great functional abnormalities but does limit function in a child.
Families recognize this at different time intervals. Sometimes it's the grandparent who may first notice this, sometimes it's the parent, and the child does not complain of pain. So they come in to see me with this thumb in a position of flexion and we spend a good deal of time explaining what the problem is.
The problem is essentially that the sheath which houses the tenant is too tight for the tenant itself. So we can institute a trial of splinting, a trial of stretching, but unfortunately these typical do not get better on their own without surgical intervention. Surgery is very successful. This is something we can cure with a five minute surgery, and patients and families tolerate this very well.
When I see a child with congenital trigger thumb, we discuss different treatment options. The most straightforward way to begin is with a course of therapy, which includes splinting and stretching. If that is effective, nothing else need be done. But most often, the trigger thumb doesn't resolve, and therefore the next step is surgery.
Surgery can be performed at any age, and is based on the comfort level of the patient and the family. We do the surgery at St. Louis Children's hospital most commonly. It's an outpatient surgery. It takes about ten minutes and the child bounces back from the surgery very well. Most kids never need to take pain medicine, and they're back to all activities the next day. So it's a very well-tolerated, minimally-invasive procedure, which entails a very small incision over the problem area and opening of the sheath to allow the tendon to glide more freely.