Pediatric trigger finger also called a congenital trigger finger is a painless condition that affects the movement of the finger in a child which gets stuck in a bent position.
That means that the finger can no longer stretch or straighten.
The term “congenital” is probably also a misnomer because it is rarely if ever seen in newborns and must therefore develop later.
It is often first seen when the child is older than 1 year of age.
Trigger finger occurs in approximately three out of 1,000 children at 1 year of age.
In one third of the cases the condition can be present bilaterally.
The most common digit involved is the thumb.
There is no clear reason why some children develop pediatric trigger finger.
Trigger thumb in children is distinctly different from trigger finger or trigger thumb in adults.
Pediatric trigger thumb is not the same condition seen in adults, but they are similar.
In adults, a trigger finger develops when the synovium around a tendon becomes inflamed and thickened.
Over time, develop a small nodule is developed on the tendon.
In children, trigger finger occurs when the tendons that move the finger and thumb enlarge and don’t slide smoothly through the tendon sheath when the finger is moved.
A thick nodule forms in the tendon becomes stuck in an A1 pulley, preventing the finger from being able to straighten.
Symptoms.
You may notice that your child cannot extend his thumb affectively.
and sometimes it is stuck in a bent position.
this is called a flexion contracture.
You may also notice a pop or a click when you straighten your child’s thumb.
This usually isn't painful.
You may be able to feel a bump in your child’s palm at the base of the thumb.
Rarely does the thumb lock in a straight position.
Diagnosis.your doctor can diagnose this condition by asking about your child’s symptoms and doing a physical exam.
Examination reveals limited motion in the thumb.
Usually, the thumb will not full extend, but will flex well.
Often there is a nodule in the palm that moves with flexion and extension of the finger, This is called a "Notta node.
Radiographs is not always necessary, it can be helpful to rule out other diagnoses.
An upper limb neurologic examination should be performed, because the thumb-in-palm deformity of cerebral palsy can be confused with trigger thumb.
Pediatric trigger thumb should not be confused with congenital clasped thumb, in which the metacarpophalangeal joint is fixed in a flexed position, with normal interphalangeal joint motion.
Treatment.
The treatment for pediatric trigger thumb varies depending on when it is first diagnosed,and if deformity is fixed or flexible.
Trigger thumb or finger will resolve on its own for up to 30 percent of children before they reach their first birthday, So your doctor will suggest to watch and wait and he will teach you stretches and massage to do at home.
Keeping the thumb straight at night or while sleeping may be helpful.
Splints should be used consistently for at least 6 months.
this treatment is only appropriate if the thumb can be straightened.
Beyond the age of 2 years old or if the thumb is fixed and cannot be straightened, the trigger thumbs are unlikely to spontaneously resolve and surgical release is generally required.
Surgery to correct trigger thumb is usually performed when a child is between 1 and 3 years of age.
Delay in surgery if the child is less than 3 years of age is not a disaster.
It does not result in permanent thumb stiffness or tendon damage.
Children with a fixed extension deformity that makes a fist difficult
should have surgery early before the age of 1.
the surgeon cuts the A1 pulley through a small cut on your child’s palm at the base of the thumb .
This takes pressure off the tendon and allows it to glide smoothly.
The surgeon doesn’t cut into the tendon or remove the nodule.
Treatment of trigger fingers other than the thumb may include surgical removal of a part of the tendon to allow the tendon to glide more smoothly.
You will need to leave a soft dressing over the incision for five days after surgery.
Use of the affected hand will be restricted during this time.
Once the dressing is removed, your child will be able to use her hand normally and without restriction.
The absorbable sutures used during surgery will fall out on their own within two weeks of surgery.
You may wonder if the trigger finger in your child can happen again.
Luckily, the trigger finger rarely happens again.
In almost all cases, it’s gone for good, and you won’t have to worry about it.
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#congenitaltriggerfinger
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