Congenital Trigger Thumb
Trigger thumb represents an abnormality of the flexor pollicis longus and its tendon sheath at the Al pulley. There is a palpable mass (Notta nodule), representing the flexor pollicis longus constriction at the Al pulley. The cause appears to be a size mismatch between the flexor pollicis longus and the Al pulley that leads to progressive constriction. Unlike adult trigger digits, there does not appear to be an inflammatory component. Surgery is indicated in infants without spontaneous resolution by 1 year of age, and in any toddler or older child presenting with a locked trigger thumb.
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 Aarogya hospital, Shankar Nagar, Raipur 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