Review Article

Management of Pediatric Trigger Thumb and Trigger Finger

Shah, Apurva S. MD, MBA; Bae, Donald S. MD

From the Department of Orthopedic Surgery, Children's Hospital Boston, Boston, MA.

Dr. Shah or an immediate family member serves as a board member, owner, officer, or committee member of the American Society for Surgery of the Hand. Dr. Bae or an immediate family member has stock or stock options held in Cubist and Optimer Pharmaceuticals and serves as a board member, owner, officer, or committee member of the American Society for Surgery of the Hand and the Pediatric Orthopaedic Society of North America.

Journal of the American Academy of Orthopaedic Surgeons 20(4):p 206-213, April 2012. | DOI: 10.5435/JAAOS-20-04-206

Abstract

Pediatric trigger thumb and trigger finger represent distinct conditions and should not be treated like adult acquired trigger finger. Over the last two decades, our understanding of the natural history of pediatric trigger thumb and the etiology and surgical management of pediatric trigger finger has improved. Pediatric trigger thumb may spontaneously resolve, although resolution may take several years. Open surgical release of the A1 pulley of the thumb is an alternative option that nearly uniformly restores thumb interphalangeal joint motion. Surgical management of pediatric trigger finger with isolated release of the A1 pulley has been associated with high recurrence rates. Awareness of the anatomic factors that may contribute to triggering in the pediatric finger and willingness to explore and address other involved components of the flexor mechanism can prevent surgical failure.