Conservative Management of Infantile Trigger Thumb: Indications and Limitations

Watanabe, Hiroshi; Hamada, Y.; Toshima, Tadahito

doi:10.1097/00130911-200303000-00008

Cited by 12 publications

(9 citation statements)

References 16 publications

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“…The mechanism is similar to the passive stretching exercise advocated by Watanabe et al 1 Patel 11 reported that it is not the thickened pulley but the nodule of the flexor tendon that causes the symptoms. Previous studies have reported treatment outcomes for patients at various stages.…”

Section: Discussionmentioning

confidence: 56%

Pediatric Trigger Thumb With Locked Interphalangeal Joint

Horii

Hattori

et al. 2012

Journal of Pediatric Orthopaedics

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Section: Discussionmentioning

confidence: 56%

Pediatric Trigger Thumb With Locked Interphalangeal Joint

Horii

Hattori

et al. 2012

Journal of Pediatric Orthopaedics

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“…21 Ovo stanje uglavnom je bezbolno, ali uz nelagodu koja se javlja pri forsiranoj ekstenziji. 5,11 Tijekom fizikalnog pregleda otežana je ekstenzija IP zgloba uz javljanje škljocanja, pucketanja odnosno preskakivanja. 26,28 Zbog mogućeg obostranog javljanja vrlo je važno pregledati obje šake.…”

Section: Prirođena Ili Stečena Deformacija?unclassified

“…29 Osim Sugimotove klasifikacije, često se rabi i podjela prema Watanabeu (tablica 2.). 11 Ona ima četiri stadija, koji su u ovoj klasifikaciji poredani od 0 za najlakši stadij do 3 za najteži, uz opis moguće poremećene ne samo ekstenzije nego i fleksije.…”

Section: Prirođena Ili Stečena Deformacija?unclassified

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Trigger Thumb in Children

Pavljak

Bulić

Antabak

2019

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The natural course of the condition in pediatric trigger thumb is still controversial, and accordingly, the recommendations for treatment vary considerably and there are no clear and broadly accepted guidelines. In this paper, we tried to provide a current literary overview of the disease progression and diagnostic and therapeutic abilities with an emphasis on the ultimate outcome of the treatment. Trigger thumb represents one of the most common pediatric hand conditions, mostly seen in preschool children. As a result of anatomic size mismatch between the flexor pollicis longus tendon and its sheath, disrupted tendon gliding is characteristic. The interphalangeal joint of the affected thumb fixed in a flexion contracture presents typical clinical finding. The first description of trigger thumb is attributed to Notta, and the palpable nodule at the volar aspect of the interphalangeal joint flexion crease still bears his name. Medical history and physical examination are used to diagnose this deformity with ultrasound as a potential early diagnostic tool. It is possible to misdiagnose a fracture, dislocation of the thumb or thumb-in-palm deformity. Clinical investigation has improved our understanding of the natural history and its benignancy. Therapeutic treatment depends on parent and physician preference. It can be either conservative, consisting of splint therapy and passive stretching exercises, or surgical, releasing of the A1 pulley that reliably restores thumb interphalangeal joint motion. Although it may take several years for spontaneous resolution, families willing to wait are given an opportunity to avoid hospitalization stress and surgical intervention.

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“…The incidence of CTT in children ranges from 0.05 to 0.3%. It is relatively rare, accounting for 2.2% of the deformities of the upper extremity [6,7]. Among childhood cases of trigger digits, the thumbs are affected in more than 90% of cases, 25% of cases are bilateral, the right and left sides are equally affected in unilateral cases [8].…”

Section: Introductionmentioning

confidence: 99%

Congenital trigger thumb in children

Khoshhal

Jarvis

Uhthoff

2012

Journal of Pediatric Orthopaedics B

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Although numerous studies have been performed on congenital trigger thumb (CTT), the pathogenesis is still unknown. Cytocontractile proteins and myofibroblasts are present during soft-tissue contraction, and they may have a role in CTT. The aim of the study is to clarify the immunohistochemical and the electron microscopy characteristics of the first annular (A-1) pulley in CTT. The specimens from the A-1 pulleys were collected from 22 children with CTT. Electron microscopy was used to study the last five specimens. Immunohistochemistry staining demonstrated that all specimens stained positively for vimentin and for α-smooth muscle actin, and stained negatively for desmin. Electron microscopy showed fibroblasts in collagenous matrix, which contain vimentin-like material and associated at the surface with elastin-like tubular matrix filaments and elastin fibers. In two specimens, a few cells showed markers of myofibroblastic differentiation. The presence of the cytocontractile proteins and myofibroblasts suggests proliferation of fibrous tissues during either the intrauterine or extrauterine phase of development and may account for the presence of congenital stenosis at the level of the A-1 pulley. We believe that CTT may be developmental; if the process started in the intrauterine phase it might present as a fixed flexion contracture and will show mature fibroblasts. If the process started in the extrauterine phase, it might present as triggering first and will show myofibroblastic changes, then with the maturation of the fibrous tissue, result in a fixed flexion contracture.

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Conservative Management of Infantile Trigger Thumb: Indications and Limitations

Cited by 12 publications

References 16 publications

Pediatric Trigger Thumb With Locked Interphalangeal Joint

Pediatric Trigger Thumb With Locked Interphalangeal Joint

Trigger Thumb in Children

Congenital trigger thumb in children

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