Percutaneous Trigger Thumb Release in Children

Abstract

The objective of this study was to determine whether percutaneous release of the A1 pulley is an adequate treatment of trigger thumb in children. Twenty-three children under the age of 6 years with 27 trigger thumbs fixed in flexion were evaluated prospectively. All were treated with a percutaneous release of the A1 pulley in an ambulatory setting and followed for at least 1 year. Interphalangeal and metacarpophalangeal joint range of motion, pinch strength, static two-point discrimination sensibility, and triggering were examined and compared with the unaffected thumb at the end of follow-up. After a mean follow-up of 3 years, 25 of the thumbs had an excellent result without residual triggering. Two of these thumbs had mild metacarpophalangeal extension deficit 1 month after surgery that resolved completely with specific exercises. One thumb relapsed and required subsequent open release and was considered a poor result. One child was lost to follow-up. There were no sensibility defects, strength loss, interphalangeal motion loss, or metacarpophalangeal hyperextension deformities. Percutaneous release of the A1 pulley is an effective and safe option in the treatment of trigger thumb in children.

Percutaneous Trigger Thumb Release in Children

“…This has been pointed out by authors from previous studies. 8,9 Although this created a potential bias in the efficacy of the release, we tried to minimize it performing the PR by the same surgeon, but probably the learning curve takes more than the 20 cases included in this cohort.…”

“…Some authors advocate percutaneous A1 pulley release over open release (OR) claiming it is faster and a less invasive procedure. [8][9][10][11] The purpose of this study was to evaluate the efficacy and safety of percutaneous trigger thumb release in the pediatric age group.…”

Pediatric Trigger Thumb

“…Still others have advocated percutaneous surgical releases using hypodermic needles, performed under sedation or local anesthesia, citing similar efficacy and safety to open techniques in small series. 19,20 Shortcomings of the evidence Given the limitations of current scientific evidence (primarily case series with short-to intermediate-term follow-up) outlined in this article, the optimal treatment of the pediatric trigger thumb remains debatable. Furthermore, little quantitative information is available regarding the physical impairment or functional compromise of IP joint flexion contractures seen in patients with "spontaneous resolution" or following surgical care.…”

Treatment of Common Congenital Hand Conditions

“…Percutaneous release of tendon sheath using an injection needle is a less invasive procedure for trigger thumb release in children. (94,95) In order to perform this procedure under local anesthesia, it is essential that the patient understands and cooperates with this operation. The major disadvantage of this procedure is that complete release of the tendon sheath cannot be assured and of course, having a child who will corporate with local anesthesia is a rarity.…”