Trigger thumb treatment approach: Results of a survey of EPOS members

Abstract

Purpose: The aim of this study is to analyze the clinical reality of pediatric trigger thumb among members of the European Paediatric Orthopaedic Society. Methods: A 35-question survey was sent to all European Paediatric Orthopaedic Society members, focusing on surgeon’s profile and experience, trigger thumb diagnostic and trigger thumb treatment approach. Descriptive statistics were performed. Results: A total of 99 responses were analyzed. Most important factor considered in the therapeutic approach was the presence of a locked interphalangeal joint (52%). Regarding treatment, 41.4% opt for conservative approach as the first line of treatment, while 30.3% consider surgery and 28.3% just observe. Nevertheless, 76% mention to treat conservatively their patients and 99% to consider surgery at some stage. Regarding surgical technique, 96% do it open and 56% consider 2 years as the minimum age for procedure. Most surgeons perform this procedure in out-patient care (87%), don’t administer prophylactic antibiotherapy (80%), use a tourniquet (75%), don’t use any postoperative immobilization (64%), and report complications related to surgery (64%), mainly recurrence/incomplete division (59%) and superficial wound infection (30%). Conclusion: Our study shows a significant variability in the initial management of pediatric trigger thumb with a predominance of conservative management, followed by surgery and observation without treatment. The disparity in treatment options and timing, or waiting times before moving on to different therapeutic options, shows us that this is a controversial issue and that the development of prospective randomized controlled studies is needed to analyze the different treatment methods and determine which ones give the best outcomes.

Trigger Thumb, Trigger Finger and Clasped Thumb

“…Other differential diagnoses to consider apart from partial or complete absence of the extensor apparatus include arthrogryposis, dislocation or fracture of the thumb or flexor tendon entrapment in the metacarpal head after trauma [15]. Regarding the treatment of trigger thumb, there is no consensus on the initial approach, the therapeutic options or the best time for treatment [25]. Treatment options range from observation (no intervention) to conservative treatment (exercise and/or splints) and to surgical treatment (open or percutaneous) [1,[26][27][28][29][30][31][32].…”

“…Regarding the treatment of trigger thumb, there is no consensus on the initial approach, the therapeutic options or the best time for treatment [ 25 ]. Treatment options range from observation (no intervention) to conservative treatment (exercise and/or splints) and to surgical treatment (open or percutaneous) [ 1 , 26 , 27 , 28 , 29 , 30 , 31 , 32 ].…”