Patient: 18-month-old child
Presentation: Right thumb locked in 70° flexion at the interphalangeal joint
History: Parents had noticed the bent thumb for several months but assumed it would correct on its own
By the time this little one came to Hand2Shoulder Clinic, the thumb had been locked at a 70-degree angle for a significant period. The parents, understandably, had hoped it might straighten with time. It had not.
On examination, the thumb was fixed in 90° flexion at the IP joint with no active or passive extension possible. A firm Notta’s node was palpable at the base of the thumb over the A1 pulley. This was a classic congenital trigger thumb with a fixed contracture — a delayed presentation, but still entirely correctable.
The child was taken up for an open A1 pulley release under general anaesthesia as a day-care procedure. Intraoperatively, the tight pulley was clearly impinging on the thickened flexor pollicis longus tendon. Once released, the thumb straightened fully and immediately on the table.
on the day of surgery by evening the child had full, effortless extension of the thumb.

What this case illustrates

Even when parents come in later than ideal, the results of surgery remain excellent. A fixed 70° deformity in an 18-month-old — corrected to full extension on the day of , after a 20-minute procedure. This is why early consultation matters: not to alarm families, but to ensure that when surgery is needed, it is done before the window of easiest recovery closes.