Congenital Trigger Thumb

Congenital Trigger Thumb
June 14, 2016

Notta_NoduleDr. Gupta, one of the most skilled specialists in the field of upper extremity handles children with compassion and tact and with finesse in surgical techniques relieves them from congenital disorders, painlessly. According to him, “Congenital trigger thumb is a disorder that is present in infants at birth but becomes evident a little later and I have observed in my 25 years experience that almost 30% of children with trigger thumb are affected by it in both their hands.”

An MBBS and MS in Ortho from AIIMS, higher intensive study from Germany and USA, forte of treating patients at FORTIS, AIIMS, The Medanta- Medicity and Max Healthcare, Dr. Gupta is safe and easy bet for perhaps the best relative new modality technique in the field of upper extremity. “Congenital Trigger Thumb is easily deducible in infants as they find it difficult to extend their thumb in the early stages and then later on impossible. It is yet unascertainable how common trigger thumb is but it constitutes almost 2% of hand problems present in children”, asserts Dr. Gupta.

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“No hereditary cause triggers congenital trigger thumb, it is the inflamed tendon at the base of the thumb which fails to glide smoothly that causes it. Pain and swelling with the formation of a bump at the base of the thumb are its visible signs which passes through mild to severe stages affecting the flexion of the thumb”, Dr. Gupta puts forth emphatically.

“If you ask me about the treatment aspect, I would like to stress that even after conducting more than 6000 surgeries, I always wait for a period of around 49 months before moving in for surgical release. The reason being that trigger thumb usually gets resolved spontaneously in more than 50% of the cases and with extension exercises and splinting, the child can be relieved of it. It is only when after wait and watch the condition does not resolve, we go in for simple surgery and am assured that its recurrence is rare thereafter”, winds up Dr. Gupta.

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FAQ – Congenital Trigger Thumb

Congenital Trigger Thumb is a painful condition present in infants in which the thumb is bent towards the palm. Even though congenital means ‘at birth’ , trigger thumb is evident only after the child is 2 years or so.
Trigger thumb is not associated with any hereditary disorder, it is an occurrence of chance. The only probable reason being, when the band under which the tendon of the thumb glides becomes too tight for easy and smooth gliding, it makes the tendon inflamed thus causing restrictions in fully extending the thumb.
The first and most prevalent sign is a bent or flexed thumb in the child’s hand. During the initial stages the child feels pain while extending the thumb with visible swelling and a clicking sound but in later stages the thumb becomes flexed and a bump gets formed at the base of the thumb.
After a complete medical history input and physical examination, the doctor easily diagnoses trigger thumb.
On the basis of clinical observations, trigger thumb is classified into four stages.

Stage 1- presence of bump known as ‘Notta nodule’ is observed without any triggering seen in the thumb joint.

Stage 2- Triggering is observed when the thumb joint is moved or extended actively.

Stage 3- In the third stage, it becomes impossible to extend the thumb joint actively and triggering is observed during passive extension of the same.

Stage 4- This is the last stage where there is complete flexion deformity present in the thumb and neither active nor passive extension of it is possible.
Congenital trigger thumb is treated by both conservative and surgical methods depending on its severity.

Conservative Techniques: The first step to conservative treatment is to wait and observe the condition for a tentative period of 49 months as it has been found that in almost 63% of infants, the trigger thumb gets resolved spontaneously.

Besides this, extension exercises and splinting are taken up by the doctor to enable repair of flexion movement of the thumb.

Surgical Techniques: In cases of severe and bilateral trigger thumb, in case the thumb has not resolved spontaneously even after splinting and extension exercises then the surgeon might undertake surgical technique whereby the fibrous band is loosened to enable smooth movement of the thumb.
Recurrence of trigger thumb after surgery is rare.
Posted in Condition & Treatments by admin