Our Summary

This research paper discusses a common thumb condition in children called Pediatric trigger-locked thumb (PT-LT). It occurs when the tendon that helps bend the thumb becomes too large for its protective sheath, causing the thumb to become stuck in a bent position. This condition can present in two ways: the thumb can be permanently locked in a bent position, or it can intermittently get stuck when bending and straightening. The second form is less common.

The paper categorizes PT-LT into two types based on whether the base of the thumb is hyperextended (bent backwards) or not. Type I does not have this hyperextension, while Type II does.

The appropriate treatment depends on factors such as the child’s age, when the condition developed, how it presents, and the type of PT-LT. Options for treatment include monitoring the condition, using a splint, undergoing therapy, or having surgery. If surgery is necessary, it typically involves cutting the A1 pulley (part of the tendon’s protective sheath) and a portion of the oblique pulley (another part of the thumb’s structure).

FAQs

  1. What is paediatric trigger-locked thumb (PT-LT)?
  2. What are the treatment options for paediatric trigger-locked thumb?
  3. What does surgery for PT-LT involve?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hand surgery for trigger-locked thumb is to follow post-operative care instructions carefully, including keeping the hand elevated, performing prescribed exercises, and attending follow-up appointments to ensure proper healing and recovery. It is important to communicate any concerns or changes in symptoms to the doctor promptly.

Suitable For

Patients who are typically recommended hand surgery for paediatric trigger-locked thumb (PT-LT) include those who have not responded to conservative treatments such as splinting and therapy, those with severe symptoms affecting daily activities, those with type II PT-LT associated with metacarpophalangeal joint hyperextension, and those with a significant size mismatch between the flexor pollicis longus tendon and the oblique pulley. Surgery may also be recommended for patients with PT-LT who are older or have had the condition for a longer duration.

Timeline

  • Patient experiences symptoms such as pain, swelling, and limited range of motion in the thumb
  • Patient seeks medical advice and is diagnosed with paediatric trigger-locked thumb
  • Treatment options such as observation, splinting, therapy, or surgery are discussed with the patient and their family
  • Surgery is recommended in cases where conservative treatments have been unsuccessful or if the deformity is severe
  • The patient undergoes surgery to divide the A1 pulley and part of the oblique pulley
  • Post-surgery, the patient may experience some pain and swelling but should gradually regain full range of motion in the thumb
  • The patient undergoes physical therapy to help with rehabilitation and strengthening of the thumb
  • Follow-up appointments with the surgeon are scheduled to monitor the patient’s progress and ensure proper healing.

What to Ask Your Doctor

  1. What is the specific diagnosis of my hand condition?
  2. What are the potential causes of my hand condition?
  3. What are the different treatment options available for my hand condition?
  4. How will hand surgery help improve my symptoms?
  5. What are the risks and potential complications associated with hand surgery?
  6. What is the expected recovery time after hand surgery?
  7. Will I need physical therapy or rehabilitation after hand surgery?
  8. Are there any non-surgical alternatives or complementary therapies that may help with my hand condition?
  9. How many surgeries have you performed for this specific hand condition?
  10. What is the success rate of hand surgery for my particular condition?

Reference

Authors: Fernandes C, Dong K, Rayan G. Journal: J Hand Surg Asian Pac Vol. 2022 Feb;27(1):2-9. doi: 10.1142/S2424835522300018. Epub 2022 Feb 23. PMID: 35193463