Trigger Finger

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Archived Q&A and Reviews

17 month old with trigger thumb

October 2007

My 17 month old has had bilateral trigger thumb since birth. The surgeon at Oakland Children's Hospital has taken a ''wait and see'' approach until 18 months. If it didn't resolve by then, he'd recommend surgery. While sometimes my son's thumbs look and act normal, they are still bent most of the time. I was wondering if anyone has had any results with alternative therapies (acupuncture, PT, etc.) or waiting longer. (I did try feldenkreis, but did not see much/if any improvement.) Or can anyone share their experiences with the surgical process and recovery? I'm very nervous about the prospect of surgery -- especially on a 'sensitive' (intense) toddler who tends to be afraid of going to the doctor. Thanks for any input! Anon

I recommend that you get a referral from your hand surgeon to the Hand Therapy clinic at Children's Hospital Oakland (if you haven't already done so). While you are ''waiting and seeing'' the occupational therapists there can evaluate your son's functional skills and how they are impacted by his thumbs. Sometimes it is helpful to splint these thumbs to make grasping more successful, as well as stretches, exercises, etc. -local OT

My 3 y.o. nephew had trigger thumb, and it went undiagnosed/untreated for over year and a half. He did have some chiropractic work done for it, but it didn't help. He eventually had to have the surgery (at Oakland Children's Hospital), and it went well, but since it was so long that he had the trigger thumb in the bent position, he now has some muscle atrophy which should improve over time. We give him small motor skill games and toys like lacing cards and puppets to help him regain control of his thumb. I don't know of other methods to improve this condition, and I know surgery for your 17 month old is extremely scary, so I understand how troubling this must be for you. I wish I could give you more information/advice, but all I can say is that my nephew has fully recovered, and I think that his mom had a harder time with the ordeal than he did. Hope your little guy heals quickly

My daughter had trigger finger in her pinkies. She had to use her other hand to straighten it out. Since it was in the pinkies it did not impact her ability to use her hands but we did consult with a surgeon. In the end she outgrew it around 4 years of age. It slowly went away. At some point she could bend them by themselves but they clicked. Now, at five, they are normal. Good luck with it. anon

We discovered my daughters triggerthumb at 24mo and we debated back and forth if to wait or go ahead with surgery...we tried for a while with massaging the thumb every evening but that,s not that easy to do with a very active 2yr old....so we finally did decide on surgery since the thumb was mostly in locked position....we were fortunate to have Dr Todd Lincoln at Kaiser Oakland as our surgeon...he is fabulous and really made us feel calm about it all...the surgery itself took only like 10min and i had just made myself comfortable in the waiting area when Dr.Lincoln already came to get me ....it is not that easy to keep the surgeryarea clean and dry and our girl developed an infection which had to be treated with antibiotics but a year later now noone can tell that something has been done and she uses her thumb like every other child....actually just a day after surgery the thumb worked totally normal as it should work....

we are happy to have done the surgery feel free to contact me if you have any questions Astrid

I am responding to this as both a hand surgeon and a mom. Congenital trigger thumb is caused by a snagging of the tendon that bends the thumb when the thumb straightens. Sometimes, the trigger finger locks, and the thumb cannot straighten at that last joint. Sometimes, the thumb locks intermittently and straightens sometimes. Wait and see is ok if the finger is clicking sometimes, but not staying in a locked position frequently. If it is locked frequently, the growing joint can be affected and become abnormally shaped.

The operation to release the trigger is simple and straightforward. It involves a small incision at the base of thumb to release the tendon pulley which is snagging the tendon. Your child will probably have a cast on for 1 week afterwards, mostly to prevent him from removing the dressing from his hand. Once the cast comes off, he will probably be back to himself. You will probably have a harder time with the procedure than he will, kids are very resilient. If you are calm and not nervous about it, he will be calm about it too. But if you are nervous and anxious, he will pick that up from you.

My kids have had surgery, and they have always recovered much more quickly than I have!

good luck Elizabeth Lee, MD

One-year-old with trigger finger thumb

March 2001

My one year old was just diagnosed with a trigger finger thumb. We will be seeing a specialist to hear about treatment options, but from what I understand the choices are pretty much fix it through surgery or do nothing. Does anyone have any experience with this syndrome or advice with making the surgery/no surgery decision? Any info/advice would be appreciated. Thanks Gabriela

In my experience, trigger thumb is a repetitive motion injury (like carpel tunnel from improper wrist position during typing, for example). So I am wondering what the source of your sons injury could be? If you can figure that out, eliminate the source and see if it heals. That's the approach we take in ergonomics. Of course, there may be an underlying medical condition that I'm not aware of. But thought I'd pose the question. hilary

I'm not a doctor, but I have had a lot of experience with trigger finger.

I once developed trigger finger after an injury to my hand -- caught myself on my knuckles after a bad fall walking the dog. Many weeks later the trigger started happening. Internist couldn't figure it out, so I saw a hand specialist for diagnosis. Scar tissue had built up and was interfering with the system of 'pulleys' that make fingers work.

I also have trigger fingers now -- many years later -- from a bad workstation and what I call chronic toddler lifting syndrome. But occupational therapy is doing wonders, and I have proper ergonomic setups now. And headsets for every phone, including the cell. (Highly recommend them for everyone!)

In general, triggering is not a good thing, and I have a hard time not playing with it myself, so I can imagine your son is doing the same. If your son's doctor can't figure out what's going on, keep at it. It's well worth the price of an out-of-pocket visit if your insurance won't cover. Some docs will reduce fees if you ask them to and are self-pay. There are excellent hand docs at UCSF (especially Diao) and an independent (Bob Markison) in San Francisco. Markison is great because he's a surgeon who doesn't like to cut. good luck! Ann

Pediatric trigger thumb is a congenital disorder which requires a simple surgery to correct. What happens is that the tendon which bends the joint in the thumb gets stuck at what is called the first annular pulley at the base of thumb and your child cannot straighten the thumb. Unfortunately, this usually does not resolve on its own. If it is left unoperated, the joint will probably become permanently stiff and may even be deformed as it grows. The surgery is simple and the healing is usually uncomplicated and rapid also. You should see a specialist in hand surgery with experience caring for children. Elizabeth Lee

Sept 2001

My 2 1/2 yr. old son was just diagnosed with trigger finger, actually it has affected his right thumb. I had noticed his thumb swollen and stuck in a bent position one day while teaching him to give a thumbs up. When we took him to his pediatrician the next day he refered me to Dr. Mathias Masem, a hand specialist, who's office is located across from Summit Medical Center. He confirmed the diagnosis of trigger finger, which starts as an inflammation of the sheath around the tendon in his hand. He recommends surgery to correct the problem since he is older than 2. I guess if he is younger than 2, just splinting works to correct this. I wondered if anyone has had experience with this problem in a child, or ever heard of it. Apparently, there is no known cause in children, and it is congenital. Thanks so much from a worried mom, Lynn

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