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Orthopaedic Surgery
Congenital Trigger Finger
Trigger finger refers to a difference in which the digit, almost exclusively the thumb in children, locks or catches when it's flexed and extended. Apparently this is a condition that develops after birth and is present at 1 year of age in as much as 3.3 per 1000 live births. In one third of the cases the condition can be present bilaterally.
The tendon that allows flexion of the thumb glides through a series of pulleys before getting to the tip of the finger. When one of the pulleys (A1) is too tight or the tendon gets swollen the movement is not smooth and the tendon starts to lock or catch in its trajectory. The symptoms can progress to the point where the thumb is completely locked and contractures may develop, often a nodule (Notta's nodule) can be palpated at the base of the finger.Hand surgeons must evaluate this condition early on in order to initiate prompt treatment and avoid contractures. In 30 percent of the patients the trigger finger recovers spontaneously. Usually depending on the age of presentation the treatment will change, between one and three years of age surgery is usually considered if the condition is still present.
The surgical procedure when indicated consists of opening the pulley that causes the tight passage for the tendon. Usually this requires a small incision on the base of the finger; the child is immobilized for one week with a soft bandage after which they return to normal activities. The risk of recurrence is minimal but appropriate surgical technique is important because of the close relation with important nerves of the finger and the pulley.
