Pediatric trigger thumb (PTT) is also called a flexion contracture of the IP joint (Picture 1). It is a condition that affects the movement of the thumb in children. The thumb gets stuck in a bent (flexed) position. A contracture means that the thumb can no longer stretch or straighten.
Tendons work to make our thumbs move. They are like strings inside your thumb and are held in place by a tunnel system of ligaments (also known as “pulleys”). These tunnels or ligaments keep the tendon next to the bone and allow it to slide back and forth (Picture 1).
|Picture 1: Inside a normal thumb||Picture 2: Pediatric Trigger Thumb and Notta's Nodule|
When the tendons are pulled through the ligament, the thumb bends or flexes.
In PTT, a tendon cannot slide back and forth through the ligament. The thumb becomes locked in a flexed position. The child can no longer straighten his thumb. The name “trigger” comes from the clicking sensation felt when the tendon pops through the ligament or “triggers” between a locked position and straight position.
The exact cause of PTT is not known. Children are not born with it. It does not occur from overuse, trauma, or injury. We do know that there is a mismatch in size between the tendon that moves the thumb and the ligament through which the tendon glides. The ligament is too tight over the tendon. The tendon then swells and becomes thick. Sometimes a bump, called a Notta’s nodule, forms on the tendon. The Notta’s nodule stops the tendons from gliding properly (Picture 2).
About 3 in 1000 children will develop PTT between age 1 and 3. Most often, it occurs in children at about age 2. Boys and girls have the same risk of developing PTT. Both thumbs can be affected in up to 30 percent of children.
To diagnose PTT, the medical provider will take a medical history and examine your child. If one or more of the following is present, the diagnosis is made:
There may also be pain and swelling at the base of the thumb, although that is rare.
There are three ways to treat PTT.
The surgeon does not need to cut the tendon or remove the Notta’s nodule. Cutting the A1 pulley takes the pressure off of the tendon so that it can glide smoothly.
After surgery, your child will have no restrictions on using his thumb. He can use it without worry of hurting the surgical repair. He will wear a bandage for 3 days (Picture 4).
|Picture 3: Small cut or incision at base of thumb||Picture 4: Bandage after surgery remains in place for 3 days|
The bandage must stay dry. Although pain after surgery is unusual, you can give your child acetaminophen (Tylenol®) or ibuprofen (Motrin®) if needed.
You may remove the bandage 3 days after surgery. Once it is removed, your child can bathe and go back to all activities. Cover the wound with a small Band-Aid® until the stitches dissolve and the wound is completely healed. Your child will have a follow-up appointment at the clinic within 2 weeks after surgery.
Call your child’s doctor if any of these things occurs:
Pediatric hand specialists at Nationwide Children’s Hospital take care of many patients with PTT. We would be pleased to treat your child and answer any questions you may have. Please call 614-722-HAND (or 614-722-4263) to schedule an appointment.
Pediatric Trigger Thumb (PDF)
HH-I-408 2/16 Copyright 2016, Nationwide Children’s Hospital