Congenital Trigger Finger

Epidemiology

 

Most common in thumb

 

Bilateral in 15%

 

Clinical

 

Present with FFD of thumb / finger

 

Pathology

 

Thumb

- constriction of A1 pulley

 

Finger

- nodules in FDS or FDP

- catching at A1, A2 or A3

- may have anomalous insertion lumbrical

- often at tendon decussation area

 

Types Trigger Thumb

 

1. True congenital

- bilateral in 50% cases

- can be sporadic

- associated with trisomy 18 / mucopolysaccharidases

 

2. Common type

- presents 6/12 - 3 years

 

NHx

 

Thumb

- spontaneous relapse 30% < 1 year

- spontaneous relapse 10% > 1 year

 

Finger

- not present at birth

- usually acquired

- more likely to spontaneously relapse

 

Operative Management

 

Indication

 

Before age 3

 

Thumb

 

> 1 year

- release A1 pulley

- careful preservation digital nerves

 

Finger

 

Extensive exposure / progressive releases / repeat intraoperative examination

- release A1 pulley

- release anomalous insertions

- partial release A2 and A3 pulley

- release single slip FDS