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