The Natural History of Pediatric Trigger Thumb

Author(s): Baek GH, Kim JH, Chung MS, Kang SB, Lee YH, Gong HS

Source: J Bone and Joint Surg 90-A (5) 980-985, 2008.

Summary:

This case series from South Korea reviews 71 thumbs in 53 children with a pediatric trigger thumb collected over a 10 year period.  No treatment was provided and patients were followed at 6 month intervals.  The median age of the patients at the time of first visit was 23 months and the median duration of follow- up was 48 months (range, 24 to 114 months).  The average initial flexion deformity of the interphalangeal joint for the 71 thumbs was 26 degrees (range, 15 to 45 degrees).  Resolution of trigger thumb as defined by interphalangeal joint flexion deformity of 0 degrees occurred in 45 of 71 thumbs (63%).  In 67 thumbs (94%), the flexion deformity decreased.  In the group of 45 thumbs that had resolution, the average age at the time of resolution was 60 months.  Kaplan-Meier analysis revealed that overall median time from the initial visit to resolution was 48 months (95% confidence interval). 

Most hand surgeons currently recommend operative treatment for pediatric trigger thumb.  However, this study indicates that the natural history of pediatric trigger thumb may result in improvement to neutral position of the interphalangeal joint in over 60% of thumbs.  In addition, most of the remaining thumbs improved in their flexion posture.  Some previous studies have indicated that delayed operative treatment may result in greater residual flexion deformity.  Considering this study and that all other reports have been case series, a prospective randomized study may be of benefit.  The data from this study however may be beneficial in counseling parents on treatment options for pediatric trigger thumb.