Trigger thumb is a common occurrence with controversial treatment. The decision to surgically intervene varies from country to country. The primary pathology remains tendon thickening at the A1 pulley with a nodule. There is a role for conservative management but failure of non-operative measures typically requires surgery to release the pulley system. Open release has uniformly resulted in excellent results. The aim of this study was to define a technique of percutaneous release in children, and to report the outcomes in this specific patient population.
This cohort consisted of a prospective series of 31 thumbs in 26 children. The procedure was performed under intravenous sedation or mask anesthesia. Bupivacaine was initially infiltrated into the A1 pulley area and an 18-gauge needle was used to release the pulley. Several longitudinal cuts were than made from distal to proximal, staying perpendicular to the A1 pulley until release was evident.
All patients were carefully followed. Sensation was extremely difficult due to the age of the population. Satisfactory outcome was obtained in all but 1 thumb that had incomplete release requiring open surgery. The procedures ranged in time from one to five minutes. No evidence of bowstringing was noted.
The authors report a percutaneous release of trigger thumb in children. The biggest advantage of trigger thumb release in adults is that the procedure can be performed in the office under local anesthesia. The use of only local anesthesia has prohibited this technique from becoming popular in children. The authors report this percutaneous technique which is completed under general anesthesia. Thus, the true benefit of a percutaneous release is not achieved. An open release takes about 10 minutes and there is direct visualization of the nerve and the constricting pulley. Although the authors report impressive results, the practical use of this technique remains questionable.