We often encounter many inquiries from parents. The common one is the trigger thumb, and there is also the less easily diagnosed buckle thumb deformity.
Recently, we met a case of a child who went to many hospitals. The child started to seek medical attention around one year old, went to many hospitals, and came to our department at the age of four and was diagnosed with trigger thumb deformity.
Trigger thumb
Trigger thumb deformity is divided into 4 stages.
Stage I (swollen type) showing localized Notta nodules, but no popping during flexion and extension activities of the knuckle joint.
Stage II (active popping type) presents with popping during active dorsal extension of the interphalangeal joint.
Stage III (passive popping type) presents with inability to actively extend the interphalangeal joint and the presence of popping during passive extension.
Stage IV (rigid type) presents with an interphalangeal joint that cannot be passively straightened (i.e., a fixed flexion deformity is present).
In patients with trigger thumb, treatment of fixed flexion deformity of the interphalangeal joint
Delaying surgery until 3 years of age does not negatively affect joint contracture or mobility function. Therefore, an appropriate period of observation is reasonable, especially in children younger than 1 year of age.
Children older than 1 year of age who present with painful popping and fixed flexion deformity (stage IV) require surgery.
Buckle thumb deformity
Type I buckle thumb deformity is mild and presents with absent or hypoplastic thumb extension devices.
Type II buckle thumb deformity is more complex and is associated with joint contracture, lateral ligament abnormalities, tiger mouth contracture, and piriformis muscle abnormalities.
Type III thumb deformity is associated with joint contracture or other related syndromes.
Treatment.
Type 1 can be treated conservatively
Type 2/3 must be treated surgically
Surgical treatment around 1 year old
Parents are reminded to consult a medical professional in a timely manner to avoid delaying treatment.