Trigger Thumb in Children

Written by edward j. lamb
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Trigger Thumb in Children
(Columbus (Ohio) Public Health)

Medically known as stenosing tenosynovitis, trigger thumb can become debilitating in its most severe form because a child will not be able to move his or her thumb. Treatments for trigger thumb depend on the severity of the condition and range from rest and soaking of the affected hand to tendon surgery. Children develop trigger thumb more often than do adults, and symptoms can begin appearing before a child reaches 12 months of age.

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Description

A child with a trigger thumb has an opposable digit that locks into position when bent to a 90-degree angle. Usually, the child can release his or her thumb with a concentrated effort or by shaking the hand with the affected thumb. Without treatment, the condition can progress until the child cannot move the trigger thumb from its locked position. A trigger thumb can cause pain and limit a child's ability to correctly grasp and hold objects.

Cause

Trigger develops as the sheath, or tenosynovium, around the tendon that controls the movement of the thumb narrows. This narrowing can happen because of repetitive strain, direct injury or a disease such as rheumatoid arthritis or diabetes. As the tenosynovium narrows, it releases less of the fluid needed to ease the movement of the tendon, which, in turn, limits the flexibility of the thumb.

Nonmedical Treatments

A brochure from the Mayo Clinic lists a range of nonmedical options for relieving the symptoms of trigger thumb. The approaches of soaking the hand with the affected thumb in warm water, splinting the thumb to enforce rest and nonuse for a specified period and gentle exercises work best for children with mild cases of trigger thumb.

Medications

At the heart of the cause of trigger thumbs lies inflammation in the tissue around the tenosynovium and its tendon. Oral non-steroidal inflammatory drugs such as ibuprofen or injections of hydrocortisone can reduce the inflammation and provide relief for some patients.

Surgical Treatments

Children whose trigger thumb has progressed to the point that they cannot unlock it need surgery. Two surgical options exist. In the first, a doctor uses a needle to inject a small amount of fluid and manipulate the thumb's tendon until the digit unlocks. The more-involved of the two procedures involves making a small slit in the thumb tendon's tenosynovium after injecting a local anesthetic.

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