Results of Surgical Release in Pediatric Trigger Thumb
Perajit Eamsobhana MD*, Kamolporn Kaewpornsawan MD*, Suphawat Tantithawornwat MD*
Affiliation : * Department of Orthopaedic Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Objective : To observe and evaluate the treatment outcome of pediatric trigger thumb in patients who had undergone surgical
release of the annular ligament with the oblique pulley partially released in patients who did not achieve full IP joint extension.
Material and Method: From 2003 to 2010, 21 surgically operated thumbs in 17 patients were reviewed. Bowstringing, range
of motion (ROM) of thumb interphalangeal joint, Notta’s node resolution and assessment of patient/parent satisfaction were
used as outcome parameters. The pulley pathology system was observed intra-operatively. The annular ligament was
completely released, and in patients who were not fully corrected, a further procedure in which 50% of the oblique pulley was
released was undertaken.
Results : One thumb had recurrent triggering after 60 months of follow-up. No infection, neurovascular injury, excessive
scarring, or bowstringing were detected. Notta’s node was fully resolved in all operated thumbs. Mean follow-up was 64
months. Improved IP joint motion without flexion contracture was observed in all patients. The procedure was well tolerated
by patients and both the patients and parents of patients expressed satisfaction with the results of the procedure.
Conclusion : Surgical release is recommended for children aged more than one year that are afflicted with trigger thumb.
This procedure delivers satisfactory results with minimal complications. To achieve full FPL excursion, some patients need
to release 50% of the oblique pulley after the first procedure.
Keywords : Trigger thumb, A-1 pulley, Notta’s node, Oblique pulley, Annular ligament
