gms | German Medical Science

Clinical issue/s: Is a conservative approach to the treatment of the paediatric trigger thumb just as effective as surgical intervention.

Clinical reasoning: There has been recent discussion about whether paediatric trigger thumbs can improve without the need for surgery.

Until 2 years ago children diagnosed with a trigger thumb were offered an A1 pulley release as gold standard. In light of these recent discussions, a conservative treatment approach at our institution of daily passive stretches has now been adopted to be completed by parents at home.

Innovative, analytical or new approach: 105 children have been recruited to the study aged 6 months to 8 years with 41 males and 64 females. 12 patients presented with bilateral trigger thumbs the rest were unilateral. The patients were categorised into 2 groups, (group 1) fixed flexion and (group 2) actively triggering. A goniometer was used to gain active and passive IPJ extension.

Each patient was seen at 6 monthly intervals. This presentation will discuss the 24-month results.

Contribution to advancing HT practice: The interim results at present identify the highest populated group is group 1. 66% of patients show an increase in passive extension and 39% show an increase in active extension however, 30% had worsened active extension. There appears to be no correlation between gender and prevalence or progress.

The results so far show an improvement regarding passive and active extension. Interestingly the patients over 4 years of age appear to show less deterioration than younger patients. The study is to continue over a 4-year period, this will provide more robust results to clarify if conservative management of trigger thumbs in children is feasible.