Advice about Trigger Finger
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Advice about Trigger Finger
My 17 month old has had bilateral trigger thumb since birth. The
surgeon at Oakland Children's Hospital has taken a ''wait and see''
approach until 18 months. If it didn't resolve by then, he'd
recommend surgery. While sometimes my son's thumbs look and act
normal, they are still bent most of the time.
I was wondering if anyone has had any results with alternative
therapies (acupuncture, PT, etc.) or waiting longer. (I did try
feldenkreis, but did not see much/if any improvement.) Or can
anyone share their experiences with the surgical process and
recovery? I'm very nervous about the prospect of surgery --
especially on a 'sensitive' (intense) toddler who tends to be
afraid of going to the doctor.
Thanks for any input!
I recommend that you get a referral from your hand surgeon to the
Hand Therapy clinic at Children's Hospital Oakland (if you
haven't already done so). While you are ''waiting and seeing'' the
occupational therapists there can evaluate your son's functional
skills and how they are impacted by his thumbs. Sometimes it is
helpful to splint these thumbs to make grasping more successful,
as well as stretches, exercises, etc.
My 3 y.o. nephew had trigger thumb, and it went
undiagnosed/untreated for over year and a half. He did have
some chiropractic work done for it, but it didn't help. He
eventually had to have the surgery (at Oakland Children's
Hospital), and it went well, but since it was so long that he
had the trigger thumb in the bent position, he now has some
muscle atrophy which should improve over time. We give him
small motor skill games and toys like lacing cards and puppets
to help him regain control of his thumb. I don't know of other
methods to improve this condition, and I know surgery for your
17 month old is extremely scary, so I understand how troubling
this must be for you. I wish I could give you more
information/advice, but all I can say is that my nephew has
fully recovered, and I think that his mom had a harder time
with the ordeal than he did.
Hope your little guy heals quickly
My daughter had trigger finger in her pinkies. She had to use her
other hand to straighten it out. Since it was in the pinkies it
did not impact her ability to use her hands but we did consult
with a surgeon. In the end she outgrew it around 4 years of age.
It slowly went away. At some point she could bend them by
themselves but they clicked. Now, at five, they are normal. Good
luck with it.
We discovered my daughters triggerthumb at 24mo and we debated
back and forth if to wait or go ahead with surgery...we tried
for a while with massaging the thumb every evening but that,s
not that easy to do with a very active 2yr old....so we finally
did decide on surgery since the thumb was mostly in locked
position....we were fortunate to have Dr Todd Lincoln at Kaiser
Oakland as our surgeon...he is fabulous and really made us feel
calm about it all...the surgery itself took only like 10min and
i had just made myself comfortable in the waiting area when
Dr.Lincoln already came to get me ....it is not that easy to
keep the surgeryarea clean and dry and our girl developed an
infection which had to be treated with antibiotics but a year
later now noone can tell that something has been done and she
uses her thumb like every other child....actually just a day
after surgery the thumb worked totally normal as it should
we are happy to have done the surgery
feel free to contact me if you have any questions
I am responding to this as both a hand surgeon and a mom.
Congenital trigger thumb is caused by a snagging of the tendon
that bends the thumb when the thumb straightens. Sometimes,
the trigger finger locks, and the thumb cannot straighten at
that last joint. Sometimes, the thumb locks intermittently and
straightens sometimes. Wait and see is ok if the finger is
clicking sometimes, but not staying in a locked position
frequently. If it is locked frequently, the growing joint can
be affected and become abnormally shaped.
The operation to release the trigger is simple and
straightforward. It involves a small incision at the base of
thumb to release the tendon pulley which is snagging the
tendon. Your child will probably have a cast on for 1 week
afterwards, mostly to prevent him from removing the dressing
from his hand. Once the cast comes off, he will probably be
back to himself. You will probably have a harder time with the
procedure than he will, kids are very resilient. If you are
calm and not nervous about it, he will be calm about it too.
But if you are nervous and anxious, he will pick that up from
My kids have had surgery, and they have always recovered much
more quickly than I have!
Elizabeth Lee, MD
My one year old was just diagnosed with a "trigger finger" thumb. We will be seeing a
specialist to hear about treatment options, but from what I understand the choices are
pretty much fix it through surgery or do nothing. Does anyone have any experience with
this syndrome or advice with making the surgery/no surgery decision? Any info/advice
would be appreciated. Thanks
In my experience, trigger thumb is a repetitive motion injury (like
carpel tunnel from improper wrist position during typing, for example). So I am
wondering what the source of your sons injury could be?
If you can figure that out, eliminate the source and see if it heals.
That's the approach we take in ergonomics. Of course, there may be an underlying
medical condition that I'm not aware of. But thought I'd pose the question.
I'm not a doctor, but I have had a lot of experience with trigger finger.
I once developed trigger finger after an injury to my hand -- caught
myself on my knuckles after a bad fall walking the dog. Many weeks
later the trigger started happening. Internist couldn't figure it out,
so I saw a hand specialist for diagnosis. Scar tissue had built up and
was interfering with the system of 'pulleys' that make fingers work.
I also have trigger fingers now -- many years later -- from a bad
workstation and what I call "chronic toddler lifting syndrome". But
occupational therapy is doing wonders, and I have proper ergonomic setups
now. And headsets for every phone, including the cell. (Highly recommend
them for everyone!)
In general, triggering is not a good thing, and I have a hard time not
"playing" with it myself, so I can imagine your son is doing the same. If
your son's doctor can't figure out what's going on, keep at it. It's well
worth the price of an out-of-pocket visit if your insurance won't cover.
Some docs will reduce fees if you ask them to and are self-pay. There are
excellent hand docs at UCSF (especially Diao) and an independent (Bob
Markison) in San Francisco. Markison is great because he's a surgeon who
doesn't like to cut.
Pediatric trigger thumb is a congenital disorder which requires a simple surgery to
correct. What happens is that the tendon which bends the joint in the thumb gets
stuck at what is called the first annular pulley at the base of thumb and your child
cannot straighten the thumb. Unfortunately, this usually does not resolve on its own.
If it is left unoperated, the joint will probably become permanently stiff and may even
be deformed as it grows. The surgery is simple and the healing is usually
uncomplicated and rapid also. You should see a specialist in hand surgery with
experience caring for children.
My 2 1/2 yr. old son was just diagnosed with "trigger
finger", actually it has affected his right thumb. I
had noticed his thumb swollen and stuck in a bent
position one day while teaching him to give a thumbs
up. When we took him to his pediatrician the next day
he refered me to Dr. Mathias Masem, a hand specialist,
who's office is located across from Summit Medical
Center. He confirmed the diagnosis of "trigger
finger", which starts as an inflammation of the sheath
around the tendon in his hand. He recommends surgery
to correct the problem since he is older than 2. I
guess if he is younger than 2, just splinting works to
correct this. I wondered if anyone has had experience
with this problem in a child, or ever heard of it.
Apparently, there is no known cause in children, and
it is congenital.
Thanks so much from a worried mom,
[no replies received]
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