Master's Surgical Technique: Surgical Treatment of Trigger Thumb and Trigger Finger

Abstract

Trigger thumb and trigger finger in children both can result in a painful “triggering” or fixed contracture of the digit. Although they clinically present in a similar fashion, they have quite different treatment methods. Trigger thumb is an acquired condition, with observation for spontaneous resolution as the initial treatment. If trigger thumb fails to resolve with observation, then surgical treatment involves release of the A1 pulley. Conversely, trigger finger is usually due to a congenital difference in the finger flexor anatomy but can be due to metabolic, inflammatory, and other conditions. Initial treatment of trigger finger involves extension splinting, but in cases requiring surgical treatment A1 pulley release and excision of a slip of the flexor digitorum superficialis tendon is typically needed. It is crucial for the treating provider to understand these differences in diagnosis and treatment to ensure the best outcome of these similar but unique conditions. Key Concepts: • Trigger thumb is an acquired condition. • If trigger thumb fails to resolve with observation, then surgical treatment involves an A1 pulley release. • Trigger finger us usually due to a congenital difference in the finger flexor anatomy but can be due to metabolic, inflammatory, and other conditions. These must be ruled out. • If trigger finger does not resolve with splinting, then surgical treatment often involves not only A1 pulley release but also an excision of a slip of the flexor digitorum superficialis tendon.