Trigger thumb of de Quervain's disease

Triggering of the thumb due to de Quervain's Disease has not been reported in an adult, and only one case in a child has been documented in the literature. Two cases of trigger thumb that were due to stenosing tenosynovitis in which the extensor pollicis brevis tendon triggered in a separate fibro-osseous tunnel within the first dorsal compartment are cited.     

Trigger thumb in adults after hyperextension injury

Three cases of trigger thumb in adults developing after hyperextension injury are described. The similarity of the mode of injury in the cases and its possible role in the production of initial stenosis in the tendon sheath is discussed. Trauma alone may not cause triggering in the fingers, for there are other important factors such as rheumatoid disease, which with trauma may play a part. Trauma may however be the sole initiating factor in other cases of adult trigger thumbs.     

Trigger thumb in children: results of surgical correction

Stenosing tenosynovitis of the thumb, or trigger thumb, is relatively uncommon in children. The surgical correction of trigger thumb in 15 children is described to illustrate the clinical features of this condition. The literature is reviewed in order to alert the orthopaedic surgeon to the natural history of triggering digits in childhood.     

Trigger fingers and thumb: when to splint, inject, or operate.

Fifty trigger fingers were treated by splinting of the metacarpophalangeal joint at 10 to 15 degrees of flexion for an average of 6 weeks (range, 3 to 9 weeks). Another 50 trigger fingers were injected with 0.5 ml of betamethasone sodium phosphate and acetate suspension (Celestone) and 0.5 ml of lidocaine. All patients were followed up for a minimum of 1 year (range, 1 to 4 years). Treatment was successful in 33 (66%) of the splinted digits and 42 (84%) of the injected digits. Fifty percent of the 10 splinted thumbs and 70% of the 40 splinted fingers had a successful outcome. Of the 17 unsuccessfully treated digits in the splinted group, 15 were later cured with injections and 2 required surgery. All of the 7 unsuccessfully treated digits in the injected group were cured with surgery. Patients with marked triggering, symptoms of more than 6 months' duration, and multiple involved digits had a higher rate of failure in both groups. Splinting offers an alternative for patients who have a strong objection to cortisone injection.     

Trigger thumb: results of a prospective randomised study of percutaneous release with steroid injection versus steroid injection alone

One hundred and twenty-seven trigger thumbs in 115 adult patients were randomised to either percutaneous release with steroid injection (n=66) or steroid injection alone (n=61). Two patients, one from each group, were lost to follow-up. Percutaneous release with steroid injection produced satisfactory results in 91% of cases whereas steroid injection alone produced satisfactory results in 47% of cases. One case in the percutaneous group developed stiffness and one in the injection group developed cellulitis. No digital nerve injury occurred in either group. We conclude that percutaneous trigger thumb release combined with steroid injection has a higher success rate than that of steroid injection alone.     

Flexion deformities of the thumb: clasped thumb and trigger thumb

Congenital clasped thumb in palm corresponds to a spectrum of anomalies leading to a loss of thumb extension and abduction. Intrinsic muscles and skin shortening are not infrequent. Conservative orthopedic treatment should be undergone as soon as possible. When this treatment fails, or when patients are seen late, surgical correction has to be customized according to the involved structures. The trigger thumb is 10 times more frequent than the trigger finger. It is bilateral in 30% of the cases. The term "congenital" remains unclear as several investigations on newborns have not evidenced trigger thumb. In children, it is very rare to find a real trigger and presentation consists in a fixed flexion deformity of the interphalangeal joint. Diagnosis is clinical, with a palpable nodule at the level of T1 pulley. Conservative treatment, consisting in a nocturnal splint, is indicated before the age of two years old. After this age, or in case of failure of splinting, surgery will be needed.     

Trigger digits

Trigger finger is an entity seen commonly by hand surgeons. It is produced by a size mismatch between the flexor tendon and the A1 pulley, which causes pain, clicking, catching, and loss of motion of the affected finger. The diagnosis is usually easy but other pathological processes (extensor apparatus instability, locked metacarpo-phalangeal joint) must be excluded. Treatment modalities in trigger finger include splinting, corticosteroid injection and/or surgery. Indication depends on the clinical form of trigger finger.     

Trigger wrist

Trigger wrist is a relatively rare phenomenon. The pathological entities to which the term trigger wrist is applied are not well defined in the literature. We present three cases of trigger wrist as a result of flexor tendon pathology, review the literature and discuss the use of the term "trigger wrist".