Mother shared her experience of her 3-year-old daughter undergoing surgery for a pediatric trigger finger.
Trigger finger is not limited to adults; it can also manifest in children. While the symptoms of trigger fingers in children may appear innocuous at first glance, this condition can significantly impact hand function more than one might initially assume. From a maternal perspective, Khun Chananan Eudulyutrakul, the mother of an adorable 3-year-old girl named Milin, wishes to share her experience of navigating her "Little Milin" through surgery to treat her trigger finger.
Trigger finger in children is of more significant concern than one might initially presume.
“When playing 'thumb war' with my little one, I noticed one of her thumbs did not straighten fully; it remained slightly bent. Initially, I did not think much of it because she led a normal daily life, engaging in play, drawing, and coloring without complaining of discomfort. Except when I tried to stretch it, she would pull back her hand, appearing somewhat uncomfortable. I presumed as she would outgrow it, her thumb would gain the strength to straighten itself when she is older.”
However, one day, her piano teacher pointed out that not addressing the issue could affect dexterity in pressing the piano keys. The piano teacher further shared that one of her friends had trigger fingers and would feel pain while playing musical instruments. This revelation, and knowing a friend taking her 2-year-old to have trigger finger surgery, prompted Ms. Chananan to delve into online research and seek advice from several doctors she knew.
“The doctor informed me that, at the age of 3, it is relatively challenging to straighten the thumb because the tendon has become constricted and cannot glide freely. If left untreated, the bones will keep growing with age, but the trigger finger will be even more bent, potentially impacting the future use of the hand.”
“I would like the doctor to fix the finger.”
Little Milin knew one of her thumbs bends more than others. However, she did not quite grasp that this was an abnormal condition different from other children. Soon, she would begin kindergarten, requiring more activities that involved hand skills. So, her mother probed for her willingness to have it fixed.
“I asked, 'Milin, do you want your thumb to be straight like the other?' She replied, 'Yes, I want it to be the same.' If she had not wanted, I would have left it alone. But when she expressed her wish to straighten it, we decided to embark on the road for her surgery.”
Given her physical therapist background, Khun Chananan consulted with friends and doctors she knew. She discovered a specialist at MedPark Hospital, Dr Kanchai Malungpaishrope, an orthopedic surgeon experienced in hand surgery, especially in treating pediatric hand conditions. She decided to consult him.
“The doctor examined the hand and felt tightness at the base of the affected thumb. In mild cases, only physical therapy and finger splinting would be sufficient. But it was quite severe. When he tried to stretch it, it failed to straighten completely. The treatment would require open surgery to release the constricting tendon sheath at the base of the thumb, allowing the tendon to glide freely and straighten the thumb.”
Pediatric trigger finger surgery requires a team of specialists.
Surgery for trigger fingers in adults typically does not require a hospital stay; it involves injecting local anesthesia into the finger, followed by a 20-minute procedure in which the doctor lays open the constricting tendon sheath. However, for children, the procedure is longer, about an hour, due to the necessity of using general anesthesia to ensure the child is asleep and the hand remains immobile, preventing any harm to the adjacent nerves.
Dr Kanchai sought consultation with a pediatric critical care specialist, who conducted a physical examination to ensure that Milin was physically fit for the surgery, as utmost safety is essential when administering general anesthesia.
“I told Milin that the doctor will put a special glove on your hand.' She understood. She was calm when she woke up with a bandage on her hand and an arm sling. She did not experience any complications or pain. There was just a tiny incision at the base of her thumb. She spoke, played, laughed, and even picked up her coloring pencils. She spent one night in the hospital and continued her recovery for ten days at home while waiting for the wound to heal.”
During the healing period, it was crucial to keep the wound free of dust and debris and avoid exposing it to water. After ten days, Milin returned to the doctor to have the dressing removed. The wound had healed, and she received advice to apply lotion and gently stretch her thumb. What delighted Khun Chananan was her wide, beaming smile.
“Milin was delighted, smiled from ear to ear. She could play with plasticine clay, coloring, and Lego and continue with her piano lessons more deftly. Her rapid recovery was likely due to the small incision, minimal pain, and unrestricted movement and use of her hand.”
Khun Chananan expressed her deep appreciation for the care of the medical team and the psychological support provided to Milin, making her feel comfortable and unafraid of the surgical procedure. She encouraged parents of children with trigger fingers to consult with a specialist doctor.
“For just one finger, we could not prophesize how it might affect her future self-confidence. We want our children to be confident and not have their hands restricted. If a child is under two, it is advisable to consult a doctor to stretch the finger and put off surgery for as long as possible until stretching does not yield results. Then, make the decision based on family convenience.”
What is a pediatric trigger finger?
Pediatric Trigger finger is a condition characterized by an abnormally bent finger. This condition prevents the affected finger from fully straightening. Pediatric Trigger finger is typically noticeable within the first year of life.
The exact cause is not yet clearly understood. The pathology of the disease is due to the constricting tendon sheath of the finger, impeding its normal movement. When addressing this condition, pay special attention to the degree of extension limitation during the first year of life. If, after one year, the finger remains unable to extend fully, it is advisable to consider a surgical intervention to release the constricting tendon sheath of the finger by a pediatric orthopedic surgeon with expertise in hand surgery.
Can a trigger finger resolve on its own?
Trigger fingers, typically found in adults and children, result in the finger bending abnormally, preventing its full extension. In adults, this condition is usually caused by the constricting tendon sheath of the finger, leading to pain at its base. In severe cases, this can lock the finger in flexion, noticeable when one wakes up, as the affected finger remains bent. Most individuals will try to straighten the locked finger or even use another hand to force it to straighten up. Most commonly, the condition afflicts adults aged 40 to 50 years; there are associations with age and repetitive hand exertion.
The thumb is most frequently involved in the pediatric trigger finger, less often in the index, middle, ring, and little fingers. Regarding whether this condition is congenital, no credible evidence exists. Since newborns naturally clench their hands. However, it can be apparent at two to three months of age, when the babies open their hands, parents, and caregivers may notice one of the thumbs may not straighten.
In the case of children like Milin, Dr Kanchai Malungpaishrope, an orthopedic surgeon specializing in hand surgery, provided insight into the potential outcomes:
“If this occurs in the first year, there is a chance it may resolve on its own, with reports suggesting a 30% chance of self-correction. However, after one year, the chances of natural correction become more challenging. The thumb would not fully extend, leading to various associated problems. Contrary to adults, children typically do not experience pain. In the case of Milin, the issue arose from her piano lessons. When a child cannot fully extend the thumb, it becomes further distorted without intervention, forming a zig-zag deformity. The upper thumb joint flexes while the base joint becomes hyperextended.”
Surgery for pediatric trigger finger
If parents bring their children to see a doctor at around 3 to 4 years of age, treatment is straightforward because the underlying pathology of the trigger thumb is a thickened tendon sheath. The doctor will release the thickened sheath, which does not affect finger function or lead to future loss of function.
Dr Kanchai explained, “Injecting local anesthetic is not applicable for children because it would be exquisitely painful for the child. For the child to be comfortable, we use general anesthesia. The incision is approximately 0.5 cm for children and about 1 cm for adults. We cut the thickened tendon sheath and then suture the incision. One of the main concerns after surgery is the risk of infection, which can occur if the hand gets wet or the child frequently touches the surgical site. Therefore, it is necessary to wear a splint to keep the elbow extended and prevent the child from bending the thumb. We explain to the child that it is like a robot.”
For Milin, it is not a complex procedure, and the treatment plan is straightforward. It usually takes about a week for the incision to heal completely. Doctors often recommend wearing a splint for about two weeks, and there is no need for suture removal as they are dissolvable sutures.
What happens if a trigger finger is left untreated?
Indeed, children who do not undergo trigger thumb surgery generally do not suffer a significant loss of hand function. They can typically grasp objects, write, and perform everyday tasks. However, over the long term, there may be some adverse effects on the affected finger, such as the distal finger joint becoming flexed while the joint at the base of the finger hyperextend. If a child wishes to engage in activities that require precise finger movement, like playing a musical instrument, they might face some challenges.
Dr Kanchai explained: “These structural hand changes are natural adaptations. For a flexed joint, the adjacent one will hyperextend to enable the finger to function as best possible.”
Therefore, he emphasized the importance of not waiting for children to complain or inform their symptoms if parents notice something unusual with their hands. It is advisable to consult a doctor for a proper assessment and diagnosis as soon as possible.
