Delayed post-traumatic trigger finger in a 14-year-old boy after blunt trauma. A case report

Adult presentation of locked 'congenital' trigger thumb: A case report

INTRODUCTION AND IMPORTANCE

Although 'congenital' or paediatric trigger thumb is commonly seen in the paediatric age group, adult presentation is very rare. However it is crucial to acknowledge the occurrence of unusual manifestations of paediatric trigger thumbs, since paediatric trigger thumbs are considered a separate disease entity compared to the commonly seen stenosing tenosynovitis in adults.

CASE PRESENTATION

We report a case of a 18-year-old young lady presenting with atraumatic locked trigger thumb, which was successfully treated surgically with intra-operative finding confirming abnormally thickened flexor pollicis longus tendon signifying a paediatric trigger thumb pathology.

CLINICAL DISCUSSION

Adult and paediatric trigger thumbs have different aetiology, with thickened A1 pulley and tendon sheath being the culprit in adults, whereas in paediatric thumbs thickened tendon nodules (Notta's node) are usually the causes of triggering.

CONCLUSION

This uncommon presentation in this case report is atypical in the age group presentation of paediatric trigger thumb, and should be distinguished from the usual trigger thumb pathology in adults. Although a transient period of extension lag in the early post-operative period may be evident, it can still be successfully treated with surgical release.

Ultrasonography in the assessment of hand injuries in children: A systematic review

Despite the frequency of paediatric hand injuries, recommendations for diagnostic investigations are limited due to paucity of published guidelines. This has led to inappropriate diagnoses and therefore inappropriate management. Ultrasonography is a portable, non-ionising imaging modality that allows rapid real-time evaluation of anatomical structures at a low cost and without sedation. In the adult population, ultrasonography has already been shown to improve accuracy in hand injury diagnoses. However, in the paediatric population, only one narrative review focuses on the application of ultrasonography to diagnose hand injury. A systematic search using PubMed, Google Scholar, EMBASE, Scopus, Cochrane database of systematic reviews and University Library of York, Keele, Edinburgh and King's College London was conducted to assess literature surrounding use of ultrasonography as a diagnostic tool for paediatric hand injuries. The literature search yielded 11,860 articles and 21 studies were identified with a total of 30 patients. Ultrasonography was observed to be an accurate tool for diagnosing bone, tendon, ligament and nerve injuries in children. The results of our study suggest that ultrasonography should be considered as an early diagnostic step for paediatric hand injuries.

Trigger finger secondary to a neglected flexor tendon rupture

Secondary trigger finger caused by trauma to the hand, especially associated with partial flexor tendon rupture, is not a common condition. Thus, the clinical manifestations of these patients are not well-known. The aim of this study is to present secondary trigger finger caused by a neglected partial flexor tendon rupture including discussion of the mechanism and treatment.We retrospectively reviewed the records of 6 patients with trigger finger caused by a neglected partial flexor tendon rupture who had been treated with exploration, debridement, and repairing of the ruptured tendon from August 2010 to May 2015. The average patient age was 41 years (range, 23-59). The time from injury to treatment averaged 4.7 months. The average follow-up period was 9 months (range, 4-18). Functional outcome was evaluated from a comparison between the Quick-disabilities of the arm, shoulder, and hand (DASH) score and the visual analogue scale (VAS) for pain, which were measured at the time of preoperation and final follow up.Four patients showed partial rupture of the flexor digitorum profundus (FDP) tendon and 3 showed partial rupture of the flexor digitorun superficialis (FDS) tendon. Both the FDP and FDS tendons were partially ruptured in 2 patients, and the remaining patient had a partial rupture of the flexor pollicis longus tendon. All patients regained full range of motion, and there has been no recurrence of triggering. The average VAS score decreased from 3.6 (range, 3-5) preoperatively to 0.3 (range, 0-1) at the final follow up. The average Quick-DASH score decreased from 33.6 preoperatively to 5.3 at the final follow up.When we encounter patients with puncture or laceration wounds in flexor zone 2, even when the injury appears to be simple, partial flexor tendon laceration must be taken into consideration and early exploration is recommended.

Stenosing Tenosynovitis Due to Excessive Texting in an Adolescent Girl: A Case Report

We present a case report of stenosing tenosynovitis of the flexor pollicis longus tendon in an adolescent girl who required surgical release after failing conservative measures. The patient had no other risk factors, aside from her excessive texting, which we postulate led to her condition. Although there have been a few reports of tendinitis and tenosynovitis secondary to texting, we believe this is the first in the literature to report trigger thumb requiring surgical release in an adolescent.

Bilateral trigger finger in a 5-year-old child: case report

Trigger finger is rare in children. Herein, we report on a 5-year-old boy with trigger digits in several of his fingers since 1 month before which got worse. Triggering occurred in decreasing order of severity in proximal interphalangeal joints of the left middle, index, ring fingers and thumb. There was also triggering of the right index finger. The patient had no history of trauma, metabolic disorders and viral infections. The examination revealed triggering of the above-mentioned digits and was otherwise unremarkable. The patient was treated with physiotherapy (eight sessions) and non-steroidal anti-inflammatory drugs (NSAIDs) (for 20 days). The symptoms were completely resolved 4 months after its onset. Although surgical release is recommended by many authors for the treatment of trigger finger in children, if an inflammatory process is not unlikely, particularly when the symptoms present at older ages, the patient may be treated with a short course of empirical treatment with physiotherapy and/or NSAIDs to see his/her response.