T Girl Thumb
T Girl Thumb
Pediatric and adult trigger thumbs represent different entities requiring different treatment approaches. Despite some controversy, pediatric trigger thumb is considered an acquired condition caused by unique anatomic abnormalities.17 Among the estimated 0.05% of all children diagnosed with trigger digits, 90% occur in the thumb, most commonly presenting at 2 years of age.7 Previous studies report a spontaneous resolution rate ranging from zero to 66%.1
In contrast, adult trigger thumb most commonly occurs in middle-aged women and may occur in conjunction with multiple trigger digits. Histological analysis has demonstrated fibrocartilaginous metaplasia, and it has been proposed this is secondary to repetitive friction between the tendon and sheath.8
Corticosteroid injection is a common first-line, minimally invasive treatment. Injection of the involved flexor tendon sheath provides long-term relief of symptoms in 60 to 92% of affected digits with up to three injections.78 A diminished response to injection has been associated consistently with an increased duration of symptoms, usually more than 4 to 6 months, and with an increasing number of injections.78 Rozental et al prospectively studied corticosteroid injections in 124 trigger digits in 199 patients with 35% involving the thumb in an attempt to identify prognostic indicators of symptom recurrence.8 The results of open A-1 pulley release generally are excellent. Turowski et al, in a group of 59 patients treated by several surgeons, reported 97% complete resolution of triggering with no complications.9
Using an electrogoniometer to measure thumb movements during mobile phone text messaging, Gustafsson et al found that subjects with musculoskeletal symptoms tended to have higher thumb movement velocities and fewer pauses in thumb movements compared with those without symptoms.16 In addition, they found that females had higher muscle activity in the extensor digitorum and APL when entering messages and tended to have greater thumb abduction, higher thumb movement velocities, and fewer pauses when compared with their male counterparts.16 Of note, values for the FPL were not measured.
In our report, we present the unique case of a 16-year-old female patient with no risk factors for the development of stenosing tenosynovitis other than her substantial texting. Though the aforementioned studies report occurrences of tendonitis or tenosynovitis due to text messaging, nearly all reports are related to dorsoradial pathology, such as in De Quervain tenosynovitis. In addition, studies using electrogonimetry and ultrasound also focused on this region of pathology, suggesting that tenosynovitis involving the flexor aspect of the thumb is rarely appreciated.1516 To our knowledge, this is the first report of stenosing tenosynovitis in a teenager that resulted in clinically disabling triggering of the thumb and ultimately required surgery. As the use of mobile devices increases while technology continues to progress, this rare clinical phenomenon may be of increasing importance in the near future. Thus, it is warranted to examine precipitating factors in our presented case in an effort to shed light on potential risk factors or preventative measures that may be implemented.
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Pediatric trigger thumb (PTT) is also called a flexion contracture of the IP joint (Picture 1). It is a condition that affects the movement of the thumb in children. The thumb gets