Trigger Thumb in Children – Information for Referrers

A trigger thumb, or finger, occurs due to thickening of the flexor tendon to the thumb at the level of the A1 pulley on the palmar surface of the hand. This is approximately at the level of the metacarpo-phalangeal joint (MCP). There is usually a palpable thickening, termed Notta’s node, at this location which you or the parents can easily feel.

This is a clinical diagnosis and made when the parents notice that their child cannot straighten the thumb all the way. The involved thumb is “bent” at the interphalangeal joint of the thumb. Occasionally the child may be able to straighten the thumb after some time but feels a pop or click when this happens.

This is often worrying to parents, and although it affects the child’s ability to straighten their thumb, it is rarely painful, causes no functional problems and often gets better without any treatment. Occasionally it may be painful for a week or so but it usually passes quickly.

Many trigger thumbs in children resolve spontaneously with no treatment although this may take a year or so. There is no evidence that splintage or exercises make any difference to this.

There for the vast majority we pass on our reassurance that it is quite safe to simply observe this and hope that the triggering settles down over time.

Referral is usually only necessary if any of the following are present:

• Age over 3
• History of fixed deformity over 12 months
• Uncertain diagnosis
• Unable to relieve parental concerns.

There is no evidence that splintage or exercise make a difference in trigger thumbs in a paediatric population. For those that do not resolve of their own accord then we would consider surgical release. This is simply a release of the tendon from its sheath where it is catching, allowing the tendon to glide more smoothly.

We would not routinely offer this before the age of 3 due the risk of injury to the digital nerve causing a painful neuroma and loss of sensation are slightly higher before that age.

There is a corresponding advice sheet available for parents and carers.