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The purpose of this study is to describe our technique of intrasheath triamcinolone injection for trigger digit and to evaluate the treatment outcome. Seventy-two patients of 81 digits treated with intrasheath triamcinolone injection were followed up for at least one year and interviewed in our clinic. The injection was performed in all patients by one of the authors at two-week intervals. The amount used was 1 ml (10 mg) of triamcinolone and was mixed with 1 ml of 1% lidocaine and tried precise injection into the tendon sheath. According to the evaluation method developed by Patel and Moradia, they were excellent in 67 digits, good in ten digits, fair in three digits, and poor in one digit. Satisfactory results were obtained in 95% of the digits, and the effectiveness rate was higher than previously reported. But it should also be noted that triamcinolone easily induces local side effects such as dermatitis.

We reviewed 110 trigger digits, treated surgically, to compare the outcomes of trigger finger and trigger thumb in terms of peri-operative characteristics and complications. The patients with trigger thumb complained mainly of pain on motion, while those with trigger finger complained of triggering or limited range of motion. Trigger fingers had a significantly longer duration before surgery than did trigger thumbs. Trigger fingers took significantly longer for the symptoms to subside. In our series, 64% of trigger fingers had a flexion contracture of the PIP joint more than three weeks after surgery. Our results suggest that the peri-operative characteristics and outcomes differ between trigger finger and thumb, and that the surgical outcome for trigger finger was poorer than that for trigger thumb, partly due to flexion contracture of the PIP joint.

Background: We report a variant of paediatric trigger thumb which is locked in extension rather than flexion.

Methods: Eleven children with 14 trigger thumbs (three bilateral) locked in extension were reviewed retrospectively over a 12-year period. The number of flexed trigger thumbs encountered over this period was established from the operating room database.

Results: All children were treated with release of the A1 pulley. Nine children achieved a full range of motion at the interphalangeal joint. One child with bilateral extended trigger thumbs required bilateral dorsal capsulotomy and another child developed temporary mild triggering in flexion.

Conclusions: Approximately 1% of trigger thumbs treated operatively at this institution presented as the extended variant. Trigger thumb locked in extension should be considered in a child presenting with inability to flex the thumb.

Paediatric trigger-locked thumb (PT-LT) is a common paediatric thumb condition. It is an acquired flexion deformity of the interphalangeal joint because of a size mismatch between an enlarged flexor pollicis longus tendon and a stenotic oblique pulley. It may present clinically as paediatric locked thumb which is more common or infrequently as paediatric trigger thumb. Paediatric locked thumb is classified into two types based on the presence of metacarpophalangeal joint (MCPJ) hyperextension. Type I does not have MCPJ hyperextension, whereas type II is associated with MCPJ hyperextension. The treatment of PT-LT is determined by the patient’s age, time of onset, presentation, and type. Treatment modalities are observation, splinting, therapy, or surgery. Surgery involves dividing the A1 pulley and, most importantly, part of the oblique pulley.

Level of Evidence: V (Therapeutic)