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Pediatric Trigger Thumb with Metacarpophalangeal Joint Hyperextension or Instability

Sheng Jin, Kaiying Shen, Yunlan Xu

Department of Pediatric Orthopedics, Shanghai Children’s Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, China (mainland)

Med Sci Monit 2020; 26:e922757

DOI: 10.12659/MSM.922757

Available online: 2020-06-02

Published: 2020-07-29

BACKGROUND: The aim of this study was to provide the first on report on the mechanism and the different treatment measures of metacarpophalangeal joint hyperextension (MCPH) or metacarpophalangeal joint instability (MCPI) in cases of pediatric trigger thumb. Some pediatric trigger thumb patients have disease combined with excessive extension of metacarpophalangeal (MCP) joint or instability of MCP joint.
MATERIAL AND METHODS: A total of 1083 children with trigger thumb surgery were divided into 2 groups (the MCPH group and the MCPI group) by the extension degree of the MCP joint. After tendon sheath released, the MCPH group was treated by a cast and the MCPI group was treated by a cast and a brace. We compared the differences in baseline data and the further functional activities of interphalangeal (IP) and MCP joint between the 2 groups.
RESULTS: Among the 1083 cases, 154 cases (185 thumbs) were trigger thumb with MCPH or MCPI, of which 167 thumbs were placed in the MCPH group and 18 thumbs were placed in the MCPI group. The average age of the MCPH group was 2.8 years, with an average duration of disease of 13 months. The average age of the MCPI group was 6.6 years, with an average duration of disease of 33 months. MCPH still existed after cast removal. In the MCPI group, 12 out of 18 thumbs recovered; 6 thumbs relapsed at 2-4 months after brace removal.
CONCLUSIONS: Trigger thumb with MCPH and MCPI in children is significantly associated with multi-joint laxity. While there was still MCPH after cast treatment, there was no need for further treatment during the short-term follow-up. Cast and brace treatment after surgery was a simple, easy method for treatment of MCPI and had a good effect.

Keywords: Joint Instability, Metacarpophalangeal Joint, Pediatrics, Trigger Finger Disorder