Presentation and Management of the Pediatric Trigger Finger: A Multicenter Retrospective Cohort Study

Lori Jia; John D King; Craig Goubeaux; Zoe E Belardo; Kevin J Little; Julie B Samora; Jennifer Marks; Apurva S Shah

doi:10.1016/j.jhsa.2023.03.015

Presentation and Management of the Pediatric Trigger Finger: A Multicenter Retrospective Cohort Study

J Hand Surg Am. 2023 Jul;48(7):665-672. doi: 10.1016/j.jhsa.2023.03.015. Epub 2023 May 29.

Authors

Lori Jia¹, John D King², Craig Goubeaux³, Zoe E Belardo⁴, Kevin J Little², Julie B Samora³, Jennifer Marks², Apurva S Shah⁵

Affiliations

¹ Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
² Cincinnati Children's Hospital, Division of Orthopaedics, Cincinnati, OH.
³ Nationwide Children's Hospital, Department of Orthopaedics, Columbus, OH.
⁴ The Children's Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA.
⁵ Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA; The Children's Hospital of Philadelphia, Division of Orthopaedics, Philadelphia, PA. Electronic address: shaha6@chop.edu.

PMID: 37256247
DOI: 10.1016/j.jhsa.2023.03.015

Abstract

Purpose: Pediatric trigger finger (PTF) is an acquired condition that is uncommon and anatomically complex. Currently, the literature is characterized by a small number of retrospective case series with limited sample sizes. This investigation sought to evaluate the presentation, management, and treatment outcomes of PTF in a large, multicenter cohort.

Methods: A retrospective review of pediatric patients with a diagnosis of PTF between 2009 and 2020 was performed at three tertiary referral hospitals. Patient demographics, PTF characteristics, treatment strategies, and outcomes were abstracted from the electronic medical records. Patients and families also were contacted by telephone to assess the downstream persistence or recurrence of triggering symptoms.

Results: In total, 321 patients with 449 PTFs were included at a mean follow-up of 3.9 ± 4.0 years. There were approximately equal numbers of boys and girls, and the mean age of symptom onset was 5.4 ± 5.1 years. The middle (34.7%) and index (11.6%) fingers were the most and least commonly affected digits, respectively. Overall, PTFs managed operatively achieved significantly higher rates of complete resolution compared with PTFs managed nonsurgically (97.1% vs 30.0%). Seventy-five percent of PTFs that achieved complete resolution with nonsurgical management did so within 6 months, and approximately 90% did so within 12 months. Patients with multidigit involvement, higher Quinnell grade at presentation, or palpable nodularity were significantly more likely to undergo surgery. There was no significant difference in the rate of complete resolution between splinted versus not splinted PTFs or across operative techniques.

Conclusions: Only 30% of the PTFs managed nonsurgically achieved complete resolution. Splinting did not improve resolution rates in children treated nonsurgically. In contrast, surgical intervention has a high likelihood of restoring motion and function of the affected digit.

Type of study/level of evidence: Therapeutic IV.

Keywords: A1 pulley; pediatric trigger finger; tendon sheath; trigger finger; trigger finger release.

Publication types

Multicenter Study

MeSH terms

Child
Child, Preschool
Female
Fingers
Humans
Infant
Male
Retrospective Studies
Splints
Treatment Outcome
Trigger Finger Disorder* / surgery
Trigger Finger Disorder* / therapy