Trigger thumb treatment

What is trigger thumb?

Trigger thumb is very common in children and is easily treated. In infants and young children trigger thumb occurs because of a size mismatch between the tendon and the tendon sheath that surrounds it. If the tendon is too big or the sheath too small, then the tendon can get stuck at the entrance to the tunnel typically causing the thumb to be stuck in a bent position. See the article on trigger thumb for more information.

Trigger thumb

In a small percentage of children with trigger thumb the condition can resolve on its own. If the trigger thumb has not resolved on its own by the time the child is about 3 years of age, the thumb remains stuck in a bent position and the child cannot manually extend the thumb, then surgery is recommended to correct the condition.

How is trigger thumb treated?

Surgery is done to allow the thumb to straighten fully. The surgeon will make a small incision at the base of the thumb, to release the tendon sheath where the tendon is catching. Your child will be given general anaesthetic for the surgery, so they will not hear or feel anything during the procedure. Local anaesthesia will be given during surgery which will numb the thumb for a few hours. The surgery will take about one hour, and your child may go home from the recovery room afterward. The thumb will be covered with a soft bandage and the Plastic Surgery Clinic will contact you for a follow-up appointment within two to four weeks after the procedure.

Your child will have a scar across the base of their thumb after surgery, which is usually very minor. You will be taught how to manage the scar with scar massage to improve its appearance. It is important to keep the incision clean as instructed by your health-care team after the surgery.

Complications of trigger thumb surgery

Trigger thumb surgery is a minor surgery that has a short recovery period, with the following risks:

• infection after surgery which would need oral antibiotics
• recurrence or incomplete release of the tendon sheath which may require further surgery
• nerve injury which can cause numbness to the thumb, which usually resolves over time

Caring for your child after surgery

After surgery, you may give your child acetaminophen for pain as needed. Children can continue to move their thumb normally inside of the bandage. However, mobility should be limited for the first 1 to 2 weeks after surgery. Your child should avoid swimming, sports (rough/contact) and activities that can put a lot of pressure on the thumb or the incision site. Five days after surgery you may remove the soft bandage and resume regular bathing with soap and water. Avoid using any lotions or creams on the hand area for the first 2 weeks, as it may cause the surgical glue to flake off.

At SickKids

On the day of surgery, you will go to the preoperative area. Take the main Atrium elevators to the 2nd floor and proceed down the hall to the preoperative area. Once you have arrived, a nurse will check you and your child in for surgery. Two caregivers are permitted in the preoperative area. We look forward to seeing you!