eMedicine Specialties > Orthopedic Surgery > Hand & Upper Extremity
Trigger Thumb: Workup
Updated: Sep 17, 2009
Workup
Laboratory Studies
- No studies are indicated for idiopathic trigger thumb.
- With suspicion of an associated systemic medical condition, such as diabetes, rheumatoid arthritis, or crystal deposition, order appropriate blood studies.
Imaging Studies
- X-rays are helpful to exclude osteoarthritis, fracture malunion, foreign body, or a large sesamoid bone that is affecting IP joint motion.
Histologic Findings
Tensile and shearing stresses in the tendons and peritendinous tissues may lead to thickening, adhesions, and cellular proliferation in both the tendon and tendon sheath. Studies of surgical specimens have demonstrated a thickening of the A1 pulley with fibrocartilaginous changes within its inner surface. This fibrocartilage metaplasia consists of an increased number of chondrocytes and extracellular matrix. Similar changes occur on the adjacent surface of the flexor tendon. Evaluation of the nodule in the pediatric trigger thumb usually reveals noninflammatory fibrosis.
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| Overview: Trigger Thumb |
Workup: Trigger Thumb |
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References
De Smet L, Steenwerckx A, Van Ransbeeck H. The so-called congenital trigger digit: further experience. Acta Orthop Belg. Sep 1998;64(3):306-8. [Medline].
Li Z, Wiesler ER, Smith BP, Koman LA. Surgical Treatment of Pediatric Trigger Thumb with Metacarpophalangeal Hyperextension Laxity. Hand (N Y). Sep 1 2009;[Medline].
Chao M, Wu S, Yan T. The effect of miniscalpel-needle versus steroid injection for trigger thumb release. J Hand Surg Eur Vol. Aug 2009;34(4):522-5. [Medline].
Lange-Rieß D, Schuh R, Hönle W, Schuh A. Long-term results of surgical release of trigger finger and trigger thumb in adults. Arch Orthop Trauma Surg. Jan 6 2009;[Medline].
Rodgers WB, Waters PM. Incidence of trigger digits in newborns. J Hand Surg [Am]. May 1994;19(3):364-8. [Medline].
Sampson SP, Badalamente MA, Hurst LC, et al. Pathobiology of the human A1 pulley in trigger finger. J Hand Surg [Am]. Jul 1991;16(4):714-21. [Medline].
Boretto J, Alfie V, Donndorff A, Gallucci G, DE Carli P. A prospective clinical study of the A1 pulley in trigger thumbs. J Hand Surg Eur Vol. Jun 2008;33(3):260-5. [Medline].
Bae DS. Pediatric trigger thumb. J Hand Surg [Am]. Sep 2008;33(7):1189-91. [Medline].
Peters-Veluthamaningal C, van der Windt DA, Winters JC, Meyboom-de Jong B. Corticosteroid injection for trigger finger in adults. Cochrane Database Syst Rev. Jan 21 2009;CD005617. [Medline].
Colbourn J, Heath N, Manary S, Pacifico D. Effectiveness of splinting for the treatment of trigger finger. J Hand Ther. Oct-Dec 2008;21(4):336-43. [Medline].
Rozental TD, Zurakowski D, Blazar PE. Trigger finger: prognostic indicators of recurrence following corticosteroid injection. J Bone Joint Surg Am. Aug 2008;90(8):1665-72. [Medline].
Patel MR, Bassini L. Trigger fingers and thumb: when to splint, inject, or operate. J Hand Surg [Am]. Jan 1992;17(1):110-3. [Medline].
Baek GH, Kim JH, Chung MS, Kang SB, Lee YH, Gong HS. The natural history of pediatric trigger thumb. J Bone Joint Surg Am. May/2008;90:980-5.
Lee ZL, Chang CH, Yang WY, Hung SS, Shih CH. Extension splint for trigger thumb in children. J Pediatr Orthop. Nov-Dec/2006;26:785-7.
Ogino T. Trigger thumb in children: current recommendations for treatment. J Hand Surg [Am]. Jul-Aug 2008;33(6):982-4. [Medline].
Turowski GA, Zdankiewicz PD, Thomson JG. The results of surgical treatment of trigger finger. J Hand Surg [Am]. Jan 1997;22(1):145-9. [Medline].
Schramm JM, Nguyen M, Wongworawat MD. The safety of percutaneous trigger finger release. Hand. Mar 2008;3(1):44-6. [Medline].
Further Reading
Related eMedicine topics
Trigger Finger (Orthopedic Surgery)
Trigger Finger (Physical Medicine and Rehabilitation)
Tenosynovitis (Emergency Medicine)
Fingers and Thumb, Trauma
Clinical guidelines
Trigger Finger (Stenosing Tenosynovitis).
American Society for Surgery of the Hand. Accessed October 22, 2008.
Trigger Finger.
American Academy of Orthopaedic Surgeons. Accessed October 22, 2008.
Clinical trial
Study Comparing One Versus Two Cortisone Injections for Trigger Finger
Keywords
trigger thumb, trigger finger, trigger finger rehabilitation, tenosynovitis, stenosing tenosynovitis, stenosing tendovaginitis, thumb pain, locked thumb, idiopathic trigger thumb, congenital trigger thumb, pediatric trigger thumb
Workup: Trigger Thumb