Trigger Thumb Workup

  • Author: David R Steinberg, MD; Chief Editor: Harris Gellman, MD   more...
 
Updated: Feb 10, 2012
 

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.
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Imaging Studies

  • X-rays are helpful to exclude osteoarthritis, fracture malunion, foreign body, or a large sesamoid bone that is affecting IP joint motion.
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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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Contributor Information and Disclosures
Author

David R Steinberg, MD  Director of Hand Fellowship, Associate Professor, Department of Orthopedic Surgery, University of Pennsylvania Health System

David R Steinberg, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons and American Society for Surgery of the Hand

Disclosure: Johnson & Johnson nothing received, but have long-term ownership of public equities none

Specialty Editor Board

Joseph E Sheppard, MD  Professor of Clinical Orthopedic Surgery, Chief of Hand and Upper Extremity Service, Department of Orthopedic Surgery, University of Arizona Health Sciences Center, University Physicians Healthcare

Joseph E Sheppard, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Society for Surgery of the Hand, and Orthopaedics Overseas

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Michael Yaszemski, MD, PhD  Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

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  2. 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].

  3. 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].

  4. 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].

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  6. 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].

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  16. Hazani R, Whitney RD, Redstone J, Chowdhry S, Wilhelmi BJ. Safe treatment of trigger thumb with longitudinal anatomic landmarks. Eplasty. Sep 15 2010;10:[Medline]. [Full Text].

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Incision for trigger thumb release placed in MP flexion crease, centered over flexor tendon nodule.
Trigger thumb. A1 pulley exposed within surgical field (arrow). Digital neurovascular bundles behind retractors.
Trigger thumb. A1 pulley has been released; flexor pollicis longus tendon now exposed. Retractors have been removed to demonstrate proximity of neurovascular bundles (arrows) to tendon.
 
 
 
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