Complete Annular and Partial Oblique Pulley Release for Pediatric Locked Trigger Thumb

Abstract

Purpose

To report the surgical treatment outcome of pediatric locked trigger thumb by sequential release of the annular pulley and partial release of the oblique pulley.

Materials and Methods

A retrospective review was undertaken on 28 operative thumbs in 24 patients with an average follow-up of 79 months. Intraoperative observations focused on the pathology of the pulley system. Surgical technique involved complete release of the annular pulley, which alone was insufficient in relieving the deformity, along with release of the proximal 50% of the oblique pulley in all patients. Postoperative parameters of bowstringing, resolution of Notta's node, thumb interphalangeal motion, and patient/parent satisfaction were assessed.

Results

The oblique pulley appeared stenotic, whereas the annular pulley was observed to be membranous and nearly indistinguishable from the tendon sheath. No patients had recurrence of thumb locking or triggering. No bowstringing was detected, and Notta's node resolved fully in 19 of 20 thumbs. Five thumbs had an average of 12^° less active IP joint motion without flexion contracture (i.e., less flexion). All patients or families expressed overall satisfaction with the procedure.

Conclusion

The annular pulley was attenuated in the majority of cases and the proximal half of the oblique pulley was stenotic in all patients. Releasing 50% of the oblique pulley after complete annular pulley release was necessary in all thumbs to achieve full FPL excursion. Mistaking the constricted proximal oblique pulley for an annular pulley may encourage releasing the entire oblique pulley, leading to an adverse result. Satisfactory outcome was achieved after surgical treatment of pediatric locked trigger thumbs. Type of Study/Level of Evidence Therapeutic IV.