What’s Wrong with Alex’s Thumb?
It was like 2 weeks ago when my mom found that Alex’s right thumb was kind of stuck in the 90 degree position, and we were not able to relax it. We worried that he got hurt, or bone fracture when he played and didn’t realize it. It didn’t bother him at all, no pain or anything. We took him to the Pediatrician Dr. Yau anyways, to have him check it out. Dr. Yau felt his bone with his fingers, no fractures, that’s a relief. He asked Alex to push the button on top of his pen, and Alex was able to use force to push it down without pain. Dr. Yau suspected that Alex had Trigger Thumb, but he asked us to observe for couple more days to see if there’s any pain complaint or swell up.For the next couple of day, Alex’s thumb was fine. It’s the matter of fact, his thumb was relaxed just like a normal thumb right after we got home from Dr. Yau’s office. His thumb was locked on and off in the 90 degree position, so we went back to Dr. Yau’s in couple of days. He wrote us a referral to Orthopedic Surgeon. We finally decided to take Alex to the Orthopedic, Dr. Wong, a week later as we found this thumb locking happened more frequently. Sure enough, Dr. Wong told us it’s Trigger Thumb, and require a minor surgery to fix it. He said the surgery will take no longer than 30mins, Alex’s thumb will be able to more right after the surgery, and will be fully recovered in 6 weeks. Sounded simple, but of course, we’re going to get 2nd opinion. So, we found this Dr. Kanel, a Pediatrics Orthopedic, and will be seeing him this Thursday. In the mean time, we serach online for more information about Trigger Thumb and the surgery.Here is what we found from www.orthoseek.com:
What is it?
Trigger thumb is a condition where the thumb is locked in the flexed position at the Interphalangeal Joint (IP joint). Sometimes, the thumb can be forcibly extended with a palpable or audible click. Sometimes, it is locked in acute flexion and cannot be extended. The condition may be familial (runs in the family) and is bilateral in 50% of cases.
Trigger thumb is due to thickening and constriction of the fibrous flexor sheath the surrounds the Flexor pollicis tendon at the base of the thumb. The constriction does not allow for free movement of the tendon within the sheath. This causes the thumb to be stuck in the flexed position.
What does the doctor do about it?
The condition may present at birth, or during infancy. Treatment is often conservative. Parents are taught to stretch the thumb and gently extend the thumb, even in the thumb that is locked in flexion. Over a period of 18 to 24 months, the triggering may resolve spontaneously. In cases where the thumb is locked in acute flexion and does not allow any extension, surgical release of the fibrous flexor sheath is indicated by age 2 to prevent permanent contracture.
Chinese version taken from www.vghks.gov.tw
定義
所謂的板機指指的是手指屈肌肌腱在指頭基部形成結節，使得手指在彎曲而想伸直時會卡在滑車(pulley)，以致指節無法完全伸直；或者在伸直時會有阻力，形成類似扣板機的情形，稱之為板機指。
板機指是先天或後天的？
許多小朋友在出生即有，因此被認為是先天形成的；但也有許多患者是後來才發生的，因此被稱為是後天的。先天的板機指，可能與壓胎現象有關。而後天的板機指，可能與局部的發炎反應、反覆刺激或創傷有關。
好發於拇指？
雖然每一個手指都有可能發生，但是姆指的板機指是發生率最高的，尤其是兒童的扳機指，幾乎青一色都發生於拇指。
治療
復健、按摩、牽拉運動：絕大多數的兒童扳機指，只要沒有完全卡住，都可經由按摩及牽拉運動恢復正常。
局部注射：大人的板機指以局部注射(local steroid injection)有相對較好的結果，但在小朋友的板機指大致不適合打針，效果也不好。
手術：手術的目的，是把卡住結節的滑車切開。由於手術簡單(平均手術時間只要10分鐘)，效果顯著，適合於完全卡住或持續疼痛，其他治療方法無效的病患使用。
