Conservative Versus Surgical Management of Congenital Trigger Thumbs in Children

Abstract

Introduction: Trigger thumb is a flexion deformity of the interphalangeal joint caused by stenosing tenosynovi- tis of the flexor pollicis longus tendon. It is a common pediatric hand condition that can affect hand function and fine motor development. While some cases resolve spontaneously, persistent or severe deformities may require surgical intervention. There is ongoing debate regarding the optimal timing and choice between conservative and operative management in children. Methods: This prospective comparative study was conducted at B.C. Roy Children Hospital over 3 years on 50 pediatric trigger thumb patients (6 months–6 years). Demographic, clinical, and outcome variables were ana- lyzed. Statistical tests included independent t-test and chi-square/Fisher's exact test, with p < 0.05 considered significant. Results: A total of 50 children with trigger thumb were studied (25 surgical, 25 conservative). The mean ages were 4.8 ± 2.1 and 4.5 ± 2.3 years, respectively (p = 0.65), with no significant differences in gender distribution, laterality, or disease stage at presentation. Complete resolution occurred in 80% of surgical and 72% of con- servative cases (p = 0.45). Complications were minimal; one infection occurred in the surgical group, while re- currence (8%) and residual flexion contracture (12%) were noted only in the conservative group. Parental satis- faction scores were comparable between groups and no significant differences (8.0 vs. 8.2, p = 0.18). Conclusion: In this study of 50 children with trigger thumb, surgical management showed superior outcomes compared to conservative treatment. Spontaneous resolution was rare, and delayed surgery often led to fixed flexion deformity with poor parental satisfaction. While children under 2 years may be managed conservatively, those over 2 years benefit from early surgical correction to achieve complete resolution and better functional outcomes.