TRIGGER-FINGER IN ADULTS AND CHILDREN

A comparison of the incidence, etiology, symptoms, pathological variations, and treatment in adults and children with trigger-finger discloses some interesting facts. The occurrence in twin children, previously reported by us3, is one of the few instances of familial involvement. The occurrence in twins, the appearance of the syndrome at birth or in early childhood, and the frequent bilateral involvement all lend support to the theory that children may have a congenital predisposition to trigger-finger. The most frequent presenting deformity in children was locking in flexion, while in the adult, snapping was the most common complaint. Loss of active flexion, except for a few degrees, with the thumb held in extension, was the next most common presenting deformity in the adult. There was double snapping in both flexion and extension in two of our adults with involvement of the thumb. In the adult, digital-fibrous-sheath involvement is prominent and tendon changes are minimal, as compared with the condition in children. The palpable mass at the base of the thumb in children is frequently due to tendon proliferation and degeneration, which results in nodular formation. Conservative management may be tried in adults who are seen shortly after the onset of symptoms. For adult patients who do not respond to conservative treatment and for those seen late, operative treatment is recommended. In children, only the operative treatment has been found to be satisfactory. Local excision of the tendon sheath, suture of only the skin, and encouragement of early motion have given satisfactory results.