Multiple Congenital Bilateral Trigger Digits in a 2-Year-Old Child: Case Report
A 2-year-old boy was seen with a complaint of triggering in the fingers of both hands. His mother stated that triggering had been noticed at birth in all the boy’s fingers. There was no history of perinatal trauma, viral or bacterial infections, or rheumatologic or metabolic disorders, and the boy’s development had been normal without any other anomaly.\nAt presentation, the physical examination showed painless nodules that could be palpated on the metacarpophalangeal joints of all fingers of both hands. Triggering was constant in all fingers; a snap was evident on flexion to 60°. Active flexion of the distal joint was not possible. Pain was associated with the triggering. Radiographs of both hands were normal.\nThe patient was treated with physiotherapy and passive home exercises of finger flexion/extension done by his mother. Physical therapy consists of passive flexion- extension stretching of the involved fingers. At the one-year follow-up, the patient presented with six trigger fingers: 3 fingers of the right hand (index, middle and ring fingers) and 3 of the left hand (middle, ring and little fingers); his thumbs were not involved in the disease. The boy was 3 years old, and surgery was decided.\nThe boy was treated surgically by a transverse incision in his right palm and release of the A1 pulleys of the index, middle and ring fingers (Fig. ). The tendons appeared to be slightly roughened on the surface; a mild tendon sheath thickening was described, and some adhesions with superficial and deeper layers were found. After the operation, good joint motion was obtained for each digit without triggering. The patient was protected with an antibrachium-metacarpal brace positioned with his fingers in extension for 4 weeks. At the one-month outpatient follow-up, the brace was removed and the patient was able to flex and extend his fingers without triggering (Fig. ).\nSix months after the first operation, the middle, ring and little fingers of the left hand were treated surgically with the same procedure (Fig. ). Post-surgery care was the same as that of the right hand. At the one-month outpatient follow-up, the left-hand fingers were also able to flex and extend without triggering and/or pain.\nAt the final follow-up, one year after the second surgical procedure, the patient could move all his fingers of both hands without triggering or pain.