Trigger Thumb

Trigger thumb/ fingers is a condition in which thumb or finger of a child pops, clicks or catches when they try to straighten it. Thumb may lock in a bent position. If the thumb locks, child can pull it straight using their other hand. But child can’t straighten his own thumb/finger using his muscles of same finger. The tendon which is responsible for the movements of the fingers runs through palm within synovial sheath (A1 pulley).

Causes

Common age group of children having trigger thumbs between the ages of one to three. Likewise, they can have triggered thumb in one hand or both hands. Usually it doesn’t associate with trauma. However the parents must get the child’s trigger thumb examined and diagnosed by an experienced paediatric orthopaedic surgeon to identify the causes and symptoms precisely.

Symptoms

Trigger thumb is a clinical diagnosis, if the child’s thumb being locked in a bent position, and catching, clicking, or popping while moving the thumb. Some children with trigger thumb even experience pain and swelling in the thumbs. Hence, the symptoms of trigger thumb differ from one child to another.

Diagnosis

The skilled paediatric orthopaedician diagnose trigger thumb by examining the finger and observing common symptoms. While diagnosing trigger thumb, the paediatric orthopaedician examine the finger thoroughly to identify other medical problems like cerebral palsy, arthrogryposis etc.

Treatment

  1. Stretching exercises
  2. Massages
  3. Splinting
  4. Surgical release (Day care)

Initially paediatric orthopaedician treat trigger thumb through stretching, splitting, and message. They advise parents to make the child practice stretching exercise and perform message regularly. Based on the symptoms, they even make the child stretch and straighten the thumb by wearing a thumb splint. However, the orthopaedic perform specific day surgery to treat trigger thumb if the initial treatment fails. They treat trigger thumb surgically by performing trigger thumb release or A1 pulley release.

Results

The recovery time differs according to the trigger thumb treatment plan. If the orthopaedic decides to treat the condition non-surgically, the parents have to make the child perform stretch exercise and massage for a specific period of time. On the other hand, the trigger thumb release surgery will require the child to wear bandages for one to two weeks to protect the thumb. Child rarely need any other intervention after the procedure.

FAQs

Q: – Why it happened to my child?? What is the possible reason??

A: – Exact cause of this unknown (Idiopathic) but it happens because tendon get stuck in A1 pulley (tendon sheath) results in non smooth movements of tendon.

Q:  – Is this curable?? Will it need surgery?? How long surgery / Hospital stay / Recovery time??

A: – Yes, it’s curable by stretching exercises and massage and splinting.  Sometime needs surgery if failed in conservative treatment or severe cases. Surgery is a day care procedure with minimal hospital stay with good and smooth recovery.

Q: – Will this affect future growth of hand  and functional stamina of my baby??

A: – If treated timely and correctly, results are good without any functional deficit.

Q: – Ideal age for surgery??

A: – one to two years of age depend on severity and response of conservative treatment.

 

Scoliosis in children:- Early the diagnosis better is the results!

Scoliosis is a three dimensional deformity of spine in which spine get deform and bend on either side of body. Early diagnosis of scoliosis can give better chances of correction as spine becomes more rigid with increasing age. Treatment can be started in very early age group so that angle of scoliosis can either reverse or stable with increasing age. Sometimes it remains unnoticeable till adolescent age group when curve start appearing. That’s why routine screening of spine for scoliosis can diagnose it very early stage. Screening is very easy and takes hardly few minutes.

Children with family history of scoliosis have more chances of having scoliosis and should be given more attention.

There are certain screening test and symptoms which can be done easily by teachers, parents, and other care givers. There are certain visual indicators of scoliosis which give us idea about scoliosis like uneven shoulder level, limb length discrepancy, uneven level of hips, and lump on either side of body, gap in between either side of body and arm and limp while walking.

SCFE (Slipped Capital femoral Epiphysis)

A disorder of hip joint during adolescent age group during growth spurt. A painless stable mobile hip joint is necessary for all physical activities like walking, running, jumping. But slipped capital femoral epiphysis (SCFE) is a hip condition that causes painful restrictions of movements with limp or even unable bear the weight. Timely diagnosis and appropriate intervention prevent possible complications and deformities.

In slipped capital femoral epiphysis (SCFE) femur (thigh bone) head slips over neck results in painful restriction of movements.

Causes

Commonly seen in obese and hyperactive children with some endocrinal disorders. During growth spurt slip occur at weakest zone of growth plate.

Symptoms

Painful restriction of movements of hip, limp, unable to bear weight and deformity are commonly seen symptoms. A child may experience intermittent pain in his groin, knee, thigh, or hip, if he is suffering from mild or stable SCFE. On the other hand, symptoms of severe or unstable SCFE includes a child experiencing pain suddenly, inability to walk or run, and the affected leg turning outward. Symptoms of SCFE may aggravate when the child performs any physical activity.

Diagnosis

Pain in hip/groin/knee during the growth years should be examined properly by an expert. Clinical examination is significantly important as it gives great help in making diagnosis. While diagnosing SCFE, an orthopaedic checks if the child is finding it difficult to move his leg or hip. A series of X-ray and magnetic resonance imaging (MRI) scan of the pelvis with both hip is also helpful.

Treatment

It’s a surgical emergency and needed emergency surgery. However, we recommend the child to take adequate rest, use crutches, and avoid putting pressure on the affected leg to prevent the growth plate from slipping further. The experienced orthopaedic even advise the parents to get the child admitted to the hospital and perform the surgery without any delay. The surgery is performed under general anesthesia and using specialized equipment.

Recovery

Once the surgery is over, the child can walk with crutches after a few days. Post op physiotherapy and exercises are recommended for faster recovery.

FAQs

Q: – Is surgery is necessary?? Any medical treatment available??

A: – Yes, surgery is recommended for it without any delay to prevent further complications.

Radial Club Hand

It is a rare congenital disease in which child born with underdeveloped or missing radius bond in arms since birth. Because of this wrist joint become unstable and twisted inwards. The severity of radial club hand depends on how much radius bone is missing ranges from complete absent to mild shortening. Sometimes absent radius associated with absent thumb on same side. This condition can affect a single or both hands of a child. Based on severity, radial club hand can be classified into four levels – types I, II, III, and IV. Timely treatment without delay gives acceptable results.

Causes

Radial club hand is caused due to underdeveloped or missing radius bone in forearm. The condition occurs during very early stages of pregnancy due to either teratogenic drugs, radiation exposure etc. It could be inherited in families. Sometimes it is associated with some specific health problems or syndromes related to heart, kidneys, or blood cells. So proper cardiac, hematological, kidney and other evaluation should be done.

Symptoms

Deformity is apparent since birth. Thumb on same side either hypoplastic or completely absent. Radial club hand changes the balance of muscles and nerves in a child’s hand. The condition sometimes makes specific muscles or nerves missing. Involved side forearm is short in length.

Diagnosis

As deformity is apparent and one can easily see this with naked eye. A skill pediatric orthopedic surgeon will examine it thoroughly and will take opinion from cardiologist, nephrologists, pediatrician to check additional health problems associated with this.

Treatment

Treatment starts initially non-surgically through stretches, splints, and similar therapeutic exercises. Serial plaster cast can be given before surgery. Surgery will help in making the ulna align with wrist to achieve more functional level.

Recovery

The child has to perform stretching, splinting, and similar therapeutic exercises for a specific period of time, if the doctor decides to treat his radical club hand non-surgically. However, the orthopaedic must examine the child’s hand consistently to assess the effectiveness of the treatment plan. Timely surgical intervention is also important.

Perthes Disease

Perthes disease is a rare childhood hip disorder which affects children from the age group of four to ten years. The disease affects a child’s hip when blood supply is interrupted to the head of the femur (thigh bone) temporarily. Because of lack of blood supply to head the cells gradually start dying and results in deformed head. Over the period of time cells start regenerating and end with deformed head. Early diagnosis and timely intervention gives better results.

Causes

Exact cause of Perthes disease is still not known (Idiopathic). Perthes disease is a complex childhood hip disorder caused due to inadequate blood supply to the femoral head of hip joint.

Symptoms

Painful restriction of movements with limp is commonly seen in Perthes disease. Pain may be in groin, hip, knee and thigh area. Limb length shortening with muscle wasting also present.

Diagnosis

Clinical examination is very important in diagnosing the disease. Orthopaedic surgeon examine child’s hip, knee joints thoroughly to see movements and muscle wasting and limb shortening. Also, initial physical examination results are confirmed through an X-ray and MRI.

Treatment

Containment of head (ball) of femur (thigh bone) in its socket is prime motive of the treatment. The perthes disease is treated in a number of ways according to the child’s age and severity. Treatment starts conservatively with analgesics, rest and physiotherapy. Child can walk with help of special braces/cruches. Strenuous physical activities should be avoided. Surgery treatment is needed in some cases for containment of head of femur in its socket.

Recovery

Early diagnosis and timely intervention gives better result. So any child during early age group with pain in and around hip and knee should be examined thoroughly by expert pediatric orthopedic surgeon. Normally, the younger children respond to the treatment more effectively without developing any hip joint disorder in the future. But if the child is more than 8 years of age, there are always chances that he may experience stiffness, arthritis, and similar hip joint problems in future.