Drew's bum thumb

So a few months ago Bill and I noticed that Drew's left thumb was stuck in a bent position. He could still move it around, but he couldn't straighten it out. It didn't seem to be causing him any pain, so we figured we would wait until he had a doctor's appointment for something else and ask about it then. So last month Drew had his health assessment to get registered for Children & Youth Services on post and we asked about it. The pediatrician thought it might have been like that since birth, perhaps it was stuck in a weird position in utero or something. She referred us to a pediatric orthopedist.

Yesterday Drew and I went to see the orthopedist in Tucson. Drew was very excited about going to see the doctor and kept saying "This thumb's broken. Doctor's going fix it," to anyone that would listen. Sometimes he would also say "All fingers broken. Doctor's going fix all fingers." Anyway, we spent about 10-15 minutes with the doctor and literally the first 1-2 minutes was all he needed to tell us exactly what was wrong with it. The rest of the time was spent trying to explain the problem and how to fix it to the science-idiot (me).

So, since I understand but the level of understanding does not translate to being able to explain it to other people and actually have them understand, I looked up the condition at:

http://www.childrenshospital.org/az/Site1025/mainpageS1025P0.html

And the explanation that follows is theirs:

Trigger thumb refers to a thumb that clicks, catches, or locks as the tip of the thumb moves from a flexed (bent) to extended (straight) position. At times, the thumb may become "locked" in a flexed position.

Trigger thumbs are caused by a size mismatch between the flexor tendon of the thumb and the A1 pulley, a fibrous band under which the tendon normally glides. When the A1 pulley is too tight to allow for easy tendon gliding, the tendon can become swollen and inflamed, ultimately leading to triggering or inability to fully extend the thumb. Trigger thumbs occur sporadically and are not associated with other hereditary or congenital disorders.

The exact incidence of this condition is unknown. It is estimated that trigger thumbs comprise approximately 2% of all hand problems in growing children. While often referred to as "congenital" trigger thumbs, multiple studies of newborns indicate that this problem does not appear at birth (so his pediatrician was wrong about this and the orthopedist said this is a very common misconception about the problem).

Patients with trigger thumbs typically present with a flexed, or bent, thumb. Early on, the thumb can be extended, though often this is accompanied by pain, swelling, or a noticeable click. In the later stages, the thumb will remain in a flexed position (we never noticed it until it was stuck). Often a palpable nodule, or bump, is felt at the base of the thumb in the palm (Drew has this...it almost feels like a little piece of bone at the base of his thumb).

How are trigger thumbs treated? Surgery is recommended for trigger thumbs in patients over the age of 1 year. Surgery involves releasing the A1 pulley overlying the flexor tendon. Patients are typically in a bulky soft bandage for 1 week. The risk of recurrent triggering following surgery is very small.

I tried to take a picture of Drew's thumb, but I'm not sure how clearly you can see the permanent flexed position, though his goofy face is very clear.

Anyhow, the little guy is scheduled for surgery on August 22nd (Grandma Mary's birthday). It's done on an outpatient basis. His doctor said he performs the surgery at least once a week, so it's apparently a fairly common affliction in the orthopedic world. The surgery itself is a very short procedure (15-20 minutes). Thank goodness for that. My nerves couldn't take very long with my baby under anesthesia. Poor Bill is probably going to wish he could sedate me in the waiting room (he's so much calmer about these things)! Drew should be in recovery afterward for less than an hour and won't have to wear a splint or cast of any kind, just bandages over the incision for a few days. He should have full mobility restored immediately. We'll keep you posted the day of the surgery but please say a little prayer for Drew, his thumb, and his mommy's anxiety.