Tuesday, November 15, 2011

Pediatric Trigger Thumb Surgery, Again

Let me explain.  About 2 years ago my 4 year-old daughter underwent bi-lateral trigger thumb surgery at Denver Children's Hospital.  Just today, my 3rd daughter (3 year-old) just had her bi-lateral trigger thumb surgery at an outpatient surgery center.  Having the somewhat rare, opportunity to take two children through trigger thumb release surgery, I'd like to do a bit of comparing and contrasting on the differences in the two experiences (which have both been positive) for those of you out there who have children whose cute little thumbs are stuck bent. (According to the stats on my blog, there are more of us out there with kiddos dealing with pediatric trigger thumb than I'd imagined.)  Here's a quick run down of each daughter and the circumstances surrounding her trigger thumb experience.

Daughter 1:
  • We first noticed her bent thumbs when she was about 2 years old.  My husband and I thought they were cute and didn't think much of it until she was 3 and a half and starting to use scissors.  She could not open scissors.  I figured her stuck thumbs might be hindering her.
  • We went though at least 2 health care professionals before I self-diagnosed my daughter and then asked for a referral to a specialist.
  • Surgery on both thumbs performed at Denver Children's Hospital.
  • Surgeon put casts on her hands and forearms to protect the incision and stitches.
  • Daughter went to a few sessions of physical therapy after the surgery.  
  • Now, two years later, daughter is doing well.  She's using scissors just fine!  
  • For more detail about her surgery, follow this link:  http://humdrumhero.blogspot.com/2009/11/congenital-trigger-thumb-or-my-child.html
Daughter 2:
  • Daughter 2 is a fraternal twin.  My husband and I jokingly checked her thumbs and her twins sister's at birth when they were born to make sure they didn't have trigger thumb.  Both girls thumbs extended fully with no problems, then.  Little did we know. 
  • By 18 months old, Daughter 2's thumbs were locked.  Interestingly, her twin sister has nodules on each tendon at the base of her thumb (tell-tale sign of pediatric trigger thumb when accompanied by thumbs that are stuck bent), but does not have locked trigger thumbs.
  • When daughter 2 turned 3 years old, I scheduled an appointment with an orthopedic surgeon. Surgery before the age of 3 is usually not recommended.
  • Surgery on both thumbs at a surgery center near a general hospital.
  • Surgeon put soft bandages on her hands and instructed us to keep them on for a couple of days.  After that, we should cover the stitches with band-aids until the stitches dissolve.
Next post I'll talk about the differences that I observed between a hospital and a surgery center. I'll also keep you posted on the healing of Daughter 2's surgery and the healing process.


20 comments:

  1. Oh geeze twice!

    Thanks for the read. My little guy (almost 9 months) has had this for awhile and finally saw the doctor today. He wants us to wait 6 months and then he'll do surgery if the problem hasn't corrected itself.

    Any advice?
    Will stay tuned to read your next update thanks!

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  2. My daughter's twins sister actually had some signs of trigger thumb for a few months (sometimes one of her thumbs would lock and then release later) and it did indeed correct itself. So, who knows, maybe your son's thumbs will do the same. It's just a waiting game at this point. Some doctors recommend splints if their thumbs haven't locked yet. As far as any advice, I did just write a post on preparing for surgery, if you haven't already read that yet. http://humdrumhero.blogspot.com/2011_12_01_archive.html

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  3. Great thanks!
    Yeah the disheartening part here is that the doc didn't suggest a single thing in terms of physical therapy in these 6 months that we wait it out. I see so many sites suggesting PT could work....so wouldn't it be worth a try?
    I would say "nothing to lose" except I guess there IS a chance I could irritate and make his condition worse so right now i'm hesitant to do anything.
    Just feel a bit powerless with this and i wonder how it would correct itself without using any form of intervention? Just nature taking it's course I guess. Spooky stuff...I can't imagine my little guy getting surgery at 14 months old!
    Thanks for the support and your info!

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  4. I'm a little slow, since I've been enjoying the holidays with my family... Yes, try some physical therapy, it can't hurt. You are right. However, if the child's thumb is locked, it won't help at all. But, if it can release and locks in a bent position once in a while, therapy could be helpful. Thing is, PT is really expensive (if you have sub-par insurance) and is more than likely something you can do on your own. Our therapist advised me to take 5-10 minutes a day helping my child bend and extend her thumb. Or, you can splint the thumb in the upright position for a few hours a day as well-- You can even buy splints for little hands to keep the thumb extended for longer amounts of time. (http://www.benik.com/peds/wrist/sizing-kit) I hope that helps. IF after all you have tried, that thumb locks in place, surgery is the only way to resolve it if you want it fixed.

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  5. update

    we realized one day cleaning his hands that his thumb can be pretty easily straightened out. just a tiny amount of pressure and pulling and the thumb pops out just fine (though no actual popping sound) with no visible pain from the baby's face at all!

    my mom who's a lifelong nurse felt it would be a good idea to splint it up so she did that for a day and he didn't seem to mind.

    all said though we went back to the doc to see if this would be a good idea and he said no. he said in his experience this never helps and if anything he could injure himself further? he said it's best to just wait to see if it naturally cures iself....otherwise surgery. he just turned 1 two days ago.....so it seems our pre-op appointment will be in the next 3 months or so :(

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  6. whelp......consultation for surgery coming up soon....our little man is 14 months now and doing great.
    not too nervous but i wish he didn't have to go through this!

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  7. My little guy has had trigger thumb since birth. We have done splints/physical therapy since he was 5 weeks old. Although it has improved a little its still not much. He is getting surgery next week.

    Did your daughter have much pain post-op? How long would you say her recovery was?

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    1. Hi there! I hope that your son's surgery goes well. Interesting to hear that your son had splints and therapy from so early on since many doctors don't even notice trigger thumb on children that young.

      With both my daughters, the post-op pain wasn't bad. They only took one dose of pain meds in the hospital and then after that I might have given them a dose of Tylenol at home. Neither of them complained about pain. Recovery was faster for my daughter who had soft casts because she could use her thumbs within just a few days of surgery. I'd say by a month her stitches were dissolved. But, really within just a couple of weeks she was using her thumbs like a normal child would. My other daughter that had hard casts after surgery took a couple weeks longer to recover, as I remember.

      Take care and feel free to share your experience with us!

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  8. How did you decide that surgery was the best option? My daughter is 3.5 and was just diagnosed with congenital trigger thumb. The doctor is recommending surgery but also said we could decide to just wait and see, or not do anything at all.... Everything I have looked at so far seems like surgery is the best option but the thought of putting my baby through a procedure if it's not needed, scares me. And did they put your daughters "under" or did they do it while they were awake? I had someone tell me they kept their child awake for this surgery...

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    1. Hi there! I guess this decision is really up to you. It isn't life-threatening, but it can hamper a child's fine motor skills a bit. I noticed it was hard for my daughter to use scissors with bent thumbs. For us, we opted to get the surgery once we knew that the thumbs were indeed locked, and could not be straightened on their own. Also, my children were put "under" for the surgery (which I think is definitely the way to go for this). I don't know if you have done this, but you can click on the trigger thumb tab on the top of this blog and read other stories. Lots of people have shared their experiences in the comments. I also have a post about preparing for trigger thumb surgery. I hope this helps! Take care.

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  9. whelp....my guy was supposed to get his surgery on Monday but my family has been quite affected by the Hurricane so we ended up postponing.

    can't wait to get this over with at this point....i'm dreading the ordeal and just want him fixed!

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  10. surgery was a success!

    he managed to rip his soft case off on DAY TWO.

    kinda freaked us out but doc said to just wrap it back up and don't worry


    he was using it as a weapon in no time lol

    cast is off now and wound is healed.......new life for my little man!

    :)

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    1. So glad to hear! Thank you for sharing your experience with the world and me. :)

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  11. Just found your blog on a google search for trigger thumb. I was at the pediatrician today getting my baby his 4 month check up. I had my 3 1/2 year old twins with me and one of them slammed the other ones thumb in the door while we were waiting for the doctor. his thumb was all bent and it looked like it was starting to bruise. The doctor looked at it and said it was trigger thumb, and had nothing to do with it being slammed in the door. She referred me to an orthopedist and that was that. The thing is I've never noticed it before. I just went through all the pictures from a family portrait session we had a few weeks ago and in some of the pictures his thumb is straight and some it is bent. As of now though, I can't even force it straight. Do you know if it's possible for it to just come on suddenly like this at 3 1/2 years old? Thanks so much!

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  12. Hi Lauren, What an astute pediatrician you have! Yes, it is possible for the thumbs to "suddenly" lock, but really, it probably has been locking and then releasing on and off for some time before it finally locked. What I'm saying is it might not have been so sudden as it seemed. When my twin girls were babies, I checked their thumbs (since their older sister had trigger thumb) and they both had straight thumbs, so I thought we were free and clear. Then, as we watched the twins, the older one would sometimes have her thumbs bent and other times straight until she was about 18 months and then they were locked. Hope all goes well with your your little one!

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    1. Thanks so much for your quick response. It was all so quick at the doctor that I didn't even have time to process what questions I wanted to ask, especially since it wasn't even an appointment for him lol.

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    2. Thought I'd update you. We met with the orthopedist, it indeed was trigger thumb, he had surgery and was a complete trooper. This was back in July, and we've had no problems since.

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  13. Hi just noticed my 3 and half year old daughter has a bent left thumb and took her to the orthopedics this morning and she was diagnosed with trigger thumb. i was really scared and almsot in tears, but after coming across this blogs online, i feel much better. thank you so much

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    1. You are so very welcome! It's so comforting to have the right information available when you need it. I hope all goes well for you and your daughter!

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  14. Thank you for a very informative blog! My 3 yr old daughter is finally having surgery for her trigger thumb in 2 days. It cant come soon enough-we have been waiting for 12 mths!!! The poor little lamb went through do much o er that period. 2 ER doctors forcefully and painfully pushing it into place-she was in so much pain!! A cast up to her elbow for 6 wks-which did nothing!! Now finally we hope that her surgery will go well! I did request physio,but was told it would not be effective at all in the case of trigger thumb!??

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