Review Question - QID 3207

Unlike adults, release of the A-1 pulley in a pediatric trigger finger alone may not resolve triggering symptoms. Trigger finger in the child may be associated with a more proximal decussation of the FDS tendon, nodules in either the FDS or FDP tendon, a thickened A-2 pulley, or a tight A-3 pulley. Cardon et al looked at 16 pediatric pts with 18 trigger fingers and found that 6 fingers continued to trigger after A-1 pulley release. The sublimis decussation and A-3 pulley were found to be the most common cause of this persistent triggering. Bae et al looked at 23 pediatric trigger fingers and found that triggering was noted to occur at the level of the FDS tendon decussation in half the cases. The conclusion was made that all pediatric trigger fingers should be treated with A-1 pulley release and resection of a single FDS tendon slip. Illustration A shows normal decussation of the FDS tendon near the level of the A2 pulley. The FDS decussation may be found to be more proximal in pediatric trigger fingers, necessitating release.