# Spontaneous Resolution of Early-Onset Pediatric Trigger Thumb: A Case Study

## TL;DR

A four-year-old girl with early-onset pediatric trigger thumb showed spontaneous resolution without surgery, suggesting non-invasive treatment could be effective.

## Contribution

This case study presents a rare instance of spontaneous resolution of a fixed deformity in pediatric trigger thumb beyond the typical 24-month age threshold.

## Key findings

- A four-year-old patient showed complete resolution of a fixed flexion deformity without surgical intervention.
- Non-surgical treatment, including splinting and observation, may be effective for pediatric trigger thumb beyond 24 months.
- Spontaneous release of the A1 pulley is hypothesized to occur through tissue remodeling and tendon adaptation.

## Abstract

Pediatric trigger thumb (PTT) is a deformity in the flexion of the thumb due to stenosing tenosynovitis. Surgery is the standard treatment protocol when the thumb is held in fixed flexion after 24 months of age. However, emerging research provides evidence that cases with a fixed deformity can be resolved without surgical management beyond 24 months. The patient, in this case, was a four-year-old female diagnosed with congenital pediatric trigger thumb with early onset in infancy starting at four months. She displayed complete resolution and release of the flexion deformity without surgical treatment at 40 months. It is possible that non-invasive treatment on fixed flexion, such as splinting and observation, extending beyond 24 months before proceeding with surgical intervention should be considered. While the mechanism is only hypothesized, resolution may occur through a combination of tissue remodeling, tendon adaptation, and gradual reduction of the entrapment. Waiting for the potential release of the A1 pulley to occur spontaneously, even in patients with a fixed deformity, may be a successful treatment modality.