Pediatric Trigger Finger due to Osteochondroma: A Report of Two Cases

Abstract

Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger.

Keywords: bone tumor; flexor tendon; pediatric; trigger finger.

Figure 1.

A 13-year-old girl with juvenile multiple osteochondromatosis, with ring finger blocking. Unable to extend the digit (a), but active flexion is present (b).

Figure 2.

Oblique radiographic view of the hand revealed a proximal phalanx osteochondroma causing extrinsic compression of flexor tendons in the A1 pulley, blocking digit motion (a). White arrow shows lesion in detail (b).

Figure 3.

Surgical treatment, wide Z-shaped incision centered at the metacarpophalangeal joint (a). On the opening of A1 pulley and proximal portion of the A2 pulley, the bone tumor is seen compressing flexor tendons and restricting digit motion (b). Bone tumor resection and curettage to smoothen phalanx edges (c). Typical osteochondroma appearance of the resected tumor (d).

Figure 4.

At 2 months postoperatively, the patient has recovered digit motion, both in extension (a) and in flexion (b).

Figure 5.

Nine-year-old girl with juvenile multiple osteochondromatosis showing middle finger blocking, unable to perform extension.

Figure 6.

Radiographs showed the presence of an exostosis located at the volar and proximal portions of the proximal phalanx (a). X-ray films also proved the presence of other osteochondromas at the distal phalanx (a and b), as well as in metacarpals, other phalanges, and distal radius and ulna (c).

Figure 7.

The region was approached through a zigzag, Brunner-type volar incision, centered at the metacarpophalangeal joint (a). After the release of A1 pulley and initial portion of A2 pulley, flexor tendons were retracted to show an osteocartilaginous mass at the proximal phalanx (b). Tumor resection was performed (c), and macroscopic examination showed a bony tissue with a cartilage cover (d).

Figure 8.

At 6 months postoperatively, the patient presented motion recovery of the operated digit, with complete extension (a) and a deficit of the last 20° of flexion (b), most likely due to a deformity created by metacarpal and middle phalanx osteochondromas of the same finger.