20250701 Cong clasped thumb & cong trigger thumb - Dr Yong CY

6-year old child with fixed flexion deformity of IP joint right thumb. Thumb is morphologically normal, with non-tender palpable nodule at base of MCPJ joint. What is the treatment of choice?

• A. Removal of the nodule in FPL

• B. Fractional lengthening of FPL at musculotendinous junction

• C. Complete release of proximal annular pulley of flexor sheath

• D. No treatment because condition usually spontaneously resolve

8-months old boy came presented with a persistent flexed and adducted thumb bilaterally. Examination revealed an inability to extend and abduct thumb with full ROM in passive extension and abduction.. There are no other digital anomalies or other joints involvement. His mother tells you that her other 2 chidren had similar deformities. What is your 1st line of treatment option for this child?

• A. Observation because condition usually spontaneously resolve

• B. Serial splinting of thumb

• C. EIP tendon transfer to EPL

• D. First metacarpophalangeal joint arthrodesis

Following are associated conditions to congenital Clasped thumb except

• A. Arthrogryposis

• B. X-linked MASA syndrome

• C.  Freeman-Sheldon syndrome

• D. VACTERL association

What is the pathoanatomy of congenital trigger thumb?

• A.  Congenital constriction of A1 pulley of thumb

• B.  Inflmmation of FPL tendon secondary to microtrauma causing increase in size

• C. Abnormal growth of FPL tendon

• D. Size mismatch of FPL and A1 pulley due to abnormal collagen degeneration

A 6-months old baby girl presented with a persistent flexed right  thumb.  Her mother claims she has not seen her child extending her thumbs fully before. There are no family history of similar condition. On examination, her right thumb is flexed at the IP joint at rest,  both her IP and MCPJ are able to be extended fully during passive motion with noticeable clicking. There is a palpable nodule at the MCPJ of the right thumb. Her mother is concerned of this condition causing a long term deformity. What is the next step in management?

• A. Percutaneous release of proximal annular pulley of flexor sheath

• B. Splinting of the IP joint in extension and MCPJ in hyperextension

• C. Passive extension excersises and observation

• D. Corticosteroid injection over A1 pulley of thumb