Avoiding digital nerve injury in paediatric trigger thumb release

Trigger thumb is ten times more common than trigger finger in infants. It presents at two years of age and is secondary to a mismatch in the flexor pollicis longus tendon to pulley size. During surgical release of the A1 pulley, the radial digital nerve is susceptible to iatrogenic injury.¹ It is sometimes difficult to fully visualise the pulley for sharp dissection. We recommend a small incision in the pulley and then insertion of a fine tip artery clip. The clip is opened and the pulley will rupture with a pop. This is repeated until the tendon glides freely.

Figure 1.

Diagram demonstrating the thumb A1 pulley with the artery clip inserted through a small incision in the visible portion of the pulley