An 8-month-old boy has a locked right thumb held in flexion at the interphalangeal joint, which cannot be passively extended. A small firm nodule is palpable over the flexor pollicis longus tendon at the level of the metacarpophalangeal joint. The recommended management is:
- A Observation until 1 year of age, then A1 pulley release if unresolved ✓
- B Steroid injection into the tendon sheath
- C Splinting in extension until skeletal maturity
- D Immediate open tenolysis of the flexor pollicis longus
Correct answer: A. Observation until 1 year of age, then A1 pulley release if unresolved
Explanation
Congenital trigger thumb presents with a fixed flexion deformity of the interphalangeal joint and a Notta nodule over the C1 pulley. Roughly 30% resolve spontaneously by one year, so observation is appropriate in infancy. If the deformity persists beyond about one year it rarely resolves and can produce a permanent flexion contracture, so C1 pulley release is performed. Steroid injection is not standard in this age group.
Reference: Green's Operative Hand Surgery, 7th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.