Trigger Thumb

Chapter 34 of Volume 1, Hand & Upper Limb. Revision notes for the FRCS (Plast).

What this chapter covers

• A1 pulley of the thumb — exact location
• Surface landmarks (what to say in a viva / where to cut)
• Danger zones (why percutaneous trigger-thumb release is risky)
• Viva pearls
• A1 – A2 – C1 – A3 – C2 – A4 – C3 – A5
• The Case & Describing the Thumb
• Q. Please describe this thumb.
• 1. Essentials - and Why “Congenital” Is a Misnomer
• 2. Staging (Sugimoto/Green)
• 3. Natural History & Spontaneous Resolution (lead with this)
• 4. Assessment & Differential Diagnosis
• Examination
• Differential diagnosis
• 5. A1 Pulley of the Thumb - Anatomy & Landmarks
• 6. Management
• Conservative (first-line)
• Surgery - open A1 pulley release
• 7. Paediatric Trigger FINGER - a Different, More Serious Entity (8-level)
• The mucopolysaccharidoses (MPS) - explained
• 8. How to Score Highest in This Station
• 9. Higher-Level Discriminator Pearls