From the Guidelines
Flexion thumb contracture in pediatric patients is primarily caused by neuromuscular disorders, such as Pompe disease, which can lead to contracture and deformity if not prevented with proper treatment and management. The causes of flexion thumb contracture in pediatric patients can be multifactorial, including:
- Neuromuscular disorders, such as Pompe disease, which can cause contracture and deformity due to muscle weakness and imbalance 1
- Congenital conditions, such as trigger thumb and congenital clasped thumb
- Traumatic causes, involving injuries to the thumb's tendons, ligaments, or bones
- Neurological disorders, like cerebral palsy and brachial plexus injuries, which can lead to muscle imbalance and spasticity Prevention of contracture and deformity is crucial, and can be achieved through:
- Daily stretching and correction of positioning
- Use of splinting and orthotic intervention, such as resting wrist/hand/finger splints to prevent hypoextensibility in long wrist/finger flexors
- Provision of adequate support in all positions, especially sitting and supported standing
- Education of patients and families on the importance of prevention and management of contracture and deformity 1 It is essential to coordinate the use of positioning, splinting, and standing devices with medical specialists due to potential contraindications, such as cardiac or pulmonary compromise, osteoporosis, and prohibitive contractures 1.
From the Research
Causes of Flexion Thumb Contracture in Pediatric Patients
- The causes of flexion thumb contracture in pediatric patients can be attributed to various factors, including:
- A size mismatch of the flexor tendon and the thumb pulley system, which can lead to pediatric trigger thumb 2
- Congenital absence or hypoplasia of one or more of the thumb extensors, resulting in congenital clasped thumb 2
- Acquired thumb flexion contracture, which can occur after birth and is characterized by a flexion contracture of the interphalangeal joint 3
- Other conditions, such as cerebral palsy, can also contribute to the development of flexion thumb contracture in pediatric patients, particularly those with spastic forms of the condition 4
- The development of trigger thumb in pediatric patients can be influenced by factors such as age, with most cases presenting with locked flexion contracture and palpable Notta's nodule 5, 6
- It is essential to note that the term "congenital" is a misnomer for acquired thumb flexion contracture, as the condition is typically acquired after birth 3