We have never discussed paediatric conditions because we don’t see babies or children at our chiropractic clinic. This morning a past client texted us to ask if there was anything we can do for his infant son’s trigger thumb. He saw a specialist previously and was immediately referred for surgery without conservative care options.
Paper 1: Case of a surgically managed congenital trigger finger
Being an evidence-based chiropractor, the first thing I did was to look into the research pertaining to trigger finger or trigger thumb in children.
The first paper that caught my attention was the management of a congenital trigger finger of a four-month old boy that underwent surgery. The paper, however, did mention that the first-line of treatment is conservative care (i.e. home-based physiotherapy program and splinting, which I will interpret as home-based exercise program).
The author also highlighted two things that are mention-worthy:
1) Most cases respond to conservative therapy!
2) The parents/guardians in this case was NON-COMPLIANT to the conservative care program
Case reports such as this are more of an recount of how specific conditions are managed in certain situations rather than evidence to support what works or what doesn’t work. While this report doesn’t discuss what are the treatment options available, it does give us an indicator that a trial of conservative care before operative care is common practice.
Which brings me to think, why did the specialist not offer my client a conservative treatment option?
Paper 2: Systematic review on treatment options for congenital trigger finger
If we think in terms of hierarchy of evidence, animal studies are at the bottom of the food chain with case reports immediately above it. The top of the pyramid lies the systematic reviews of randomised controlled trials or a meta analysis.
For paediatric cases, however, randomised controlled trial studies are not easily available. Furthermore, trigger finger is a fairly rare condition.
My point is this systematic review is pretty solid. It included seven studies or 118 fingers. It would seem none of these fingers included the thumb.
Before we discuss the findings, it should be noted the authors suggest trying conservative treatment first because over 50% of trigger fingers resolved SPONTANEOUSLY. This meant the trigger finger recovered by itself WITHOUT treatment.
Again, why is conservative treatment not offered FIRST.
So the authors condensed their finding into a treatment algorithm:
So there you go, there are three treatment options that the systematic review identified: 1) watchful waiting, 2) splinting, 3) surgery.
I am surprised that there is no mention of exercise treatment as an option.
Michael Beere very kindly pointed us to a trigger finger exercise therapy resource at Ortho Bullets.
Navigating treatment options with Singapore’s evidence-based chiropractor
We haven’t looked into exercise therapy as a treatment option for trigger finger in children. Given the patient is only one year old, exercise may not even be feasible. We have suggested the child’s parent to consider splinting as a first-line treatment option before surgical intervention.
We do think that patients should work in collaboration with their choice of health care provider. However, it is reasonable for patients to choose to question the advice provided.
This is why at Square One, we don’t expect you to take our word for it. All of our professional advice comes backed with solid research data. We are likely the only chiropractic clinic in Singapore to openly discuss about our treatment methods and to provide adequate referencing for all our our claims.
Again, we don’t work with paediatric conditions in our clinic. The best course of action for us is to refer the child on to another health care provider. In this case, we agree with the parents that splinting would be the starting point for their child. (They were considering splinting as an option.) Because we don’t offer splinting services at our practice, we have referred them on to some one else.
If you find yourself in a situation where you might need a second opinion, do not hesitate to reach out to us. We will be happy to assist. Again, Square One prides ourselves on offering best clinical care – even if that means referring you on to some one else.
For additional readings, check out:
- Why we choose exercise? A chiropractor’s approach to pain
- Your things your chiropractor doesn’t want you to know