Strum Thumb

Back to the beginning....Rowen has always favored his thumbs to be in a flexed position. Of course this is normal in a newborn. I did notice last summer that he kept his thumbs flexed, but as I was able to passively extend his thumbs, I did not think much of it. Fast forward to December. I noticed Rowen never straightened his right thumb. This was particularly noticeable when he would give us a "thumbs up".

When we noticed Rowen's thumb we brought it to the attention of our family doctor. She had never seen something like this in a child and decided to get some x-rays to make sure the hand bones were normal (see above, Rowen's little flexed thumb). She was not sure what the underlying problem might be. It appeared that this had occurred since he started playing his guitar for hours at a time. Therefore, our doctor referred to it as his "strum thumb".

Within 3 hours of the x-rays, I had gone google crazy and discovered what is called, "congenital trigger finger". I quickly became convinced this was Rowen's diagnosis. I spoke to my resident's husband who is an orthopedic resident and he confirmed this was the likely diagnosis. We were scheduled to see Dr. Bobby Chhabra in 1 week. Life being as it is, Dr. Chhabra and I are connected by 2 degrees of separation and I knew him on a casual level, but did not realize he was the top hand surgeon, reportedly "in the country".

We saw Dr. Chhabra today and he confirmed the Rowen has "congenital trigger finger". He reassured us that this was not due to his extensive rockin' guitar playing. But was just natures course. This occurs in 3/100,000 births (approximately). The condition is quite rare. When it occurs, 30% of children have both hands affected. Rowen's left hand appears to be normal. However, Dr. Chhabra says we should keep a close eye on it.

Much to my relief, he said that even if I had brought Rowen in over the summer when I first noticed his preferred flexed hand position, we would not have avoided surgery. He also reassured us that we had identified the problem very early. Bryan and I went back over the last 6 months of pictures and videos and are quite certain that Rowen had normal extension of his thumb, possibly into November.

Many parents do not notice this problem until children are 3 or 4 years old and can communicate that their hand hurts them or have difficulties with writing. Rowen, interestingly, is able to functionally use the hand without difficulty. He prefers his right hand for eating, drawing, and of course strumming the guitar. But after a long session of guitar strumming, he has told me the last few days that his thumb hurts.

It is very good that we identified the problem early and Dr. Chhabra recommended surgery in the next few weeks. The longer the thumb stays in a flexed position, the more possibility there is for joint damage. If the joint becomes damaged, then even after surgery, the thumb may not have normal recovery. At this time, he is very optimistic that surgery will fix the problem. But, he wanted to do it sooner rather than later.

We are planned for surgery 2/11/2011. This will be an outpatient event. Rowen will come in at 6am and go under general anesthesia. Little people have to be put under because they can not hold their hand still. Once asleep the procedure is very "simple". I guess that is hand surgeon talk for boring. Anyway, should only be about 30 minutes. Then Rowen will get a cast from his finger tips to his shoulder to keep the thumb extended and the wound protected. This my friends....I think will be the hardest part. I can already see my frustrated little boy tyring to feed himself with his left hand and just finding the whole thing impossibly unbearable. But....this too shall pass.

During our visit today, I took off my academic, dedicated the shaping the young minds and skills of future physicians hat and put on my Mommy hat. I requested that a resident not participate in the actual surgery. So although surgery in a 2 year old is never desirable, with Dr. Chhabra we are in good hands....get it "hands"....