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Muslim Savin
Muslim Savin

T Girl Thumb \/\/TOP\\\\

Pediatric and adult trigger thumbs represent different entities requiring different treatment approaches. Despite some controversy, pediatric trigger thumb is considered an acquired condition caused by unique anatomic abnormalities.17 Among the estimated 0.05% of all children diagnosed with trigger digits, 90% occur in the thumb, most commonly presenting at 2 years of age.7 Previous studies report a spontaneous resolution rate ranging from zero to 66%.1

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In contrast, adult trigger thumb most commonly occurs in middle-aged women and may occur in conjunction with multiple trigger digits. Histological analysis has demonstrated fibrocartilaginous metaplasia, and it has been proposed this is secondary to repetitive friction between the tendon and sheath.8

Corticosteroid injection is a common first-line, minimally invasive treatment. Injection of the involved flexor tendon sheath provides long-term relief of symptoms in 60 to 92% of affected digits with up to three injections.78 A diminished response to injection has been associated consistently with an increased duration of symptoms, usually more than 4 to 6 months, and with an increasing number of injections.78 Rozental et al prospectively studied corticosteroid injections in 124 trigger digits in 199 patients with 35% involving the thumb in an attempt to identify prognostic indicators of symptom recurrence.8 The results of open A-1 pulley release generally are excellent. Turowski et al, in a group of 59 patients treated by several surgeons, reported 97% complete resolution of triggering with no complications.9

Using an electrogoniometer to measure thumb movements during mobile phone text messaging, Gustafsson et al found that subjects with musculoskeletal symptoms tended to have higher thumb movement velocities and fewer pauses in thumb movements compared with those without symptoms.16 In addition, they found that females had higher muscle activity in the extensor digitorum and APL when entering messages and tended to have greater thumb abduction, higher thumb movement velocities, and fewer pauses when compared with their male counterparts.16 Of note, values for the FPL were not measured.

In our report, we present the unique case of a 16-year-old female patient with no risk factors for the development of stenosing tenosynovitis other than her substantial texting. Though the aforementioned studies report occurrences of tendonitis or tenosynovitis due to text messaging, nearly all reports are related to dorsoradial pathology, such as in De Quervain tenosynovitis. In addition, studies using electrogonimetry and ultrasound also focused on this region of pathology, suggesting that tenosynovitis involving the flexor aspect of the thumb is rarely appreciated.1516 To our knowledge, this is the first report of stenosing tenosynovitis in a teenager that resulted in clinically disabling triggering of the thumb and ultimately required surgery. As the use of mobile devices increases while technology continues to progress, this rare clinical phenomenon may be of increasing importance in the near future. Thus, it is warranted to examine precipitating factors in our presented case in an effort to shed light on potential risk factors or preventative measures that may be implemented.

Florida Rep. Matt Gaetz attempted to humiliate a teenage girl after arguing that overweight and unattractive women don't need to worry about getting pregnant or needing abortions. That same girl has since raised over $700,000 for abortion care.

Meanwhile, Gaetz has been criticized for his actions. Once more, the incident drew unwanted attention to an ongoing investigation from 2020 involving the congressman and a series of allegations involving sex with an underage girl. Gaetz has denied the allegations made against him.

Pediatric trigger thumb (PTT) is also called a flexion contracture of the IP joint (Picture 1). It is a condition that affects the movement of the thumb in children. The thumb gets stuck in a bent (flexed) position. A contracture means that the thumb can no longer stretch or straighten.

About 3 in 1000 children will develop PTT between age 1 and 3. Most often, it occurs in children at about age 2. Boys and girls have the same risk of developing PTT. Both thumbs can be affected in up to 30 percent of children.

Congenital clasped thumb describes an anomaly which is characterized by a fixed thumb into the palm at the metacarpophalangeal joint in one or both hands.[5]The incidence and genetic background are unknown. A study of Weckesser et al. showed that boys are twice as often affected with congenital clasped thumb compared to girls. The anomaly is in most cases bilateral (present in both hands).[5]A congenital clasped thumb can be an isolated anomaly, but can also be attributed to several syndromes.

In order for the thumb to maintain a normal position, a strict balance between these groups is required. Weak or absent extensors and/or abductors (the extensor pollicis brevis tendon, the extensor pollicis longus tendon or, rarely, the abductor pollicis longus tendon), can cause a disbalance, leading to an abnormal position of the thumb: congenital clasped thumb. There is also the possibility that two tendons are affected simultaneously.[citation needed]

Furthermore, a tight thumb web space (the area between thumb and index finger) can contribute to congenital clasped thumb. The thumb cannot be properly abducted (moved outwards), if the web space is too tight.[citation needed]

To summarize, the causes of congenital clasped thumbs may vary between patients and can sometimes be a combination of the preceding components. Treatment should be tailored to all occurring components in order to achieve good results.[citation needed]

Diagnosing the congenital clasped thumb is difficult in the first three to four months of life, as it is normal when the thumb is clutched into the palm in these first months.[6]Diagnoses that cause the same flexion or adduction abnormalities of the thumb are:

There are a few different classifications conceived to categorize the spectrum of variety of congenital clasped thumb. In literature, X classifications have been described for clasped thumb. The two most relevant of the existing classifications, to our opinion, are the classifications of McCarrol[12] and Tjuyuguchi et al.[13]

The most global format is the classification of McCarrol, which divides the congenital clasped thumbs into two groups. Group I includes the supple clasped thumb, when the thumb is only passively correctable. While complex clasped thumbs, thumbs which cannot be moved neither passively or actively, belong to group II.[citation needed]

Treatment of all categories of congenital clasped thumbs should start with either serial plaster casting or wearing a static or dynamic splint for a period of six months,[5] while massaging the hand. Extension by splinting shows reduction of the flexion contracture. To gain optimal results, it is important to start this treatment before the age of six months. The result of this therapy is better in less severe deformities.[14] In most uncomplicated cases, a satisfactory result can be gained when splint therapy starts before the age of six months.[15] Splinting should be tried for at least three months and possibly for as long as six months or longer. If the result of splint therapy stagnates, surgery treatment is indicated.[16]

Polydactyly is the most common congenital hand deformity. It affects boys and girls equally. A baby born with polydactyly has more than five fingers on one hand. An extra finger is often a small piece of soft tissue that can be simply removed. Sometimes, the extra finger contains bones but not joints. Very rarely, the extra finger is a fully functioning digit. A baby may be born with several extra fingers. There are different types of polydactyly:

Moderate symbrachydactyly: Most or all of the finger bones are missing, and the baby has small projections of skin and soft tissue. The thumb is usually present, but it may be short.

Radial club hand: Children with club hand on the radial side (radial dysplasia) often have a short forearm and wrist curved toward the thumb side. Once a baby is between 6 and 12 months of age, surgery may be recommended to straighten the forearm bone and to fix the tendons. The condition may also be related to other medical syndromes such as Fanconi anemia, Holt-Oram syndrome, and VATER syndrome.

Ulnar club hand: This condition is less common than radial club hand and is usually unrelated to other syndromes. It can range from mild to more severe cases with the baby's wrist to be in a fixed and bent position toward the little-finger side of the hand. The thumb by be deformed or absent.

For stable thumb-wrist joints, reconstructive surgery is generally recommended to build up the thumb and its tendons. For loose or floating unstable joints, the small thumb is removed and the index finger is converted to a thumb.

From the moment they first discover their fingers and toes (consciously or not), many babies have a fascination with sucking their thumbs. You may even have left an ultrasound appointment during pregnancy with a grainy photo of your little one happily self-soothing in the womb.

Meanwhile, well-meaning friends, family members, and even strangers at the grocery store are warning you that letting your child suck their thumb for too long can lead to a bunch of oral and dental problems. Great.

If you notice your child only sucks their thumb before bedtime, they may just need another way to wind down and prepare for sleep. You may want to try offering a warm cup of milk or a toddler-safe herbal tea before nighttime teeth brushing.

If your child has a favorite stuffed animal or toy, use it to your advantage! Pretend that Teddy wants to stop sucking his thumb. Ask your child if they can help Teddy by setting a good example and offering suggestions. 041b061a72


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