Paediatric: congenital trigger thumb: practice question

A Orthopaedics question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Orthopaedics · Paediatric: congenital trigger thumb

Sample item

A 2-year-old has a thumb held in flexion at the interphalangeal joint, with a palpable nodule at the base of the thumb on the palmar side. The thumb cannot be actively extended. What is the diagnosis and the usual definitive treatment?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Paediatric trigger thumb with Notta node; surgical release of the A1 pulley

A paediatric trigger thumb is a fixed flexion posture of the interphalangeal joint caused by a nodule in the flexor pollicis longus (Notta node) catching at the A1 pulley. Unlike the adult condition it usually does not trigger but is locked. Release of the A1 pulley is the definitive treatment when it persists, usually after 1 year of age.

Option by option

  • A. Gamekeeper thumb; spica cast for 6 weeks

    Gamekeeper thumb follows trauma to the ulnar collateral ligament.

  • B. Dupuytren contracture; fasciectomy

    Dupuytren contracture affects the palmar fascia in adults and does not occur in toddlers.

  • C. Paediatric trigger thumb with Notta node; surgical release of the A1 pulley (correct)

    Correct. A Notta node with a locked flexed thumb is treated by A1 pulley release.

  • D. Congenital absent thumb extensor; tendon graft

    The extensor tendon is intact and the problem lies in the flexor sheath.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Orthopaedics question

What is the answer to this Orthopaedics question?

The best answer is C, Paediatric trigger thumb with Notta node; surgical release of the A1 pulley. A paediatric trigger thumb is a fixed flexion posture of the interphalangeal joint caused by a nodule in the flexor pollicis longus (Notta node) catching at the A1 pulley.

Why is "Gamekeeper thumb; spica cast for 6 weeks" not the answer?

Gamekeeper thumb follows trauma to the ulnar collateral ligament.

Why is "Dupuytren contracture; fasciectomy" not the answer?

Dupuytren contracture affects the palmar fascia in adults and does not occur in toddlers.

Why is "Congenital absent thumb extensor; tendon graft" not the answer?

The extensor tendon is intact and the problem lies in the flexor sheath.

What concept does this question test?

It tests Paediatric: congenital trigger thumb in Orthopaedics. Unlike the adult condition it usually does not trigger but is locked. Release of the A1 pulley is the definitive treatment when it persists, usually after 1 year of age.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Paediatric: congenital trigger thumb?

Pair each fracture with its classic complication and nerve injured. Then use the flashcards and the other Orthopaedics questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.