Prirođeni škljocavi palac

master's thesis

• Title (english): Congenital trigger thumb
• Author: Lucija Pavljak
• Mentor: Krešimir Bulić (mentor)
• Committee member: Anko Antabak (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Krešimir Bulić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Pediatrics
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Škljocavi palac u djece predstavlja jednu od najčešćih anomalija dječje šake, koja od svih prstiju najviše pogađa palac. Ne javlja se odmah po rođenju nego u ranom djetinjstvu, kao rezultat nepodudarnosti u veličini tetive mišića fleksora policisa longusa i njezine ovojnice što dovodi do poremećenog i otežanog klizanja tetive. Pacijenti se općenito prezentiraju s palcem zaključanim u fleksiji interfalangealnog zgloba, odnosno u fiksnoj fleksijskoj kontrakturi. Prvi opis dao je Notta, čiji naziv nosi čvor palpabilan na volarnoj strani metakarpofalangealnog zgloba u području fleksorne brazde. Do dijagnoze se dolazi prvenstveno na temelju anamneze i fizikalnog pregleda, uz ultrazvuk kao potencijalno rano dijagnostičko sredstvo. Treba biti oprezan kako ga se ne bi zamijenilo s dislokacijom, frakturom ili anomalijom poznatom kao palac u dlanu deformacija. Klinička istraživanja su poboljšala razumijevanje samog prirodnog tijeka škljocavog palca te ukazala na benignost ovog stanja i mogućnost spontanog oporavka, koji premda može potrajati godinama, omogućuje obiteljima voljnim čekanja odgodu invazivnog liječenja, odnosno mogućnost da kirurška intervencija kao takva nije ni potrebna. Za još bolje razumijevanje prirode ovog stanja, potrebna su dodatna istraživanja. Terapijske mogućnosti variraju o samom izboru liječnika. Tako jedni, zbog spomenute spontane rezolucije, preferiraju inicijalno konzervativno liječenje korištenjem udlage ili izvođenjem vježbi pasivne ekstenzije, dok se drugi, zbog gotovo univerzalnog uspješnog ishoda, odlučuju na rani kirurški zahvat, otvorenim pristupom otpuštanja prvog anularnog fibroznog držača koji pouzdano vraća pokretljivost interfalangealnog zgloba palca.

Abstract (english)

Trigger thumb in children is one of the most common paediatric hand conditions. The thumb is affected more often comparing to other digits. It is not present at birth but appears in early childhood as a result from size mismatch between the flexor pollicis longus tendon and its sheath, disrupting normal tendon gliding. Patients most commonly present with the interphalangeal joint of the affected thumb locked in a flexed position, a fixed flexion contracture. The first description of trigger thumb is attributed to Notta and the palpable nodule at the volar aspect of the metacarpophalangeal joint flexion crease still bears his name. Medical history and physical examination are used to diagnose this deformity with ultrasound as potential early diagnostic tool. Caution is necessary to avoid misdiagnosing a fracture, dislocation of the thumb or thumb-in-palm deformity. Clinical investigation has improved our understanding of the natural history and its benign nature. Spontaneous resolution can occur but may take several years, which gives an opportunity of avoiding an unnecessary invasive approach to families that are willing to wait. Further research is needed in order to improve our knowledge of trigger thumb natural behaviour. Management techniques vary based on physician preference. In addition to spontaneous resolution, some doctors prefer initial conservative management consisting of splint therapy and passive stretching exercises. On the other hand, near universally excellent outcome of surgical intervention, lead others to recommend proceeding directly to open surgical release of the A1 pulley that reliably restores thumb interphalangeal joint motion.

• Keywords: škljocavi palac; djeca; prirodni tijek
• Keywords (english): trigger thumb; children; natural history
• Language: croatian
• URN:NBN: urn:nbn:hr:105:899400
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-12-12 13:20:49