Bilateral stenosing flexor tenosynovitis in a pediatric patient. A case report

Background: Introduction: Trigger finger most commonly occurs in two age groups: children under 8 years of age and adults between 40 and 60 years. The incidence in the pediatric population is approximately 3.3 per 1,000 live births. The etiology remains unclear, with many authors proposing both hereditary and acquired causes. Approximately one-third of cases managed conservatively fail to resolve and subsequently require surgical release. Methods: A 1-year and 5-month-old male patient with no relevant medical history. The current condition began at birth, presenting with difficulty in extending the third finger of the left hand and the third and fourth fingers of the right hand. Targeted physical examination revealed forced flexion of the third finger of the left hand with a palpable snap (+/A1 pulley); on the right hand, forced flexion of the third and fourth fingers with a similar snapping sensation (+/A1 pulley). Results:Following an unsuccessful course of conservative treatment, the patient was scheduled for surgical intervention consisting of exploration of the flexor mechanism of the aforementioned digits. Discussion: Unlike flexor stenosing tenosynovitis in adults, the condition is rare in children, and its pathophysiology is poorly understood. Currently, there is no consensus regarding the optimal treatment for pediatric flexor stenosing tenosynovitis. Treatment options vary and include both surgical and non-surgical approaches. Conclusion: Flexor stenosing tenosynovitis in pediatric patients is an uncommon condition with diverse etiologies and an incompletely understood pathophysiology. A comprehensive diagnosis should consider both systemic factors and local anatomical abnormalities. While initial management is typically conservative, surgery becomes necessary when symptoms persist, potentially revealing bony anomalies beyond the involvement of the A1 pulley. Further studies are needed to establish accurate diagnostic and therapeutic protocols for the pediatric population. Keywords: Tenosynovitis.