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best practices BUSINESS SIDE | Q & ART | TABLE LESSONS | SAVVY SELF-CARE hand specialist, who correctly identified the problem as trigger thumb, and recommended surgery. Resigned to that fate, the family told J.'s piano teacher that he would miss several lessons. The piano teacher (who happened to be a client of mine) recommended they might want to consult with me before committing to surgery. Shortly thereafter, the family was in my office. J. demonstrated his movement Tiny Trigger Thumb A Strategy for Young Clients By Douglas Nelson "It isn't clicking anymore. Cool, huh?" My little client, A., flashed a smile that lit up the room. She glanced at her mom, as if she needed approval to show her elation. Her mom was clearly thrilled with her daughter's progress. This story began two years earlier, with little A.'s older brother, J., in my office and the whole family in tow. J. was 8 years old when he began complaining to his family about a pain in his thumb. Each time he would completely flex the digit, it would get stuck, and he would manually "unclick" it, which was painful. J.'s pediatrician referred the family to a limitations—clearly a case of trigger thumb. While I have addressed trigger thumb in many adults, I had never seen it in someone so young. His parents were research scientists and the conversation that followed was candid. They wanted to know what my success rate was, what strategy I would pursue, and why soft-tissue treatment was a reasonable approach. I shared with them my experience with trigger thumb and the science behind my approach, but also my lack of experience addressing trigger thumb with children. "We are conflicted about surgery," they said. "If we need to do that, we will. We'd like to explore all the options before we commit to that." Pondering the situation for a minute, I offered them an option. "I have an idea. First, speak with the hand specialist and find out if the surgery is time sensitive. That is, are there any downsides to waiting for four months? If he says waiting will not place your child at risk, let's plan on a four-month window of time to make a difference. If what we do isn't successful, you can still do the surgery. Sound reasonable? In the meantime, I need to comb the literature to see what I can find about presence of trigger thumb in children." Visit the newly designed ABMP.com. Log in. Explore. Enjoy. 41