Beyond Trigger Thumb: Wide Awake Surgery Gets 2 Thumbs Up

Finley's guitar teacher noticed her thumbs did not fully extend all the way up and that it was impacting her ability to reach the chords. She couldn’t fully “strum” the guitar.  

“Honestly, we thought it was a cute feature when she was little,” said Kim, Finley’s mom. “Kind of like a half thumbs’ up.”

And no, Finley had no pain in her thumbs whatsoever.
 

Finley Meets Dr. Chaudhry

So, off Finley went to get her thumbs checked out. Her pediatrician, Carolyn Ganeles, MD, suggested they meet Connecticut Children’s Sonia Chaudhry, MD, FAAOS, an internationally trained pediatric orthopedic surgeon who specializes in hand and nerve surgery, a rare skillset in the field of pediatrics. Dr. Chaudhry leads Connecticut Children’s Division of Orthopedics Hand & Nerve Surgery program in partnership with the Division of Neurosurgery.

Right away, Dr. Chaudhry diagnosed Finley with trigger thumb, a condition that happens in about three out of every 1,000 children. It presents as a thumb that gets stuck or clicks with movement.

Her assessment? Finley needed surgery on both thumbs. But like many young kids, Finley was scared to “go to sleep.”
 

What causes trigger thumb in kids?

Trigger thumb happens when the tendon surrounding the area thickens. In kids, it’s like a mechanical block which is why they need surgery to correct it. Trigger thumb isn’t congenital (at birth) but kids develop it along the way, often between 1 and 5 years old.  
 

Trigger thumb is very different in kids than in adults, more reason to get proper care and treatment from a team of orthopedic experts 100% dedicated to kids.  

“In children, trigger thumb doesn’t hurt like it does adults, but if not corrected, the joint and tendons get tighter as the bones grow and the soft tissues don't stretch to keep up with them, resulting in permanent contracture," said Dr. Chaudhry. 

After a few minutes of getting to know Finley, Dr. Chaudhry thought she’d be the perfect candidate for wide awake surgery, a simple operation that takes just minutes and is exactly what it sounds like: surgery without general anesthesia. 

Connecticut Children’s is one of the only pediatric health systems in the region that offers this technique.

What is wide awake surgery for trigger thumb?

During wide awake surgery, also called "WALANT" (Wide Awake Local Anesthesia No Tourniquet), the patient stays fully awake while the surgeon operates after injecting a local anesthetic to numb the area. The child feels like an active participant during the procedure and can communicate freely.

Dr. Chaudhry explained to Finley that she would be awake the whole time, with a curtain over her hand, and able to watch her favorite show on the iPad. The only somewhat painful part would be the numbing injection, but even that discomfort is eased by a cold spray and other methods. She compares the local to the pain of getting a vaccine—not fun, but tolerable and better than the alternative. Then, the rest—maybe some slight pressure and tugging during Dr. Chaudhry’s surgery.

With wide awake surgery, the team gives the numbing medicine in the preoperative room so that patients have the support of their caregivers, and then the child goes into the OR without the parents. There, they can indulge in some screen time or chat it up with a nurse or Child Life specialist. Then, they go home the same day without any of the side effects or sleepiness of anesthesia.

"We help kids to feel empowered and mature."

“Wide awake surgery isn’t for every 7-year-old or for every 17-year-old," emphasized Dr. Chaudhry. “Finley was so even-keeled and had the perfect temperament for it—and of course, we make sure the child and parents agree as a team to this approach. This gives them more trust in the system, and we aim to help kids feel empowered and mature.” 

Wide awake surgery is also a great choice for families who are nervous about general anesthesia or sedation and the need to fast before the procedure—both of which are eliminated. To date, Dr. Chaudhry has performed over 150 wide awake surgeries, the youngest child being 6, for surgeries ranging from bone/tendon/nerve repairs to soft tissue and bony tumors being removed from the arms and legs.
 

Dr. Chaudhry corrected one thumb at a time, with a month in between, to allow Finley to return to normal activity. The family was mindful to schedule the procedure during the winter because Finley is a swimmer and the surgery site couldn’t be soaked for two weeks. 

“It was super easy and took about 20 minutes for each surgery. Everyone at Connecticut Children’s was so nice to her and gave her a standing ovation when her nurse wheeled her out into the recovery room,” said Kim. “Dr. Chaudhry made it so much easier with our nerves, and Finley was a rock star the entire time.” 

For each surgery, Finley took just one day off, then it was back to school. Once she took the bandage off two weeks later, she was fully functioning and writing. It did take a few weeks for her to return to full athletic and musical activity, which is to be expected. But overall, a win-win. 

"We absolutely love Connecticut Children's!

“We absolutely love Connecticut Children’s,” raved Kim. 

“If your child is ever in this position and you’re considering wide awake surgery, do it. The benefits seriously outweigh anything negative. Talk to your child and if they’re on board, don’t look back.”