Characteristics and association of trigger thumb with congenital malformation and developmental milestones in children: Nationwide analyses of a birth cohort

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This cohort study, using Korean National Health Insurance data, analyzed 1.9 million births (2009–2012) followed to age 6. We identified 10,167 trigger thumb cases and matched them 1:10 by sex and birth year with controls. Baseline features, congenital malformations (ICD-10, Q00-Q89), and development at ages 4–6 (Korean Developmental Screening Test) were compared. Logistic regression assessed comorbidity risk, expressed as odds ratio (OR), while generalized estimating equations evaluated the association between trigger thumb and developmental outcomes. The trigger thumb group (average diagnosis age: 31.3 months, 46.6% male) had 32.6% of surgery rate at an average age of 43 months. Trigger thumb group had significantly higher rates of musculoskeletal (OR 5.80, 95% CI 5.38–6.26), lens (OR 2.76, 95% CI 1.19–6.42), and circulatory system malformations (OR 1.27, 95% CI 1.09–1.49) compared to controls. However, assessment using the Korean Developmental Screening Test revealed no significant delays in development, including gross and fine motor skills. Pediatric trigger thumb is linked to increased congenital malformations but doesn't seem to hinder development. Screening for coexisting conditions and reassuring parents about development are crucial. Health sciences/Medical research/Epidemiology Health sciences/Medical research/Paediatric research trigger thumb big data co-morbidity congenital development pediatric Figures Figure 1 Figure 2 Introduction Pediatric trigger thumb is characterized by the locking or catching of a finger in a bent position by thickening and trapping in the tendon sheath (A1 pulley). There is some controversy over the exact etiology of pediatric trigger thumb [ 1 ]. Previously classified as a congenital anomaly, pediatric trigger thumb is rarely detected at birth; approximately 69% of cases are diagnosed at age 2–5 years [ 2 ]. Understanding the prevalence and characteristics of pediatric trigger thumb is essential for effective diagnosis and management. Previous studies have reported varying incidence rates and management plans [ 2 – 5 ] There is no histological evidence that trigger thumb in children is a congenital condition [ 6 ]. Microscopic examination has shown no signs of infection, inflammation, or degeneration in the thumbs of pediatric patients with trigger thumb [ 7 ]. However, several studies have suggested that genetic factors play an important role in its etiology [ 8 – 10 ]. Hence, the potential association with congenital abnormalities highlights the need for further research in pediatric patients with trigger thumbs. Despite these congenital issues, research on developmental delays in children with trigger thumbs remains lacking. Although pediatric trigger thumb is not a rare disease, there is still a knowledge gap regarding its management and associated congenital comorbidities based on nationwide data. To fill this gap, we analyzed multiple epidemiological features of pediatric patients with trigger thumb in a nationwide cohort population, including the initial diagnosis and surgical treatment rate. In addition, we aimed to comprehensively investigate the presence of congenital comorbidities by considering genetic factors. We also investigated whether children with trigger thumb experienced developmental delays when comorbid conditions were present. Methods Study design and population This study was approved by the Institutional Review Board (IRB) of our institution (2023-10-204). The requirement for informed consent was waived by the IRB as all personal identifying information was removed from the database. Research was performed in accordance with the Declaration of Helsinki. Data for this study was derived from the National Health Insurance Service (NHIS) of Korea, encompassing a cohort of 2,395,966 individuals between 2009 and 2018. Among this cohort, 1,919,162 participants born between 2009 and 2012 were selected and followed up until 2018. The exclusion criteria were the absence of the Korean Developmental Screening Test for Infants and Children (K-DST) [ 11 ], missing birth weight records, and chromosomal anomalies (ICD-10 codes Q90 to Q99) due to multiple anomalies associated with chromosomal anomalies. This led to the enrollment of 1,581,177 participants. Trigger thumb was defined using ICD-10 codes, and participants with trigger thumb were matched at a 1:10 ratio with control participants who had no history of trigger thumb. The matching criteria were sex and birth year. This resulted in 10,167 participants with trigger thumbs and 101,670 control participants (Fig. 1 ). The surgical history of trigger thumb was also examined. Exposed cohort The exposed cohort for trigger thumb was defined using the ICD-10 code M65.3, including M65.30 to M65.35 for various fingers and thumbs, with surgical intervention identified using the operation code N0830 in the Korea NHIS database. This encompassed both general and specific diagnoses for each finger, including the thumb. Both trigger finger and trigger thumb were included in this study because of the interchangeable use of clinical diagnostic codes, and the prevalence of pediatric trigger finger (2nd, 3rd, 4th, or 5th ) was much lower than that of trigger thumb [ 12 , 13 ]. The trigger thumb group was further divided into surgical and nonsurgical groups for analysis, and their characteristics were compared. Concurrent congenital comorbidity Associations between pediatric trigger thumb and other congenital comorbidities were also considered. The presence of congenital comorbidities was examined based on ICD-10 codes, starting with the Q code, to ensure comprehensive assessment. [ 14 ]. The percentage of patients with congenital comorbidities was compared between the trigger thumb and control groups. The higher and lower ICD-10 categories were analyzed separately. The details of the ICD-10 codes, including the higher and lower categories of congenital anomalies, are summarized in Supplemental Table 1 [15]. K-DST for developmental screening K-DST is a validated developmental screening tool specifically designed for Korean children. Pediatricians use this tool to screen for developmental issues, monitor progress, and assess the effects of interventions [16]. K-DST assessments were conducted at 42–48 months (5th K-DST), 54–60 months (6th K-DST), and 66–71 months (7th K-DST). This study analyzed changes in K-DST results over time using these assessments. K-DST evaluates six developmental domains: gross motor skills, fine motor skills, cognition, language, social skills, and self-help. Each domain has eight questions scored from 0 to 3, resulting in a total score of 0 to 24 for each domain. These scores are categorized into four levels based on the total score in each domain: advanced development (total score ≥ 1 standard deviation [SD]), age-appropriate (total score ≥ − 1 SD and < 1 SD), need for follow-up (total score ≥ − 2 SD and < − 1 SD), and recommendation for further evaluation (total score < − 2 SD) [16, 17]. In this study, the primary focus was identifying adverse outcomes, defined as scores indicating a “need for follow-up” or a “recommendation for further evaluation” across any of the domains. A child was considered to have an unfavorable overall K-DST score if they recorded an unfavorable result in any of the six domains. The rate of K-DST completion was comparable between the control and pediatric thumb groups, with 81.15% vs. 82.29% for the 5th, 73.12% vs. 75.55% for the 6th, and 50.81% vs. 52.15% for the 7th K-DST. Covariates For comprehensive assessment, the covariates included in this study encompassed a wide range of demographic and clinical characteristics. Demographic characteristics included sex (boys or girls), prematurity status (yes or no), birth weight (kg), breastfeeding status (yes or no), region of birth, and income. Specifically, birth weight, prematurity status, and breastfeeding information were obtained from parental responses to questionnaire items in the first round of the national health screening program. Prematurity was defined as birth before 37 weeks of gestation. Birth residence was categorized as Seoul, metropolitan, city, or rural. Income was estimated based on premium quartiles from the Korean National Health Insurance Statistical Yearbook. As all Koreans must pay insurance premiums based on their housing income, we assumed that income would be higher if a patient paid a higher insurance premium. The patients were divided into four groups for convenience of analysis (Q1–Q4). The lowest 25% and top 25% of the patients were classified as Q1 and Q4, respectively. Statistical analysis General characteristics were compared between the pediatric trigger thumb and control groups using the chi-square and t-tests. The data are expressed as the mean ± SD or as the median and interquartile range. Logistic regression was used to assess the association between pediatric trigger thumb and congenital comorbidities by calculating odds ratios (ORs) and 95% confidence intervals (CIs). The K-DST results were compared between the pediatric trigger thumb and control groups. Generalized estimating equation (GEE) analysis was used to determine interactions at different time points (5th, 6th, and 7th K-DSTs) [18]. The results of the GEE analyses are described using group estimates and Wald 95% CIs. All analyses were adjusted for sex, birth year, premature birth, income, region of birth, breastfeeding at 4 months of age, and birth weight. The significance level was set at p < 0.05. All statistical analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, USA). Results General characteristics of pediatric trigger thumb patients Table 1 presents the basic demographic characteristics of children with trigger thumb compared with those of the control group. The overall incidence of pediatric trigger thumb was 0.64% (approximately 6 in 1000 births). In the trigger thumb group, 46.8% of the patients were male. In general, no significant clinical differences were found in birth weight or breastfeeding habits between the two groups, although statistical significance was observed, likely because of the large sample size of the study. There were no significant differences in income between the pediatric trigger thumb and control groups (p = 0.191). Table 1 Summary of clinical characteristics of trigger thumb and matched unexposed cohort Variable (Unit) Matched unexposed cohort (N = 101,670) Trigger thumb cohort (N = 10,167) p-value Sex, Boy, n (%) 47,400 (46.8) 4,740 (46.8) 1 Prematurity, n (%) * 3,742 (3.68) 396 (3.89) 0.275 Birth weight, kg (mean ± SD ‡ ) 3.18 ± 0.46 3.17 ± 0.46 0.020 Breast feeding, n (%) § 26,774 (26.3) 2,724 (26.8) 0.006 Region of birth, n (%) ∥ 0.039 Seoul and Metropolitan 43,718 (43.0) 4,434 (43.6) Urban 48,502 (47.7) 4,728 (46.5) Rural 8,396 (8.3) 901 (8.9) Income, n (%) ¶,** 0.191 Q1 (Low) 11,195 (11.01) 1,164 (11.45) Q2 22,273 (21.91) 2,258 (22.21) Q3 38,645 (38.01) 3,891 (38.27) Q4 (High) 25,660 (25.24) 2,480 (24.39) Age at diagnosis of trigger thumb, month mean ± SD 31.3 ± 21.2 Surgery of trigger thumb Proportion of surgery, n (%) 3,313 (32.59) Duration from diagnosis to surgery, month, mean ± SD 11.3 ± 16 Age at surgery, month, mean ± SD 42 ± 18.1 * Any birth before 37 weeks completed weeks of gestation, ‡ Standard deviation, § Status of breastfeeding was obtained from parental responses to questionnaire items in the first round of the national health-screening program. ∥ Missing: 1.04% in matched unexposed cohort and 1.02% in trigger thumb cohort, ¶ The patients’ income status was estimated based on the premium quartile from the Korea national health insurance statistical yearbook. As all Koreans must pay insurance premiums based on their housing income, we assumed that income would be higher if a patient paid a higher insurance premium. ** Missing: 3.83% in matched unexposed cohort and 3.68% in trigger thumb cohort. The average age at the diagnosis of pediatric trigger thumb was 31.3 months, and the median age was 26 months (Q1–Q3:16–41 months). In total, 32.6% of the patients in the trigger thumb group underwent surgical treatment. The average duration from the initial diagnosis of pediatric trigger thumb to surgical treatment was 11.3 months, with a median of 3 (Q1–Q3: 1–17) months. The average age at surgery was 43.0 (4–113) months, and the median age at surgery was 40 (30–53) months. When comparing the general characteristics of the operated and non-operated trigger thumb groups, there were no differences in sex, prematurity, birth weight, breastfeeding, or income level (p > 0.05, Supplemental Table 2 ). Concurrent congenital comorbidity We analyzed congenital malformations among children with trigger thumb and found several significant associations compared with the matched unexposed cohort. Overall, the trigger thumb group exhibited a higher prevalence of congenital malformations in some disease categories. We found that children with trigger thumb had notably greater odds of having musculoskeletal system malformations, with an OR of 5.80 (95% CI 5.38–6.26). In addition, there was a significantly increased risk of lens malformations among children with trigger thumb, with an OR of 2.76 (95% CI 1.19–6.42). Furthermore, our analysis revealed a significant association with circulatory system conditions, where the odds ratio was 1.27 (95% CI 1.09–1.49), indicating a modest but statistically significant increase. These results underscore the broader association of pediatric trigger thumb, which extends beyond the musculoskeletal system to include other congenital malformations, such as lens malformations and circulatory system conditions. The statistical results for each disease category are summarized in Fig. 2 . Development Developmental assessments of children with trigger thumb, analyzed using GEE from ages 4 to 6 years, revealed no significant interaction with time (all p < 0.05). The overall developmental outcomes according to the K-DST did not significantly differ between the trigger thumb and control groups (OR 1.04, 95% CI 0.95–1.14, p = 0.380). Gross and fine motor skill assessments indicated no developmental delay attributable to trigger thumb. Similarly, cognitive, language, social, and self-help skill development were on par with those of the control group, demonstrating no significant deficits. These results indicate that despite the presence of congenital malformations associated with trigger thumb, the condition does not adversely affect developmental milestones in various domains during early childhood. The detailed statistical results for each developmental domain are summarized in Table 2 . Table 2 Effect of trigger thumb on the development analyzed by Korea development screening test Cohort (%) * Odd ratio Problem domain Matched unexposed cohort Trigger thumb cohort Adjusted OR † 95% CI ‡ p-value Any six domains 9.80 10.29 1.04 0.95 to 1.14 0.3802 Gross motor skills 3.49 3.65 1.12 0.97 to 1.28 0.1256 Fine motor skills 3.66 3.85 1.08 0.94 to 1.25 0.2621 Cognition 4.70 4.66 1.05 0.92 to 1.19 0.4924 Language 4.69 4.87 1.05 0.92 to 1.19 0.4621 Social skills 3.23 2.90 0.92 0.79 to 1.09 0.3348 Self-help 2.60 2.52 1.03 0.87 to 1.22 0.7157 The Korea development screening test (K-DST) evaluates six developmental domains: gross motor skills, fine motor skills, cognition, language, social skills, and self-help. Each domain has eight questions scored from 0 to 3, resulting in a total score ranging from 0 to 24 for each domain. The developmental assessments of children with trigger thumb, analyzed using generalized estimating equations (GEE) from ages 4 to 6, revealed no significant interaction with the time variable (all p values < 0.05). * Percentage of each group (matched unexposed cohorts: 101,670, trigger thumb cohorts: 10,167 patients) defined as scores indicating either a “need for follow-up” or a “recommendation for further evaluation”, † Odds ratio, ‡ Confidence interval Discussion This study provides insights into the characteristics, congenital comorbidities, and developmental outcomes of children with trigger thumbs. The incidence was 0.64%, with no significant demographic differences in birth weight, breastfeeding habits, or income levels between the affected and control groups. Notably, children with trigger thumb have greater odds of developing musculoskeletal malformations, lens malformations, or circulatory system conditions. Despite these associations, developmental assessments using GEE showed no significant delays in gross motor, fine motor, cognitive, language, social, or self-help skills. These results indicate that although pediatric trigger thumb is linked to certain congenital malformations, it does not adversely affect the overall developmental milestones during early childhood, emphasizing the need for comprehensive care and monitoring. Our study revealed a trigger thumb incidence of 6 per 1,000 births in this cohort, which is slightly greater than the previously reported range of 1–3 per 1,000 births [6, 19–22]. This discrepancy may be due to underestimation in previous studies with limited sample sizes, overestimation in our study due to the inclusion of cases that mimic trigger thumb, and ethnic variations, as seen in the higher rates among Hispanic populations [23]. A Japanese study reported an incidence of 3.3 cases per 1,000 births [ 6 ], and their method of postal questionnaires to parents one year after birth might have underestimated the true prevalence. Further research is warranted to investigate these potential explanations and to establish a more accurate understanding of trigger thumb incidence across different populations. The mean time to diagnosis of trigger thumb was 31.3 months, which is similar to or slightly earlier than the previously reported age [2, 19, 24]. Generally, pediatric patients visit clinics with an abnormally flexed thumb and/or an inability to extend the thumb, which is often noticed by their parents or caregivers at approximately age 2 years [19]. Improved medical accessibility and government pediatric health checkup programs may facilitate earlier diagnosis. In Korea, all children aged 4 months to 6 years are required to undergo pediatric health examinations, which may lead to earlier diagnosis. More than half of the patients in this study were managed non-surgically. The 32.6% rate of surgical treatment for pediatric trigger thumbs was lower than that previously reported [ 2 ]. In the US, national health claims data showed a 49% rate of surgical treatment for trigger thumb [ 2 ]. The low surgical rate in our study may be due to the early diagnosis of less severe cases, which could be managed with observation or conservative treatment. The outcomes of nonsurgical treatment vary; an observational US study reported spontaneous resolution in approximately one-third of patients [ 4 ]. However, for patients with > 30° interphalangeal joint flexion and contracture at diagnosis, surgical treatment is more likely [ 4 ]. In another prospective follow-up study, the spontaneous resolution rate was estimated to be greater than 75% after at least 5 years of follow-up [25]. Given the high rate of spontaneous recovery [5, 26], early detection and supportive care in our study may explain the lower rate of surgical intervention. Our study found that children with trigger thumb had a higher prevalence of musculoskeletal, lens, and circulatory system malformations. This association may be attributed to genetic, environmental, or physiological factors. Pediatric trigger thumb, although not diagnosed at birth, has been reported in twins and siblings, suggesting a congenital or genetic link [5, 8, 27–31]. Specific genetic mutations may cause both trigger finger and congenital malformations owing to their impact on musculoskeletal and connective tissue development. Environmental stressors or toxins during critical stages of fetal development can also result in malformations in various body systems, including the lens and circulatory system. These systems are particularly sensitive during early gestation, and disruptions can lead to malformations. Moreover, the trigger thumb itself may indicate abnormalities in specific physiological processes during fetal development, potentially leading to other developmental abnormalities. Mechanical stress or abnormal growth patterns associated with the development of trigger finger can result in systemic malformations. These findings suggest that the association between pediatric trigger finger and concurrent malformations is multifaceted and involves genetic, environmental, and physiological influences, warranting further research to clarify the causal pathways involved. One point to consider here is the high likelihood of developing musculoskeletal system disorders (ICD-10 codes Q65-79). This could be due to misdiagnosis, as the trigger thumb is often mistaken for a congenital abnormality of the musculoskeletal system, although the actual co-occurrence rate is not high. Some primary care physicians are unfamiliar with this condition and may miscode it as a musculoskeletal malformation. To further clarify this issue and gain a more accurate understanding of the comorbidities associated with pediatric trigger thumb, a more detailed analysis of the lower-level codes within the Q65-79 category is required. Our study found no significant association between trigger thumb and developmental delay. Despite the presence of trigger thumb and associated congenital malformations, affected children generally achieve developmental milestones at a rate comparable to that of their peers. This lack of association can be attributed to the fact that the trigger thumb primarily affects the tendons and does not disrupt the neurological or muscular systems critical for overall development. These findings highlight the importance of distinguishing between congenital physical abnormalities and their effects on development. Although it is crucial to monitor and manage trigger finger and its associated conditions, parents and healthcare providers can be reassured that the condition alone is unlikely to hinder a child’s development. Further research should continue to monitor developmental outcomes in children with trigger finger to confirm these findings and explore any long-term effects. In this study, a large sample exceeding 2,000,000 children, including those with trigger thumb and a matched control group, provided a robust and representative dataset. Employing GEE accounted for correlations and was adjusted for multiple confounders, thus enhancing the reliability of the findings. The inclusion of confounding factors, such as sex, birth weight, prematurity, breastfeeding, and socioeconomic status, strengthened the validity of the conclusions. Additionally, a detailed analysis of specific congenital malformations associated with trigger thumbs offers valuable insights into their broader health implications. However, this study had some limitations. First, the initial diagnostic code for congenital malformations of the trigger thumb and comorbidities could have been incorrectly recorded due to incomplete diagnostic work-up, potentially overestimating the prevalence in patients with trigger thumbs. Second, the health claims data lacked detailed information, making it difficult to discriminate trigger thumb from trigger finger and to analyze laterality and bilateral cases. Third, this study only included patients who visited clinics, potentially excluding subclinical or undiagnosed patients. Finally, the follow-up period ending in 2018 may have missed some children who later underwent surgery. Conclusion The prevalence of pediatric trigger thumb was 6 per 1,000 births, with the diagnosis occurring at approximately 31.3 months and surgery performed in 32.6% of cases. Pediatric trigger thumb was associated with a greater incidence of congenital malformations such as musculoskeletal, lens, and circulatory system malformations. However, there was no motor or developmental delay in children with trigger thumbs. These epidemiological features and comorbid conditions of pediatric trigger thumb can be valuable in managing pediatric patients with this condition. Declarations Acknowledgement: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIT) (No. 2022R1F1A1074057) and by a grant of the Korea Health Technology R&D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health & Welfare, Republic of Korea (No. HR22C1605) Authors’ contributions: S.K.: Project administration; data curation; formal analysis; writing original draft H.L.: Data curation; formal analysis; writing original draft H.Y.: Data curation, formal analysis B.H.: Data curation M.H.: Conceptualization; funding acquisition; investigation; methodology; manuscript review and editing S.L.: Conceptualization; funding acquisition; investigation; methodology; manuscript review and editing Data availability statement The data used in this study cannot be shared publicly due to legal restrictions but are available from the corresponding author upon reasonable request Competing interests statement There is no competing interest in any authors. 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Epub 2010/03/31. doi: 10.3928/01477447-20100129-33. PubMed PMID: 20349881. Brinkman D, Sheridan G, O'Sullivan M. Trigger Twins: 2 Cases of Ipsilateral Twin Trigger Digit and a Review of Published Literature. Case Rep Orthop. 2019;2019:8697360. Epub 2019/07/19. doi: 10.1155/2019/8697360. PubMed PMID: 31316851; PubMed Central PMCID: PMCPMC6604469. McCarroll HR, Jr. Congenital flexion deformities of the thumb. Hand Clin. 1985;1(3):567-75. Epub 1985/08/01. PubMed PMID: 3831051. van Loveren M, van der Biezen JJ. The congenital trigger thumb: is release of the first annular pulley alone sufficient to resolve the triggering? Ann Plast Surg. 2007;58(3):335-7. Epub 2007/05/02. doi: 10.1097/01.sap.0000238336.30617.72. PubMed PMID: 17471142. Additional Declarations No competing interests reported. Supplementary Files TTSupplementalTablev3Final.docx Cite Share Download PDF Status: Published Journal Publication published 15 May, 2025 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 03 Dec, 2024 Reviews received at journal 02 Dec, 2024 Reviewers agreed at journal 14 Nov, 2024 Reviews received at journal 01 Oct, 2024 Reviewers agreed at journal 26 Sep, 2024 Reviewers invited by journal 25 Jun, 2024 Editor assigned by journal 25 Jun, 2024 Editor invited by journal 21 Jun, 2024 Submission checks completed at journal 19 Jun, 2024 First submitted to journal 16 Jun, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4591017","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":320931404,"identity":"dcad4601-a3e0-44ab-bb5d-d7495fad0281","order_by":0,"name":"So Young Kim","email":"","orcid":"","institution":"Seoul National University College of Medicine","correspondingAuthor":false,"prefix":"","firstName":"So","middleName":"Young","lastName":"Kim","suffix":""},{"id":320931405,"identity":"6daa5d43-490d-4b69-92c4-04f5560e85a7","order_by":1,"name":"Hyun Il Lee","email":"","orcid":"","institution":"Inje University","correspondingAuthor":false,"prefix":"","firstName":"Hyun","middleName":"Il","lastName":"Lee","suffix":""},{"id":320931406,"identity":"9ab47d41-354e-4847-9b9a-157addbd49e9","order_by":2,"name":"Ha-Na Yoo","email":"","orcid":"","institution":"CHA Bundang Medical Center, CHA University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Ha-Na","middleName":"","lastName":"Yoo","suffix":""},{"id":320931407,"identity":"180cadb6-a610-4911-91b9-fc19dc1650e7","order_by":3,"name":"Bo Eun Han","email":"","orcid":"","institution":"CHA University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Bo","middleName":"Eun","lastName":"Han","suffix":""},{"id":320931408,"identity":"6234d7b1-88cd-477c-90f2-9097aff711cc","order_by":4,"name":"Man Yong Han","email":"","orcid":"","institution":"CHA University School of Medicine","correspondingAuthor":false,"prefix":"","firstName":"Man","middleName":"Yong","lastName":"Han","suffix":""},{"id":320931409,"identity":"fcfea086-52aa-47e3-baf1-9858a2d21961","order_by":5,"name":"Soonchul Lee","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYBACAxDxAEjaH28+AGRKyBCnJQFEnjmWANLCQ6QWEHEjB8wmQgv/4YcPEgruyDH2nPn86kaNBQ8D++GjG/BqkUgzNkgweGbMzN67zTrnGNBhPGlpN/Br4WGTSDA4nNjGc3abcQ4bUIsEjxl+Lfxn2H8AtdT3SOQ8M875R4wWhhw2YIgdTpCQyGF+nNtGjBagX0AOM9zAc8yMObcP6E5CfrHvP/zww4c/h+UN2Jsff875VifHz374GF4tyIBNAkwSqxwEmD+QonoUjIJRMApGDgAAyZtF+m73oHUAAAAASUVORK5CYII=","orcid":"","institution":"CHA Bundang Medical Center, CHA University School of Medicine","correspondingAuthor":true,"prefix":"","firstName":"Soonchul","middleName":"","lastName":"Lee","suffix":""}],"badges":[],"createdAt":"2024-06-16 23:22:29","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4591017/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4591017/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1038/s41598-025-01423-2","type":"published","date":"2025-05-15T15:58:06+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":60447165,"identity":"8a7d234d-ff22-48b4-8350-8d18a8868a04","added_by":"auto","created_at":"2024-07-16 21:59:21","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":42691,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eStudy population\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eKorea development screening test, The K-DST assessments were conducted at 42 - 48 months (5\u003csup\u003eth\u003c/sup\u003e K-DST), 54 - 60 months (6\u003csup\u003eth\u003c/sup\u003e K-DST), and 66 - 71 months (7\u003csup\u003eth\u003c/sup\u003e K-DST).\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-4591017/v1/0cb1a06c1773a84f7de8a744.png"},{"id":60447164,"identity":"fa795ae8-0f1e-489e-9386-e0b7a8402709","added_by":"auto","created_at":"2024-07-16 21:59:21","extension":"jpg","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":1142520,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eForest plot of odds ratios for congenital comorbidity between unexposed matched cohort and trigger thumb cohorts.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis forest plot illustrates the odds ratios (OR) with 95% confidence intervals (CI) for the prevalence of various ICD-10 based Q codes comparing matched unexposed cohorts and trigger thumb cohorts. Each row represents a specific diagnosis category, showing the number of event cases in both cohorts and the corresponding odds ratio. The plot helps visualize the differences in disease prevalence, highlighting areas where the trigger thumb cohorts show significantly higher or lower odds compared to the matched unexposed cohorts\u003c/p\u003e","description":"","filename":"Figure2.jpg","url":"https://assets-eu.researchsquare.com/files/rs-4591017/v1/4f2ecd76d32a5ffb8b443859.jpg"},{"id":83068106,"identity":"f93b6e52-4fbb-49d1-858f-2ea484d3f0d7","added_by":"auto","created_at":"2025-05-19 16:10:05","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1968585,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4591017/v1/d323d871-cdaf-434a-a521-7fdaf5c8df2d.pdf"},{"id":60447161,"identity":"2b7e8070-b57b-4a31-ba94-c9f2555cfa2d","added_by":"auto","created_at":"2024-07-16 21:59:20","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":46933,"visible":true,"origin":"","legend":"","description":"","filename":"TTSupplementalTablev3Final.docx","url":"https://assets-eu.researchsquare.com/files/rs-4591017/v1/e8fd8ef41d74e7bbbc52d77b.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Characteristics and association of trigger thumb with congenital malformation and developmental milestones in children: Nationwide analyses of a birth cohort","fulltext":[{"header":"Introduction","content":"\u003cp\u003ePediatric trigger thumb is characterized by the locking or catching of a finger in a bent position by thickening and trapping in the tendon sheath (A1 pulley). There is some controversy over the exact etiology of pediatric trigger thumb [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Previously classified as a congenital anomaly, pediatric trigger thumb is rarely detected at birth; approximately 69% of cases are diagnosed at age 2\u0026ndash;5 years [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Understanding the prevalence and characteristics of pediatric trigger thumb is essential for effective diagnosis and management. Previous studies have reported varying incidence rates and management plans [\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThere is no histological evidence that trigger thumb in children is a congenital condition [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Microscopic examination has shown no signs of infection, inflammation, or degeneration in the thumbs of pediatric patients with trigger thumb [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, several studies have suggested that \u003cem\u003egenetic\u003c/em\u003e factors play an important role in its \u003cem\u003eetiology\u003c/em\u003e [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Hence, the potential association with congenital abnormalities highlights the need for further research in pediatric patients with trigger thumbs. Despite these congenital issues, research on developmental delays in children with trigger thumbs remains lacking.\u003c/p\u003e \u003cp\u003eAlthough pediatric trigger thumb is not a rare disease, there is still a knowledge gap regarding its management and associated congenital comorbidities based on nationwide data. To fill this gap, we analyzed multiple epidemiological features of pediatric patients with trigger thumb in a nationwide cohort population, including the initial diagnosis and surgical treatment rate. In addition, we aimed to comprehensively investigate the presence of congenital comorbidities by considering genetic factors. We also investigated whether children with trigger thumb experienced developmental delays when comorbid conditions were present.\u003c/p\u003e"},{"header":"Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy design and population\u003c/h2\u003e \u003cp\u003e This study was approved by the Institutional Review Board (IRB) of our institution (2023-10-204). The requirement for informed consent was waived by the IRB as all personal identifying information was removed from the database. Research was performed in accordance with the Declaration of Helsinki. Data for this study was derived from the National Health Insurance Service (NHIS) of Korea, encompassing a cohort of 2,395,966 individuals between 2009 and 2018. Among this cohort, 1,919,162 participants born between 2009 and 2012 were selected and followed up until 2018. The exclusion criteria were the absence of the Korean Developmental Screening Test for Infants and Children (K-DST) [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], missing birth weight records, and chromosomal anomalies (ICD-10 codes Q90 to Q99) due to multiple anomalies associated with chromosomal anomalies. This led to the enrollment of 1,581,177 participants.\u003c/p\u003e \u003cp\u003eTrigger thumb was defined using ICD-10 codes, and participants with trigger thumb were matched at a 1:10 ratio with control participants who had no history of trigger thumb. The matching criteria were sex and birth year. This resulted in 10,167 participants with trigger thumbs and 101,670 control participants (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). The surgical history of trigger thumb was also examined.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003eExposed cohort\u003c/h2\u003e \u003cp\u003eThe exposed cohort for trigger thumb was defined using the ICD-10 code M65.3, including M65.30 to M65.35 for various fingers and thumbs, with surgical intervention identified using the operation code N0830 in the Korea NHIS database. This encompassed both general and specific diagnoses for each finger, including the thumb. Both trigger finger and trigger thumb were included in this study because of the interchangeable use of clinical diagnostic codes, and the prevalence of pediatric trigger finger (2nd, 3rd, 4th, or 5th ) was much lower than that of trigger thumb [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. The trigger thumb group was further divided into surgical and nonsurgical groups for analysis, and their characteristics were compared.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003eConcurrent congenital comorbidity\u003c/h2\u003e \u003cp\u003eAssociations between pediatric trigger thumb and other congenital comorbidities were also considered. The presence of congenital comorbidities was examined based on ICD-10 codes, starting with the Q code, to ensure comprehensive assessment. [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The percentage of patients with congenital comorbidities was compared between the trigger thumb and control groups. The higher and lower ICD-10 categories were analyzed separately. The details of the ICD-10 codes, including the higher and lower categories of congenital anomalies, are summarized in \u003cb\u003eSupplemental Table\u0026nbsp;1\u003c/b\u003e [15].\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003eK-DST for developmental screening\u003c/h2\u003e \u003cp\u003eK-DST is a validated developmental screening tool specifically designed for Korean children. Pediatricians use this tool to screen for developmental issues, monitor progress, and assess the effects of interventions [16]. K-DST assessments were conducted at 42\u0026ndash;48 months (5th K-DST), 54\u0026ndash;60 months (6th K-DST), and 66\u0026ndash;71 months (7th K-DST). This study analyzed changes in K-DST results over time using these assessments.\u003c/p\u003e \u003cp\u003eK-DST evaluates six developmental domains: gross motor skills, fine motor skills, cognition, language, social skills, and self-help. Each domain has eight questions scored from 0 to 3, resulting in a total score of 0 to 24 for each domain. These scores are categorized into four levels based on the total score in each domain: advanced development (total score\u0026thinsp;\u0026ge;\u0026thinsp;1 standard deviation [SD]), age-appropriate (total score\u0026thinsp;\u0026ge;\u0026thinsp;\u0026minus;\u0026thinsp;1 SD and \u0026lt;\u0026thinsp;1 SD), need for follow-up (total score\u0026thinsp;\u0026ge;\u0026thinsp;\u0026minus;\u0026thinsp;2 SD and \u0026lt;\u0026thinsp;\u0026minus;\u0026thinsp;1 SD), and recommendation for further evaluation (total score\u0026thinsp;\u0026lt;\u0026thinsp;\u0026minus;\u0026thinsp;2 SD) [16, 17].\u003c/p\u003e \u003cp\u003eIn this study, the primary focus was identifying adverse outcomes, defined as scores indicating a \u0026ldquo;need for follow-up\u0026rdquo; or a \u0026ldquo;recommendation for further evaluation\u0026rdquo; across any of the domains. A child was considered to have an unfavorable overall K-DST score if they recorded an unfavorable result in any of the six domains. The rate of K-DST completion was comparable between the control and pediatric thumb groups, with 81.15% vs. 82.29% for the 5th, 73.12% vs. 75.55% for the 6th, and 50.81% vs. 52.15% for the 7th K-DST.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eCovariates\u003c/h2\u003e \u003cp\u003eFor comprehensive assessment, the covariates included in this study encompassed a wide range of demographic and clinical characteristics. Demographic characteristics included sex (boys or girls), prematurity status (yes or no), birth weight (kg), breastfeeding status (yes or no), region of birth, and income. Specifically, birth weight, prematurity status, and breastfeeding information were obtained from parental responses to questionnaire items in the first round of the national health screening program. Prematurity was defined as birth before 37 weeks of gestation.\u003c/p\u003e \u003cp\u003eBirth residence was categorized as Seoul, metropolitan, city, or rural. Income was estimated based on premium quartiles from the Korean National Health Insurance Statistical Yearbook. As all Koreans must pay insurance premiums based on their housing income, we assumed that income would be higher if a patient paid a higher insurance premium. The patients were divided into four groups for convenience of analysis (Q1\u0026ndash;Q4). The lowest 25% and top 25% of the patients were classified as Q1 and Q4, respectively.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eStatistical analysis\u003c/h2\u003e \u003cp\u003eGeneral characteristics were compared between the pediatric trigger thumb and control groups using the chi-square and t-tests. The data are expressed as the mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or as the median and interquartile range.\u003c/p\u003e \u003cp\u003eLogistic regression was used to assess the association between pediatric trigger thumb and congenital comorbidities by calculating odds ratios (ORs) and 95% confidence intervals (CIs). The K-DST results were compared between the pediatric trigger thumb and control groups. Generalized estimating equation (GEE) analysis was used to determine interactions at different time points (5th, 6th, and 7th K-DSTs) [18]. The results of the GEE analyses are described using group estimates and Wald 95% CIs. All analyses were adjusted for sex, birth year, premature birth, income, region of birth, breastfeeding at 4 months of age, and birth weight. The significance level was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. All statistical analyses were performed using SAS version 9.4 (SAS Institute Inc., Cary, NC, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eGeneral characteristics of pediatric trigger thumb patients\u003c/h2\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the basic demographic characteristics of children with trigger thumb compared with those of the control group. The overall incidence of pediatric trigger thumb was 0.64% (approximately 6 in 1000 births). In the trigger thumb group, 46.8% of the patients were male. In general, no significant clinical differences were found in birth weight or breastfeeding habits between the two groups, although statistical significance was observed, likely because of the large sample size of the study. There were no significant differences in income between the pediatric trigger thumb and control groups (p\u0026thinsp;=\u0026thinsp;0.191).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of clinical characteristics of trigger thumb and matched unexposed cohort\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable (Unit)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMatched unexposed cohort (N\u0026thinsp;=\u0026thinsp;101,670)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eTrigger thumb cohort (N\u0026thinsp;=\u0026thinsp;10,167)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex, Boy, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e47,400 (46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,740 (46.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrematurity, n (%)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3,742 (3.68)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e396 (3.89)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.275\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBirth weight, kg (mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003csup\u003e\u0026Dagger;\u003c/sup\u003e)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e3.18\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3.17\u0026thinsp;\u0026plusmn;\u0026thinsp;0.46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.020\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBreast feeding, n (%)\u003csup\u003e\u0026sect;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26,774 (26.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,724 (26.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.006\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegion of birth, n (%)\u003csup\u003e∥\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSeoul and Metropolitan\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e43,718 (43.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,434 (43.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUrban\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e48,502 (47.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4,728 (46.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRural\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e8,396 (8.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e901 (8.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIncome, n (%)\u003csup\u003e\u0026para;,**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.191\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ1 (Low)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11,195 (11.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e1,164 (11.45)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e22,273 (21.91)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,258 (22.21)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e38,645 (38.01)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,891 (38.27)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eQ4 (High)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e25,660 (25.24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e2,480 (24.39)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at diagnosis of trigger thumb, month mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e31.3\u0026thinsp;\u0026plusmn;\u0026thinsp;21.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgery of trigger thumb\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProportion of surgery, n (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e3,313 (32.59)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration from diagnosis to surgery, month, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e11.3\u0026thinsp;\u0026plusmn;\u0026thinsp;16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge at surgery, month, mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u0026thinsp;\u0026plusmn;\u0026thinsp;18.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e*\u003c/sup\u003eAny birth before 37 weeks completed weeks of gestation,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003eStandard deviation,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u0026sect;\u003c/sup\u003eStatus of breastfeeding was obtained from parental responses to questionnaire items in the first round of the national health-screening program.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e∥\u003c/sup\u003eMissing: 1.04% in matched unexposed cohort and 1.02% in trigger thumb cohort,\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e\u0026para;\u003c/sup\u003eThe patients\u0026rsquo; income status was estimated based on the premium quartile from the Korea national health insurance statistical yearbook. As all Koreans must pay insurance premiums based on their housing income, we assumed that income would be higher if a patient paid a higher insurance premium.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003csup\u003e**\u003c/sup\u003eMissing: 3.83% in matched unexposed cohort and 3.68% in trigger thumb cohort.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe average age at the diagnosis of pediatric trigger thumb was 31.3 months, and the median age was 26 months (Q1\u0026ndash;Q3:16\u0026ndash;41 months). In total, 32.6% of the patients in the trigger thumb group underwent surgical treatment. The average duration from the initial diagnosis of pediatric trigger thumb to surgical treatment was 11.3 months, with a median of 3 (Q1\u0026ndash;Q3: 1\u0026ndash;17) months. The average age at surgery was 43.0 (4\u0026ndash;113) months, and the median age at surgery was 40 (30\u0026ndash;53) months. When comparing the general characteristics of the operated and non-operated trigger thumb groups, there were no differences in sex, prematurity, birth weight, breastfeeding, or income level (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05, \u003cb\u003eSupplemental Table\u0026nbsp;2\u003c/b\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eConcurrent congenital comorbidity\u003c/h2\u003e \u003cp\u003eWe analyzed congenital malformations among children with trigger thumb and found several significant associations compared with the matched unexposed cohort. Overall, the trigger thumb group exhibited a higher prevalence of congenital malformations in some disease categories. We found that children with trigger thumb had notably greater odds of having musculoskeletal system malformations, with an OR of 5.80 (95% CI 5.38\u0026ndash;6.26). In addition, there was a significantly increased risk of lens malformations among children with trigger thumb, with an OR of 2.76 (95% CI 1.19\u0026ndash;6.42). Furthermore, our analysis revealed a significant association with circulatory system conditions, where the odds ratio was 1.27 (95% CI 1.09\u0026ndash;1.49), indicating a modest but statistically significant increase. These results underscore the broader association of pediatric trigger thumb, which extends beyond the musculoskeletal system to include other congenital malformations, such as lens malformations and circulatory system conditions. The statistical results for each disease category are summarized in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eDevelopment\u003c/h2\u003e \u003cp\u003eDevelopmental assessments of children with trigger thumb, analyzed using GEE from ages 4 to 6 years, revealed no significant interaction with time (all p\u0026thinsp;\u0026lt;\u0026thinsp;0.05). The overall developmental outcomes according to the K-DST did not significantly differ between the trigger thumb and control groups (OR 1.04, 95% CI 0.95\u0026ndash;1.14, p\u0026thinsp;=\u0026thinsp;0.380). Gross and fine motor skill assessments indicated no developmental delay attributable to trigger thumb. Similarly, cognitive, language, social, and self-help skill development were on par with those of the control group, demonstrating no significant deficits. These results indicate that despite the presence of congenital malformations associated with trigger thumb, the condition does not adversely affect developmental milestones in various domains during early childhood. The detailed statistical results for each developmental domain are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eEffect of trigger thumb on the development analyzed by Korea development screening test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eCohort (%)\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c6\" namest=\"c4\"\u003e \u003cp\u003eOdd ratio\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eProblem domain\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eMatched unexposed cohort\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eTrigger thumb cohort\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eAdjusted OR\u003c/b\u003e\u003csup\u003e\u0026dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e95% CI\u003c/b\u003e\u003csup\u003e\u0026Dagger;\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003ep-value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAny six domains\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9.80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10.29\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.95 to 1.14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3802\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGross motor skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.97 to 1.28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.1256\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFine motor skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.94 to 1.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.2621\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCognition\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.70\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.92 to 1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.4924\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLanguage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4.87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.92 to 1.19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.4621\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSocial skills\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.79 to 1.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.3348\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-help\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.87 to 1.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.7157\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eThe Korea development screening test (K-DST) evaluates six developmental domains: gross motor skills, fine motor skills, cognition, language, social skills, and self-help. Each domain has eight questions scored from 0 to 3, resulting in a total score ranging from 0 to 24 for each domain. The developmental assessments of children with trigger thumb, analyzed using generalized estimating equations (GEE) from ages 4 to 6, revealed no significant interaction with the time variable (all p values\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003e\u003csup\u003e*\u003c/sup\u003ePercentage of each group (matched unexposed cohorts: 101,670, trigger thumb cohorts: 10,167 patients) defined as scores indicating either a \u0026ldquo;need for follow-up\u0026rdquo; or a \u0026ldquo;recommendation for further evaluation\u0026rdquo;, \u003csup\u003e\u0026dagger;\u003c/sup\u003eOdds ratio, \u003csup\u003e\u0026Dagger;\u003c/sup\u003eConfidence interval\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis study provides insights into the characteristics, congenital comorbidities, and developmental outcomes of children with trigger thumbs. The incidence was 0.64%, with no significant demographic differences in birth weight, breastfeeding habits, or income levels between the affected and control groups. Notably, children with trigger thumb have greater odds of developing musculoskeletal malformations, lens malformations, or circulatory system conditions. Despite these associations, developmental assessments using GEE showed no significant delays in gross motor, fine motor, cognitive, language, social, or self-help skills. These results indicate that although pediatric trigger thumb is linked to certain congenital malformations, it does not adversely affect the overall developmental milestones during early childhood, emphasizing the need for comprehensive care and monitoring.\u003c/p\u003e \u003cp\u003eOur study revealed a trigger thumb incidence of 6 per 1,000 births in this cohort, which is slightly greater than the previously reported range of 1\u0026ndash;3 per 1,000 births [6, 19\u0026ndash;22]. This discrepancy may be due to underestimation in previous studies with limited sample sizes, overestimation in our study due to the inclusion of cases that mimic trigger thumb, and ethnic variations, as seen in the higher rates among Hispanic populations [23]. A Japanese study reported an incidence of 3.3 cases per 1,000 births [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], and their method of postal questionnaires to parents one year after birth might have underestimated the true prevalence. Further research is warranted to investigate these potential explanations and to establish a more accurate understanding of trigger thumb incidence across different populations.\u003c/p\u003e \u003cp\u003eThe mean time to diagnosis of trigger thumb was 31.3 months, which is similar to or slightly earlier than the previously reported age [2, 19, 24]. Generally, pediatric patients visit clinics with an abnormally flexed thumb and/or an inability to extend the thumb, which is often noticed by their parents or caregivers at approximately age 2 years [19]. Improved medical accessibility and government pediatric health checkup programs may facilitate earlier diagnosis. In Korea, all children aged 4 months to 6 years are required to undergo pediatric health examinations, which may lead to earlier diagnosis.\u003c/p\u003e \u003cp\u003eMore than half of the patients in this study were managed non-surgically. The 32.6% rate of surgical treatment for pediatric trigger thumbs was lower than that previously reported [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. In the US, national health claims data showed a 49% rate of surgical treatment for trigger thumb [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The low surgical rate in our study may be due to the early diagnosis of less severe cases, which could be managed with observation or conservative treatment. The outcomes of nonsurgical treatment vary; an observational US study reported spontaneous resolution in approximately one-third of patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. However, for patients with \u0026gt;\u0026thinsp;30\u0026deg; interphalangeal joint flexion and contracture at diagnosis, surgical treatment is more likely [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In another prospective follow-up study, the spontaneous resolution rate was estimated to be greater than 75% after at least 5 years of follow-up [25]. Given the high rate of spontaneous recovery [5, 26], early detection and supportive care in our study may explain the lower rate of surgical intervention.\u003c/p\u003e \u003cp\u003eOur study found that children with trigger thumb had a higher prevalence of musculoskeletal, lens, and circulatory system malformations. This association may be attributed to genetic, environmental, or physiological factors. Pediatric trigger thumb, although not diagnosed at birth, has been reported in twins and siblings, suggesting a congenital or genetic link [5, 8, 27\u0026ndash;31]. Specific genetic mutations may cause both trigger finger and congenital malformations owing to their impact on musculoskeletal and connective tissue development. Environmental stressors or toxins during critical stages of fetal development can also result in malformations in various body systems, including the lens and circulatory system. These systems are particularly sensitive during early gestation, and disruptions can lead to malformations. Moreover, the trigger thumb itself may indicate abnormalities in specific physiological processes during fetal development, potentially leading to other developmental abnormalities. Mechanical stress or abnormal growth patterns associated with the development of trigger finger can result in systemic malformations. These findings suggest that the association between pediatric trigger finger and concurrent malformations is multifaceted and involves genetic, environmental, and physiological influences, warranting further research to clarify the causal pathways involved.\u003c/p\u003e \u003cp\u003eOne point to consider here is the high likelihood of developing musculoskeletal system disorders (ICD-10 codes Q65-79). This could be due to misdiagnosis, as the trigger thumb is often mistaken for a congenital abnormality of the musculoskeletal system, although the actual co-occurrence rate is not high. Some primary care physicians are unfamiliar with this condition and may miscode it as a musculoskeletal malformation. To further clarify this issue and gain a more accurate understanding of the comorbidities associated with pediatric trigger thumb, a more detailed analysis of the lower-level codes within the Q65-79 category is required.\u003c/p\u003e \u003cp\u003eOur study found no significant association between trigger thumb and developmental delay. Despite the presence of trigger thumb and associated congenital malformations, affected children generally achieve developmental milestones at a rate comparable to that of their peers. This lack of association can be attributed to the fact that the trigger thumb primarily affects the tendons and does not disrupt the neurological or muscular systems critical for overall development. These findings highlight the importance of distinguishing between congenital physical abnormalities and their effects on development. Although it is crucial to monitor and manage trigger finger and its associated conditions, parents and healthcare providers can be reassured that the condition alone is unlikely to hinder a child\u0026rsquo;s development. Further research should continue to monitor developmental outcomes in children with trigger finger to confirm these findings and explore any long-term effects.\u003c/p\u003e \u003cp\u003eIn this study, a large sample exceeding 2,000,000 children, including those with trigger thumb and a matched control group, provided a robust and representative dataset. Employing GEE accounted for correlations and was adjusted for multiple confounders, thus enhancing the reliability of the findings. The inclusion of confounding factors, such as sex, birth weight, prematurity, breastfeeding, and socioeconomic status, strengthened the validity of the conclusions. Additionally, a detailed analysis of specific congenital malformations associated with trigger thumbs offers valuable insights into their broader health implications.\u003c/p\u003e \u003cp\u003eHowever, this study had some limitations. First, the initial diagnostic code for congenital malformations of the trigger thumb and comorbidities could have been incorrectly recorded due to incomplete diagnostic work-up, potentially overestimating the prevalence in patients with trigger thumbs. Second, the health claims data lacked detailed information, making it difficult to discriminate trigger thumb from trigger finger and to analyze laterality and bilateral cases. Third, this study only included patients who visited clinics, potentially excluding subclinical or undiagnosed patients. Finally, the follow-up period ending in 2018 may have missed some children who later underwent surgery.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThe prevalence of pediatric trigger thumb was 6 per 1,000 births, with the diagnosis occurring at approximately 31.3 months and surgery performed in 32.6% of cases. Pediatric trigger thumb was associated with a greater incidence of congenital malformations such as musculoskeletal, lens, and circulatory system malformations. However, there was no motor or developmental delay in children with trigger thumbs. These epidemiological features and comorbid conditions of pediatric trigger thumb can be valuable in managing pediatric patients with this condition.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis work was supported by the National Research Foundation of Korea\u0026nbsp;(NRF) grant funded by the Korea government\u0026nbsp;(MSIT) (No. 2022R1F1A1074057)\u0026nbsp;and\u0026nbsp;by a grant of the Korea Health Technology R\u0026amp;D Project through the Korea Health Industry Development Institute (KHIDI), funded by the Ministry of Health \u0026amp; Welfare, Republic of Korea (No. HR22C1605)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.K.: Project administration; data curation; formal analysis; writing original draft\u003c/p\u003e\n\u003cp\u003eH.L.: Data curation; formal analysis; writing original draft\u003c/p\u003e\n\u003cp\u003eH.Y.: Data curation, formal analysis\u003c/p\u003e\n\u003cp\u003eB.H.: Data curation\u003c/p\u003e\n\u003cp\u003eM.H.: Conceptualization; funding acquisition; investigation; methodology; manuscript review and editing\u003c/p\u003e\n\u003cp\u003eS.L.: Conceptualization; funding acquisition; investigation; methodology; manuscript review and editing\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe data used in this study cannot be shared publicly due to legal restrictions but are available from the corresponding author upon reasonable request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is no competing interest in any authors.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eMurgai RR, Lightdale-Miric N. 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The natural history of pediatric trigger thumb: a study with a minimum of five years follow-up. Clin Orthop Surg. 2011;3(2):157-9. Epub 2011/06/02. doi: 10.4055/cios.2011.3.2.157. PubMed PMID: 21629478; PubMed Central PMCID: PMCPMC3095788.\u003c/li\u003e\n\u003cli\u003eLeong L, Chai SC, Howell JW, Hirth MJ. Orthotic intervention options to non-surgically manage adult and pediatric trigger finger: A systematic review. J Hand Ther. 2023;36(2):302-15. Epub 2023/07/01. doi: 10.1016/j.jht.2023.05.016. PubMed PMID: 37391318.\u003c/li\u003e\n\u003cli\u003eWang ED, Xu X, Dagum AB. Mirror-image trigger thumb in dichorionic identical twins. Orthopedics. 2012;35(6):e981-3. Epub 2012/06/14. doi: 10.3928/01477447-20120525-48. PubMed PMID: 22691680.\u003c/li\u003e\n\u003cli\u003eKakel R, Van Heerden P, Gallagher B, Verniquet A. Pediatric trigger thumb in identical twins: congenital or acquired? Orthopedics. 2010;33(3). Epub 2010/03/31. doi: 10.3928/01477447-20100129-33. PubMed PMID: 20349881.\u003c/li\u003e\n\u003cli\u003eBrinkman D, Sheridan G, O\u0026apos;Sullivan M. Trigger Twins: 2 Cases of Ipsilateral Twin Trigger Digit and a Review of Published Literature. Case Rep Orthop. 2019;2019:8697360. Epub 2019/07/19. doi: 10.1155/2019/8697360. PubMed PMID: 31316851; PubMed Central PMCID: PMCPMC6604469.\u003c/li\u003e\n\u003cli\u003eMcCarroll HR, Jr. Congenital flexion deformities of the thumb. Hand Clin. 1985;1(3):567-75. Epub 1985/08/01. PubMed PMID: 3831051.\u003c/li\u003e\n\u003cli\u003evan Loveren M, van der Biezen JJ. The congenital trigger thumb: is release of the first annular pulley alone sufficient to resolve the triggering? Ann Plast Surg. 2007;58(3):335-7. Epub 2007/05/02. doi: 10.1097/01.sap.0000238336.30617.72. PubMed PMID: 17471142.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"trigger thumb, big data, co-morbidity, congenital, development, pediatric","lastPublishedDoi":"10.21203/rs.3.rs-4591017/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4591017/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eDespite extensive research on pediatric trigger thumb, nationwide data on patient characteristics, coexisting birth defects, and development remain limited. This cohort study, using Korean National Health Insurance data, analyzed 1.9\u0026nbsp;million births (2009\u0026ndash;2012) followed to age 6. We identified 10,167 trigger thumb cases and matched them 1:10 by sex and birth year with controls. Baseline features, congenital malformations (ICD-10, Q00-Q89), and development at ages 4\u0026ndash;6 (Korean Developmental Screening Test) were compared. Logistic regression assessed comorbidity risk, expressed as odds ratio (OR), while generalized estimating equations evaluated the association between trigger thumb and developmental outcomes. The trigger thumb group (average diagnosis age: 31.3 months, 46.6% male) had 32.6% of surgery rate at an average age of 43 months. Trigger thumb group had significantly higher rates of musculoskeletal (OR 5.80, 95% CI 5.38\u0026ndash;6.26), lens (OR 2.76, 95% CI 1.19\u0026ndash;6.42), and circulatory system malformations (OR 1.27, 95% CI 1.09\u0026ndash;1.49) compared to controls. However, assessment using the Korean Developmental Screening Test revealed no significant delays in development, including gross and fine motor skills. Pediatric trigger thumb is linked to increased congenital malformations but doesn't seem to hinder development. Screening for coexisting conditions and reassuring parents about development are crucial.\u003c/p\u003e","manuscriptTitle":"Characteristics and association of trigger thumb with congenital malformation and developmental milestones in children: Nationwide analyses of a birth cohort","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-16 21:59:16","doi":"10.21203/rs.3.rs-4591017/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-12-03T05:49:49+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-12-02T07:40:59+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"86886100392286490714455055257432222185","date":"2024-11-15T03:06:48+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2024-10-01T19:46:27+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"42704359426901143818690607477245870349","date":"2024-09-26T13:04:54+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2024-06-26T02:15:46+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-06-26T02:12:24+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2024-06-21T13:32:01+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-06-19T06:04:25+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2024-06-16T23:21:12+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"b29bf837-2e4c-446f-94d8-2ad44bfdd6a3","owner":[],"postedDate":"July 16th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":33926449,"name":"Health sciences/Medical research/Epidemiology"},{"id":33926450,"name":"Health sciences/Medical research/Paediatric research"}],"tags":[],"updatedAt":"2025-05-19T16:07:20+00:00","versionOfRecord":{"articleIdentity":"rs-4591017","link":"https://doi.org/10.1038/s41598-025-01423-2","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2025-05-15 15:58:06","publishedOnDateReadable":"May 15th, 2025"},"versionCreatedAt":"2024-07-16 21:59:16","video":"","vorDoi":"10.1038/s41598-025-01423-2","vorDoiUrl":"https://doi.org/10.1038/s41598-025-01423-2","workflowStages":[]},"version":"v1","identity":"rs-4591017","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4591017","identity":"rs-4591017","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}