Notta's nodules and trigger digits
Adrian E. Flatt, MD
In 1850 Dr. A. Notta, an "internè" in Paris, described four adult patients between the ages of 20 and 60 who had a nodule on a flexor tendon of a finger, thereby inhibiting its normal movement (1). This publication in the Archives Générales de Médecine led to these "nodules" being named "Notta's nodules," but a multitude of subsequent papers have largely ignored his claim to fame.
Trigger digit occurs from infancy to old age. In infants it usually occurs in the thumb but is not often diagnosed at birth. The flexed position of the thumb is often recognized sometime after the first 3 months of life. About 30% of these thumbs will gradually gain a full range of motion, and early attempts to passively straighten the thumb often cause significant pain. Some recommend splinting the thumb in full extension, but the reported
results vary considerably and I have not usually
employed this treatment. The reported rate of
spontaneous relief from the flexed posture varies
from 0% to 49% but is probably in the area of 30%. This rate
drops to 10% to 12% between 6 months and 3 years of age.
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