Click phenomenon in acquired Jaensch-Brown syndrome and trigger finger/thumb: the Notta syndrome

Abstract

The click phenomenon occurs when an acquired mechanical restriction of the elevation in adduction of the eye or of the extension of the finger/thumb, is forcefully overcome. The common cause is anodule either of the superior oblique tendon posterior to the trochlea in the case of aJaensch-Brown syndrome or of the digital flexor tendon anterior to the A1 annular pulley in the case of atrigger finger. Both locations share similar anatomical conditions for the development of the nodule and the pathomechanism of the click. From these identical findings in the eye and the hand in small children it can be assumed that the results from the studies of the hand in newborns and infants with atrigger thumb/finger are also applicable to the situation of the eye. 1.This motility disorder is not congenital. This is most likely due to an incomplete development at the time of birth of the sliding factors needed for afree passage of the tendon through the trochlea and the A1 annular pulley. 2.Adistinction must be made between stages 0-3: stage0 = no more restriction of the motility and no click phenomenon; stage1 = forced active extension/elevation possible; stage2 = only passive extension/elevation, each with aclick phenomenon; stage3 = no extension/elevation possible and no click phenomenon. 3.In most cases in early childhood there is aspontaneous complete recovery (75% after 6-7years). In the eye this spontaneous course can only limitedly be shortened with motility exercises in combination with segmental occlusion. The click phenomenon is asymptom of stages1 and2 of an acquired mechanical restriction of the elevation in adduction of the eye or the extension of the finger/thumb. It should not be called asyndrome.