Tuesday, July 3, 2012

Clinodactyly


Clinodactyly is a curvature of a finger (or thumb).  The bend is in relation to the next finger rather than towards the palm or towards the top of hand.  This is not to be confused with camptodactyly as we discussed in a previous post, http://congenitalhand.wustl.edu/2012/03/camptodactyly.html .  Additional information, as always, is available from our website, http://ortho.wustl.edu/content/Patient-Care/3220/SERVICES/Hand-Wrist/Congenital-Hand-Disorders.aspx
Small finger clinodactyly with bending of the small finger towards the ring finger


Clinodactyly most commonly affects the small finger and causes a bending towards the ring finger through the middle phalanx.  However, clinodactyly can occur in any finger and often affects the thumb in children affected by syndromes (Downs syndrome, Aperts syndrome).  A complete listing of associated syndromes is beyond the scope of this review but more can be found at http://www.ncbi.nlm.nih.gov/omim

Unusual clinodactyly of the index finger.
The middle phalanx is typically the site of an abnormal growth plate.  The growth plate is usually only at the base of the finger bone but in this situation, there may be a growth plate around one side of the bone- a "bracketed epiphysis."  This actually causes abnormal growth with one side growing more slowly, thus causing the curvature of the finger.  This typically worsens with age.
Clinodactyly xray with abnormal growth plate of middle phalanx, a "bracketed epiphysis."  This leads to abnormal growth and worsening of the abnormality with time.
In most cases, clinodactyly is not severe and is most often an appearance issue rather than a function problem.  However, when severe or if particular activities are limited, surgery can be considered.  In young children, I prefer a simple procedure which divides the abnormal growth plate, thus correcting the tether from the bracketed epiphysis.  This procedure does not provide immediate correction but allows gradual correction with growth.  It is performed in younger kids, ideally less than age 5.  This concept is not new and an early description of this technique was provided by Caouette-Laberge, http://www.jhandsurg.org/article/S0363-5023(02)00014-X/abstract .

It is more common that clinodactyly becomes noticed or problematic in older children, past the age where this simple procedure is effective.  In those children, the bone can be cut and realigned (an osteotomy) with good results.  There are a number of different techniques with all providing similar good outcomes.  One issue after this surgery is stiffness affecting the last joint in the finger (the DIP joint).  This improves over time.  We reviewed these two basic procedures in the following article:
http://journals.lww.com/techhandsurg/Abstract/2010/03000/Surgical_Correction_of_Clinodactyly__Two.12.aspx

Here are a few clinical photographs of patients before and after surgery.   Patients and families are typically quite happy with the results of surgery.

Clinodactyly after correction on the left hand small finger and before correction on the right.


A different patient with clinodactyly correction on the one pinky but not yet on the other.

12 comments:

  1. I have understand your stuff previous to and you are just extremely fantastic. I actually like what you’ve acquired here, certainly like what you are stating and the way in which you say it. You make it enjoyable and you still take care of to keep it smart. I cant wait to read far more from you. This is really a terrific website.

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  2. My son has this on both his hands. They look EXACTLY like the photo above. I was wondering if I should be concerned. He has no developmental delays. He's extremely smart. He was born with hair all over his body, it has fallen out since then but is now growing dark hair on his legs at the age of 6? He is healthy and active, good growth, weight, height, etc. He makes little piglet noises when he eats and sometimes has difficulty with textured food. Especially rice. He also has little "fatty" deposits on the sides of the back of his head and sides of his neck. His regular pediatrician says there fine and may go away someday. No worries because they are not swollen. Curious, with all of these things together, should I be seeing a specialist of some sort? Just concerned that these things would be tied in together somehow and I would miss something important that should be reviewed.

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    1. ColoradoMom,

      Thank you for the question. Your son's situation is interesting. And clinodactyly can be associated with syndromes and other anomalies. Yet, none of the specific points you raise are indicative to me of a specific issue. Importantly, I defer to your pediatrician who knows your son but your suspicions could be correct.
      Good luck.

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  3. Hello, Your description of clindodactyly is the first description I have found that sounds like what my daughter has. I am not sure, however, because it seems to effect or be present in all of her fingers to some degree except her thumbs. It has progressively worsened so that at age 25 she is having a hard time using her fingers:hands for many tasks if everyday living. She also can't snap because of the position of her fingers, and is having a hard time with many fine motor things. She also complains that her fingers and palm, especially the palm area next to her thumbs, is very tight and stiff. I'm wondering if these things are consistent with clindactyly or not? Thank you very much. Laura

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    1. Hello. I don't believe that I can be of much help. As I understand your description, this is not consistent with clinodactyly. A hand surgeon familiar with birth differences is your best resource for assessing and potentially helping your daughter.

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  4. Dr Goldfarb,
    I find it very interesting there is a correlation between clinodactyly and downs. I have the curved pinkie which seems to be getting worse with age. I do not have downs but two of my sisters have had babies with downs and I have a cousin with downs. They've all been tested for the common downs hereditary gene but all have returned negative. Could it be possible that clinodactyly is an indicator of a hereditary gene that "carries" downs? Or is it solely found in those with downs themselves? Would appreciate your opinion on this.

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    1. Hello and thank you for the great question. Clinodactyly is common and may be seen as an isolated finding or can be associated with other conditions like Downs. We certainly do not know each gene problem that may be associated with clinodactyly but it is possible that as we learn more about the humane genome, there could be a link. And as you likely know, Downs is caused by an extra chromosome whereas the error that causes clinodactyly is much smaller. I wish I could answer more definitively and really think your question is a good one.

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  5. I have it and I live with it no problems. Nobody seems to notice it and I had so much fun as a child telling my mean friends when they kicked the ball at me too hard for example that they broke my finger �� .... or tell wild stories about how I broke my finger. Of course I tell everybody the truth at the end. Even I forget about it sometimes and live my life.

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    1. No noo,
      Thank you for sharing your experience. I am glad the diagnosis can be a source of enjoyment. If you are functioning well, then good function should be expected to continue.

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  6. Dear Dr Goldfarb, My son (44) and daughter-in-law (36) are expecting a baby in July. The latest scan shows Clinodactyly in the pinkie of one of the hands of the fetus. Everything else seems to be normal. I see you say that Clinodactyly is common and may be seen as a isolated finding. Does this mean that even if there is no evidence of this condition in the family history, it can crop up randomly out of the blue? How high is the likelihood that in this case it could be associated to Downs or another syndrome?

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    1. Worriedgran,
      Thank you for the question. I am glad everything seems ok aside from the isolated clinodactyly. While there are numerous associations (see OMIM), I often see clinodactyly as an isolated condition. Clearly, more information will be available at birth which will allow a more precise examination. US can help clarify potential diagnoses and clinodactyly does not confirm a particular diagnosis for me.

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