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.

24 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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  7. Hello Dr. Goldfarb,
    My wife and I recently noticed an underdeveloped index finger on our 9 month old's hand. It is very slight but noticeably shorter on his right hand then on his left, it is a also thinner from the middle to the tip of his finger, it is clinched 95% of the time even when he is opening up the rest of the hand. When he does open the finger it almost bends out to towards his thumb before he it goes out straight. Our pediatrician summed it up as an abnormality, but didn't think it needed to be looked at further. After pressing they referred us to an Orthopedic who took an X-Ray which to him looks normal with just one phalange looking on the small side, he has only recommended we stretch his finger in hopes it loosens the tendons which "he thinks may be tight" and if it gets tighter maybe surgery to release the tendon. They both think the shortness is just an abnormality but have no name for it. We just want to make sure we are not missing anything. Thank you.

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    1. DBJR,
      Thank you for the question. I wish I were able to answer more definitively but I am uncertain what is your son's specific anomaly. A visit to a hand surgeon (ideally one who works with kids regularly) may be your best option. Good luck. Feel free to contact me offline if I can answer additional questions. congenitalhand@wudosis.wustl.edu

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  8. Hi Dr. Goldfarb,
    I have clinodactylyl in both pinkies and I have never really given it much thought till recently. The bend is quite pronounced in my right pinky and I've noticed my phone always rests in the dip of the bend when I hold it. It kind of hurts sometimes and I feel like it's more bent than it used to be. At almost 21, could I fix it with minor surgery? Thank you in advance for your feedback!

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    1. Victoria, thank you for your question. At your age (no offense), the surgery is not quite so simple but is still not complex. The bone is 'cut' and realigned. It can be a very effective solution. It requires pins in the finger for approximately 6 weeks and stiff of the last finger joint is sometimes a challenge. I hope this helps.

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  9. Hi,

    I was wondering if it is common to have clinodactyly more predominantly in the index finger rather than the pinkie? If you look closely enough all my fingers are curved but the only ones immediately noticeable are the index fingers which curve inwards towards the other fingers. It's not severe but is significant enough that I can't properly manage bar chords on a guitar (for example). Most of the stuff I've seen talks about the pinky but, while mine are mildly affected, it's mainly my index fingers.

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    1. Thea. The small finger is much more commonly involved compared to the index finger. Many people have a subtle curve or angulation of their fingers so this is not always a condition that needs treatment. But if a functional problem (ie, guitar), you may want to visit a hand surgeon to discuss your options. Good luck.

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  10. Dear Dr. Goldfarb,

    I stumbled upon this page as I was searching for a term to describe my sons' crooked thumbs. Their paternal great grandmother and a few older cousins have inherited this gene. Their paternal grandfather and father have not. My oldest son is now 6 years old and both of his thumbs are curved. The right thumb is more severe and curves inward towards his ring finger about midway up and the left thumb curved outward, but like I said is not as pronounced as his right hand. So far it has not effected him in functional tasks so I have not bothered to pursue it. I have a six month year old son and his thumbs are just like his brothers. I read that it can worsen with age and am wondering if I should pursue this and contemplate treatment. I know that one of the cousins thumbs (he's in his 50's now) are not only curved, but cannot bend. I'm worried that this may happen over time..? Not sure if it's related but my oldest son's big toe has a joint that is pronounced on the inside. Any advice is greatly appreciated!
    Thank you in advance,
    Janine

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    1. Janine. Thank you for writing. The short answer is that yes- this can worsen over time. It would probably make sense so see a hand surgeon that specializes in children for an xray and assessment. Good luck.

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  11. Hi Dr. Goldfarb,
    I am 17 and both my pinkies have clinodactyly. I measured the curvature of my right hand pinkie and it's at 40 degrees (a very rough measurement), and I was just wondering why someone would need surgery? How much worse does the curvature get over time and what could it affect in my day to day life? I am just wondering why someone would need surgery besides appearance, I most likely will not get it.
    Thanks,
    Cat

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    1. Cat,
      Thanks for the question. First of all, you may never need treatment for the clinodactyly. If your fingers do not bother you now, they may never bother you. In my experience, things like typing or playing a musical instrument are most likely to be a problem. Finally, the surgery today is the same as any surgery you would have in the future (i.e., there is no harm in waiting).

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  12. I have a daughter who was born with camptodactyly. It affected her 4th and 5th fingers on the left hand only. We took her to a pediatric orthopedic hand specialist, who told us to stretch out her fingers frequently (he suggested every time I nurse her). Anyways, after a year, the clinching of her fingers eased significantly. She is doing great now. However, I also have a son who always had a curve to his middle and ring finger (the middle finger curves toward the ring finger and the ring finger curves toward the middle finger). I never mentioned it to the doctor, but as he grows (he is 6 now), the curving seems to be more pronounced. Should I address this or is it just cosmetic? He doesn't seem to notice or care. His toes look a little strange too. It's like some of the toes pop toward more than others. Any information you have give would be greatly appreciated. Thank you.

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    1. Thank you for the comment Christy. I agree that camptodactyly in newborns may be improved with stretching as you describe. However, sticking to the topic of this thread- clinodactyly- your son's finger may be affected. While many times this will not affect function, there are two question. First, will it get worse and may it affect function in the future. This is tough to predict but an x-ray may be helpful. And second, is there intervention now that differs from treatment in the future? If there is a bracketed epiphysis causing the curvature, it will get worse and can be simply treated now whereas at an older age, a bigger procedure may be required. The bottom line- I would take your son to the same congenital hand surgeon who gave you good advice about your daughter. Good luck.

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