Sunday, November 29, 2015

Hand Limitations in Ulnar Longitudinal Deficiency

My mentor, Paul Manske, clarified years ago that the hand is often the greatest limitation for children with ulnar longitudinal deficiency in this classic ARTICLE.  And, as I have previous blogged HERE, the hand limitations can manifest in many different ways.  There are many different ways this presents in ulnar longitudinal deficiency including: thumb and index finger webspace tightness, syndactyly, absent digits, as well as other findings.  And as noted in previous posts, there may be surgeries which can help the function of the hand affected by ulnar longitudinal deficiency by addressing these limitations.   If surgery is considered in ulnar longitudinal deficiency, the goals of this surgery must be clear and obtainable.

But, many times, function is just fine in ulnar longitudinal deficiency without thinking about a surgery.  Kids with one normal hand can do almost all of life's activities and if the other hand has at least one digit, function is certainly improved.  Here is one child with ulnar longitudinal deficiency and really, really good overall function.  Like many parents, early in the patient's life, surgery was of interest.  But, as the patient has grown and her excellent abilities have become clear, surgery is becoming of less interest.  She has great elbow, forearm, and wrist motion.  The index finger is a bit stiff but functional.  The thumb does not really help functionally.  If surgery were to ever be considered, making the thumb a bit stiff might provide a functional improvement.

A patient with ulnar longitudinal deficiency and one good finger.

A patient with ulnar longitudinal deficiency and one good finger.

X-ray of a patient with ulnar longitudinal deficiency and one good finger.
Charles A. Goldfarb, MD
My Bio at Washington University