Charles Goldfarb, MD, the author of this blog, is an orthopedic hand surgeon at Washington University in St. Louis specializing in congenital hand and upper extremity disorders. He practices at St Louis Childrens Hospital and Shriners Hospital for Children in St Louis, Missouri. This blog was created to demystify abnormalities of the hand and wrist that children may experience from the time of birth. We encourage comments and feedback.
My favorite day of the month is our 'big' clinic at the Shriners where my partner and I see patients all day (no surgery). It is such a pleasure to see new and followup patients with so many different rare conditions. I learn at each of these clinics because patients show me (and sometimes tell me) what works, what doesn't, and why. Needless to say, the residents and fellows learn so much as well- it is an unusual experience with rare conditions, great kids and great families.
Today, I had the pleasure of seeing one patient back, about 6 years after reconstruction of his left thumb. He has hypoplastic thumbs, a topic on which I have posted about several times including HERE and HERE. Actually both of his thumbs are small with limited muscle but his left side was the problem leading to surgery. The right side has continued to do well despite a lack of full muscle development.
Underdeveloped thumb, left side had surgery for reconstruction with Huber Opposition.
The left side was reconstructed with a Huber opposition transfer in which a muscle (abductor digiti minimi) is transfer to the thumb. This is one great option and it used to be my first choice to help the thumb move better. We recently published our positive experience with this operation in The Journal of Hand Surgery. These pictures are, to me telling. The thumb is nicely resting in a position of function. However, some have observed that it is hard for the patient to flatten the thumb after this procedure. I have been using a somewhat different surgery over the last few years (the FDS tendon opposition transfer) with very good results also.
Pictures are helpful but video tells the real story. Watch his 'new' skill. He is quite talented and his thumbs work amazingly well.
