Saturday, October 28, 2017

First Pitch World Series

Hailey Dawson has been in the news over the last few months as she seeks to throw the first pitch in all the Major League Ballparks.  Well, she took a big step tonight on the biggest stage- the World Series!  World Series Story.   What a great story which helps to raise awareness of birth differences of hand and upper extremity and 3D printed prosthetics.

Hailey has symbrachydactyly associated with Polands syndrome.  Symbrachydactyly means short, webbed fingers but it can be very different from patient to patient.  It appears that she has a reasonably well developed thumb and otherwise small digits (monodactyly type).  I have posted a number of times about symbrachydactyly, as can be found HERE.  Included in those links is some information on Poland syndrome as well.  Poland syndrome is the lack of development of a portion of the chest muscle, the pectoralis major muscle.

While I am confident that Haley functions quite well with her normal left hand and a very functional right hand, the 3D printed prosthetic can offer function, appearance, and social benefits as noted in these posts, from my blog.  These 3D printed prosthetics are inexpensive, relatively easy to make, easy to use (depending on something called the tenodesis effect in Hailey's case) and are available in a variety of styles and colors.  There are many examples of these on the web and it seems the UNLV is helping Hailey and her family.  A recent Review Article summarizes the state of 3D printed prosthetics for the upper extremity and cites our experience here in St Louis.  We continue to refine the powered 3D printed hand (so- called myoelectric hand) with the support of the St. Louis Childrens Hospital Foundation.  Here are two of more recent 3D printed prosthetic hands.

3D Printed hand in one of our younger patients

3D printed myoelectric hand developed in St. Louis

Go Hailey!  

Charles A. Goldfarb, MD
My Publication List

Saturday, October 14, 2017

The 5 Finger Hand

The 5 Finger Hand is a rare congenital hand difference which I have written about in this blog once before, HERE..  It is, as it sounds, the presence of 5 fingers, all in the same plane, instead of 4 fingers and a shorter (2 phalanx), palmarly placed thumb.   The challenges of the 5 Finger Hand include
- a lack of a full first web space which is so important for large object grasp
- a finger with its extra length instead of the thumb
- a notable appearance difference

These images show a 5 Finger Hand with a small extra thumb.

The 5 Finger Hand with a small extra thumb

The 5 Finger Hand with a small extra thumb
When I consider the 5 Finger Hand, two other diagnoses come to mind.  First is the mirror hand as I have written about HERE.  This diagnosis is clearly different but the extra finger and the general hand appearance and the surgical strategies for reconstruction all make me consider the two diagnoses in a similar fashion.  And second, the thumb in the plane of the hand.  I have previously shared my thoughts in this blog specifically around ulnar deficiency and the thumb in the plane of the hand/ fingers HERE.  We have also shared our experience in the medical literature HERE.

The treatment for the 5 Finger Hand is surgical reconstruction for functional reasons and also for appearance considerations.  We typically prefer a pollicization for our reconstruction.  Most commonly, when we discuss pollicization- as we have in these Pollicization links, we do so for treatment of radial deficiency and the hypoplastic thumb.  This is clearly a different surgical indication but the surgery itself is quite similar.  In the child demonstrated above with a 5 Finger Hand, we excised the small extra thumb and pollicized the 1st finger.

Charles A. Goldfarb, MD
My Publication List

Friday, October 13, 2017

Hand Camp 2017

One of the highlights of my year is Hand Camp.  Each year (see previous posts), I have shared a brief post but for those of you without a Hand Camp experience, I will briefly describe.  This is a camp run by the Shriners Hospital team including the occupational therapists, recreational therapists, social workers and nurses.  Planning is a year long process and Camp Lakewood in Potosi, Missouri has been our camp site each year.  Approximately 15 families (including the child with a limb difference, parent(s), siblings) join with junior counselor, staff and team members to create an amazing weekend of learning, bonding, and growth.  Hand Camp allows kids to see and interact with others with birth differences that may be similar to their own.  It allows kids and families to interact with our amazing group of junior counselor who have successfully navigated childhood and adolescence and have such wonderful stories and experiences to share.  And it allows all to participate in great camp activities including horseback riding, archery, rock wall climbing, and so much more. 

There are so many reasons that I enjoy Hand Camp.  A few include:
- Seeing kids and families outside of the hospital environment
- Watching kids with notable hand differences accomplish so much (i.e, climbing the rock wall)
- Seeing kids and junior counselors interact
- Listening to the junior counselors as they share a lifetime of wisdom with parents of younger campers.  These lessons can be very emotional but the experience is incredible.
- Watching kids bond. 
Two amazing kids who met and bonded at Hand Camp.

A more spontaneous and 'natural picture'.  The girls share an a difference with ulnar deficiency of the left arm.

Hand Camp 2017 was a success.  Already looking forward to next year.

Charles A. Goldfarb, MD
My Publication List