Central Deficiency with 2-3 fingers

Central deficiency (cleft hand) is classically as I have shown in previous blogs.  https://congenitalhand.wustl.edu/2012/05/cleft-hand-surgery.html We have previously published our experience with the classic central deficiency, that is the hand with a limited thumb- index web space, 3 fingers (index, ring, and small finger), and a large cleft http://www.ncbi.nlm.nih.gov/pubmed/18984341 However, there are many different varieties of cleft […]


Hemihypertrophy is a difficult diagnosis due to its rarity and the variety of associated conditions.  Basically, the diagnosis means that one extremity (or one side of the body) is enlarged compared to the other side.  As little as a 5% difference can be diagnostic but usually families seek care when the difference is more notable. […]

Too much about me

I have been asked on several occasions by patients (or prospective patients) to provide more information on the blog about my professional career.  Enclosed, please find a variety of links including local and regional publications and videos.  I have included links to several books and articles. First, my basic bio from Washington Universityhttp://www.ortho.wustl.edu/content/Patient-Care/2637/Find-a-Physician/Listing-of-Faculty/Charles-Goldfarb-MD/Bio.aspx Others:1) Great […]

Severe Ulnar Deficiency

Ulnar deficiency, as described in a previous post has characteristic findings at the elbow, forearm, and hand.  https://congenitalhand.wustl.edu/2011/09/ulnar-longitudinal-deficiency-basics.html Most classifications describe 4 types of ulnar deficiency (or ulnar longitudinal deficiency- ULD).  These classifications only address the bony deficiency (and not the important other issues such as muscles, tendons, nerves, etc).  While there are a number […]

Severe Symbrachydactyly and Nubbins

Symbrachydactyly, as noted previously, https://congenitalhand.wustl.edu/2011/12/normal.html  means “short, webbed fingers.”  The use of this label is clearly appropriate for some children who (brace yourself for this truth) have short and webbed fingers (i.e., a syndactyly).  The term symbrachydactyly has further meaning as it has implications for etiology (i.e., cause). I believe symbrachydactyly occurs due to difficulties with the AER […]

Limb Formation

I have been remiss in that I have not given an overview of limb formation.  Mind you, this is  a topic that is constantly changing- we learn more each year about the process, the proteins, the timing, etc.  So this is a hand surgeon’s perspective in 2012.  There are others with a much better understanding […]