Finger Deformities Symbrachydactyly

Short Fingers- Brachydactyly

I have written several times about symbrachydactyly– that is short, webbed fingers.  This common condition is distinctive in appearance (although there are multiple different types).   I have actually written 10 posts that relate to symbrachydactyly.

Brachydactyly, or short fingers, is a different condition as there are the normal 5 digits with shortening of either the phalanges or metacarpals or both.  The different classifications are helpful as there are so many types and the classifications help keep some sort of organization.  Most commonly cited are those by Bell and Temtamy and McKusick (Temtamy SA, McKusick VA. The Genetics of Hand Malformations. New York: Alan R Liss, INC; 1978).  There are a number of good educational sites on the topic of brachydactyly.  One such site is the OJRD- Orphanet Journal of Rare Disease which provides information through the NIH
and another great site is through OMIM- the Online Mendelian Inheritance in Man which categorizes each individual type.

I will not repeat all the detailed information available through these amazing sites.  A few key points, however, are worth repeating.  First, brachydactyly can be isolated or can be part of a larger syndrome.  This means that for most people, the short fingers are the only issue- there are not other conditions to worry about.  Second, it is most commonly passed in an autosomal dominant fashion (50% chance of passing it on to your children).  So, in most cases, a parent will have brachydactyly which obviously helps in understanding the abnormality.  And last, many of the genes associated with brachydactyly have been identified.  We actually know where the problem is in the human genome but, as of now, we can’t do anything about it. Eventually, we may be able to “fix” the problem, but the science is simply not there yet.

Brachydactyly is typically a condition that affects the appearance of the hand more than the functional ability of the hand.  The type of brachydactyly obviously matters as some types will cause finger deviation, some an isolated shortness of the digits and some a combination.  The finger deviation is a type of clinodactyly as I have previously discussed.

Surgery is not usually required but can be helpful for marked deviation or, rarely, for marked shortening of the digits.  Surgery is usually an osteotomy (cutting of the bone).

This is an example of brachydactyly type E.  This patient had no pain, excellent motion (as shown), and was not overly concerned about the appearance of her hand.

Brachydactyly– both hands affected but the right hand is more noticeable.
Note the knuckle asymmetry in brachydactyly.
Brachydactyly with different length metacarpals.
The most notable finding in this patient with brachydactyly is the short 5th metacarpal. The 4th metacarpal is also short.
The right hand in the same patient with brachydactyly shows a very short 3rd and 5th metacarpal along with a short 4th metacarpal.


  1. I was born with a short third metacarpal on my left hand only. The finger is considerably shorter than the others (almost half the size), is bent to the left. I am interested to know what may have caused this as I have never had it investigated. It is weakening as I age (I am currently 30 years old) and I am interested in whether this is related to rheumatoid arthritis at all – as my mother was diagnosed with this in her early thirties.

  2. Tara, thank you for writing. I am going to add a post today about a single, short digit- so check that out. But the bottom line is that this is unlikely to be related to rheumatoid arthritis given that you were born with it. It is probably an isolated short metacarpal.

  3. Hi Charles,
    Thanks for the great blog!
    I'm an Australian doctor currently studying anatomy (again!) for my specialist exams.
    I always knew I had a short 5th finger bilaterally, but just happened to notice today while studying the upper limb that it is not my phalanges that are shortened. It must be the metacarpals!
    I found your blog and after seeing the part about autosomal dominance I raced in and checked my 2 children. Both of them have it! 2 for 2! So cool. From memory I think my only sibling has it too.
    I took pictures and it seems like my youngest child has metacarpals that are the most shortened – which I wasn't expecting as she resembles me the least physically.
    She also has an unusual 5th toe on the R side. It seems of normal size but sort of overlaps the 4th. None of this is obvious at all – luckily people expect the 5th digit to be smaller than the others!
    We don't seem to have any serious cognitive defecits or any other syndromes.
    (Haha! Although in studying right now I wish for any extra IQ points available!)
    I saw (I think on radiopedia?) an association of short 5th metacarpal with Type 2 Diabetes, which my grandfather had. Then again, a lot of people have diabetes, so I wonder how strong this association is.
    Anyway, thanks for putting this out there!

  4. Hi Charles,

    Is there any reconstructive surgery to bring a short 5th metaparpal to the normal length ? I have bilateral short 5th metacarpal and my dexterity is fine but it's really annoying on an esthetic point of view. I want to become a surgeon so it is really important for me ! What are the risks of such a surgery ?

    Thank you !

  5. Metacarpal bones may be lengthened (see other posts in my blog) but it is probably not the right decision for you. Typically, an external fixator is utilized and good length can be accomplished. The problem related to the tendons which may not accomodate to the longer bony length. This can lead to finger stiffness and worse function. Good luck.

  6. hi Charles, i have a congenital deformation that i think you will find interesting, and also i am curious about it, i don´t know another person with this an i would like to know more about it.
    The issue is that i was born without the metacarpals of the pinky fingers and this pinky fingers are united with the 4th metacarpal. If you can let me an email or another way of contact in wich is possible to pass documents i can show you my bone scans, it would be great for me to know your opinion
    (excuse my english, i am from spain)

  7. Hi dr.goldfarb my son has short four fingers in his left hand with no nails but the thumb is normal, what is the cause of that? is there is any treatment for him he is 2 months old and i want to know if i gonna to have other children they will have the same problem or not.

  8. Hadir,
    Congratulations on the birth of your son. The fact that his thumb is normal is really, really important and it means that his function will be very good. The most likely diagnosis, based on your brief description, is brachydactyly or symbrachydactyly. There may be treatments to deepen webspaces or lengthen finger bones but only as he gets old.
    Finally, there is a possibility that your next child will be affected- it depends on exactly what type of anomaly your son has. I hope that is helpful- an experienced hand surgeon or genetics doctor would be able to examine your son and give you the best information. Good luck.

  9. Hi charles, interested in your opinion on my condition. Doc told me 25 years ago that my tendons were to short on my dominant left hand and op success would only be 50/50. Both hands are the same size however with my left wrist straight to pushed back i am unable to extend any of my fingers. Wrist bent forward I can fully extend.
    Is this def a tendon issue and if so are the op chances any better 25 years on? Thanks in advance ☺

  10. Andrew,
    It is difficult for me to give much helpful advice unfortunately. But I agree, it does sound like a tendon issue. And if so, correction now would probably not make much sense.

    Sorry I could not be more helpful.

  11. Hi my name is Quade rose. I am also interested in your opinion. I am a 22 year old male and I have had short 4th metacarpals in both of my hands since I can remember. I would like some information on treatment if thats possible. I have pictures and X-rays if you would like see them.

  12. Quade,
    Thank you for the question. In most cases, we do not treat isolated 4th metacarpals. The only possible treatment is to lengthen the bone but that does create a notable scar. The reason to consider this procedure is to treat a functional limitation. Since most patients with a short 4th metacarpal function at a high level, this surgery is not regularly performed.

    I hope this helps.

  13. Hi! I have pinkies that are shorter and have an indent where the knuckle should be. I never looked into this until now (I'm 34). Could I email you pictures? It never bothered me or got in the way. No one ever notices as well but I'm just curious. No one else in my family has this.

  14. Hello Tracy. Please see my other responses. It sound like you may have a short metacarpal bone for the pinky. As you say, function is typically excellent and most don't notice. Xrays would be required for a diagnosis.

  15. Hello doctor I have bdd type d (stub thumb) and have 2 questions.
    1. Is there any type of standard cosmetic surgery that could make my short broad tipped thumbs appear more "normal" and if so what would that entail. I know I should just accept it since it doesn't really affect me
    Besides being self conscious but I've always been curious if there is a corrective plastic surgery.
    2. I always read this is an inherited condition but counting down from all four grandparents including my parents, siblings, cousins uncles aunts exc. not a single other person has my thumbs. Are there other possibilities as to what could have caused it such as my mothers behavior when pregnant only something of that nature. Dying to know; thanks a bunch in advance for any info.

  16. Thank you for the question Brett.
    I am not aware of cosmetic surgery for the broad, short thumb (more common than most people realize). I would absolutely hope that you can accept it for the way it is.
    The question of inheritance is interesting. I have read similar thoughts but agree, for many people, there is not a demonstrated relative. It may be a spontaneous mutation and I believe unlikely related to maternal risk factors/ behavior.

  17. I have shortened fingers on both hands. On my left the third, fourth, and fifth fingers are affected and on the right so are my third and fifth fingers. I have clubbed thumbs on both hands and my fourth toes on both feet are shortened and set back. I have always known my hand strength was not great but as I am getting older I am realizing it is decreasing even more. Could this be because of the length of my fingers? Is there anything I can do other than using hand grips and is this something I can expect to worsen over time? I am only 32 and I am worried that as I age I will lose a significant amount of function.

  18. Thank you for the question. You have a form of brachydactyly. It may affect strength and I agree with your strengthening plan- likely your only option. I don't think you will lose function in the future.

  19. I thought that I didn't have a knuckle, i have a little finger on my right hand and I really thought that I had fetal alcohol syndrome. Thank you for sharing, I know that i am not alone in this.

  20. Charles,

    Thank you for the insight. I believe I inherited this from my mothers side of the family. Both my mother, and maternal grandmother and a short 5th metacarpal on one hand each. I however am affected with short metacarpals 3-5 on my left hand, and 3-4 on my right hand. I am noticing that as a very active person, as I age, the more prone I am to wrist injuries on my left hand. I would like to learn more participate in any study for something like this, but I am not sure where to look. I am located in Eastern Washington State. If you know of any one I might be able to reach out to in my area that would be much appreciated.

    I also have rather small feet for my height, 5'8 and I wear a size 6 bowling shoe. I'd be curious to see if there was some additional stunting of the bones in my feet due to this congenital condition.

    Thanks again for your insight.

  21. Thanks Joseph. While sometimes a genetic condition passes from one generation to the next in a very similar way, other times it differs. There can be different reasons for this including what the geneticists would call variable expressivity or possibly reduced penetrance.

    I do not know of any ongoing studies. Good luck.

  22. My third metacarpal is short on both my hands, meaning my middle fingers are set back and appear short. I also have club thumbs and my Grandma has one small club thumb. My hands are also very small generally (about the size of a eight year old's). My mum took me to a paediatrician was I was 12 and they just said it was a genetic mutation. Now I'm doing more research and I've found this and that girl's right hand looks just like mine. Is it worth pursuing a diagnosis now?

  23. Isobel,

    I always believe in trying to confirm a diagnosis as it can be helpful for you and potentially to better understand the possibility of passing this on to children. A hand surgeon like me who specializes in kids born with hand an upper extremity anomalies may be helpful; the other option would be a geneticist. Good luck.

  24. I am a physician but do not know much about hand conditions. A year ago, my 6 year old daughter was diagnosed with bradydactyly. We were not told the type but it looks like the images above of Type E. We have not brought attention to this condition but she is becoming increasingly self conscious. Are there any stem cell treatments for this?

  25. BG. Thank you for the question. Unfortunately, there are no effective treatments. Hopefully, and typically, function is very good. Appearance and concerns around it, vary. There are not stem cell treatments for this issue.

  26. Hi, my daugther 10 years old has short the 3th finger of her left hand, she suffer for the bullying in her school, if there are surgery for that? The re is a good cases or success?

  27. Anna,
    I hope that you can help your daughter work through this. Certainly, the 10-14 year old age can be tough with social pressure. But if her function is good, surgery would not make much sense. There are procedures to grow the shortened bone but these are complex procedures and have a high rate of complications. I hope this helps.

  28. Tracy – I do also! My pinkies are barely above the lowest joint of my ring fingers, and only indentions where knuckles should be. Someone told me it's a mark of Scottish ancestry, I have no idea if that's true, but I am of Scottish descent. I am the only one I know with this, and it is often noticed and remarked on.

  29. From birth my pinkie fingers are barely above the lower joint on both hands, and are quite low set. Drawing a line over my 5 knuckles is same shape as a semi-circle. They have only caused problems in typing. A stranger once asked me if I was of Scottish descent, when I said yes she said short pinkies are common in Scottish people. I have never saw anyone else's shaped like mine.

  30. Hello, I looked at my photo when I was 23-24 where I have my fingers stretched fully and they are really long, I am 190cm, but now when I look at my hands, at 27 almost 28, my fingers have significantly shortened. My father has normal finger length still, I think also my mother. Is brachydactyly since birth or it can develop in adulthood? Thank you.

  31. I finally found people like me lol. Makes me feel kind of better now.

    When I was 12 yrs old I realized my middle finger on the left hand stopped growing, by the time my 2nd, 3rd and 4th fingers were same size, now that I’m 27 it’s very visible that my middle finger is shorter. My other hand was perfect.

    I went to X rays and realized I have short my 5th metacarpal on both hands and short my 3rd metacarpal on my left hand. When I make a fist it looks exactly like the image above. 🙂

    Also, only on my right hand I can’t make adduction of the 5th finger but I can do it with the opposite hand which is weird because both have absence of knuckles. My function is very good ok both hands tho.

    It would be cool if we could share images.

    Greetings from Colombia.

  32. I am a 16 year old girl and I've never found anyone with my finger sizes. I think I may have type E. My hands are proportionate to each other but they are so small. I put my hand up to a 8 years old hand and they were the same size. My toes are the exact same. My parents both have fingers and toes just like me so I was thinking it might be this as it is hereditary. I play guitar and bass guitar and it makes it really hard to play because of my finger lengths. Does this sound anything like type E brachydactyly? Is it normal to have proportionate small hands with type E?

  33. Madigirl6234,
    Thank you for the question. I geneticist might be helpful in confirming a diagnosis. The relative length of the fingers to the palm matters- Brachydactyly Type E suggests variably short metacarpals (ie, the palm) vs the fingers. Good luck.

  34. Hello Dr. Goldfarb,

    I believe my daughter and I were both born with brachydactyly type B. We were both born short fingers, that stop at the first knuckle, and we each have clubbed thumbs with one thumb looking as though it was split. My wide thumb in on my left hand and hers in on her right. We have similar feet as well. We both have normal big toes, and a second toe that is smaller. My 2nd and 3rd toes are missing and I have a tiny pinky toe, where my daughter has nothing after her 2nd toe.

    I am the first and only, before my daughter, that has this. I also have a son that does not have it. I have had a pretty uncomplicated life, but I am certainly concerned about passing this on further. I am done having children, but I worry that my children (especially my daughter) will continue to pass it on. Any knowledge you have is greatly appreciated. Thank you for your time.

  35. Kasie. Thank you for writing. It is difficult for me to give advice based on limited information but certainly an autosomal dominant pattern of inheritance is possible. A geneticist will be your best bet for information.

  36. Hi Dr i am 35yrs old my left hand look exactly as the right hand in the picture and the right as the left. my mom have same little fingers. She has developed high blood pressure and now recently kidney diseases. Is this abnormality related to those deseases.

  37. Hi Chris,
    Thank you for the question. Unfortunately, I cannot answer your question definitively. The hand difference is most likely genetic but I am doubtful that the other conditions are related. I would, however, talk to your primary physician for advice.
    Good luck.

  38. hello, thankyou very much. i think i am the only person who get this brachydactily,i'm so confused before. and right now i feel thankyou for find this page . my left fourth finger is little shorter than my right fourth finger .and it's kinda hurt sometimes.
    almost same like pict that you share.

  39. Hello, I looked at my photo when I was 23-24 where I have my fingers stretched fully and they are really long, I am 190cm, but now when I look at my hands, at 27 almost 28, my fingers have significantly shortened. My father has normal finger length still, I think also my mother. Is brachydactyly since birth or it can develop in adulthood? Thank you.

  40. Hi, I was diagnosed with this as a child (I have five shortened metacarpals between my hands, and two in my feet) I have a weakened grip, and I'd probably break my hand if I tried to punch something due to the angles of my fingers, but fortunately boxer was never on my careers list. One thing I've always been curious about though, and I can't see it even in the x-rays, is the cause of the indented knuckle. Although aside from being behind the muscle of my palm, it works like a normal joint, it feels disconnected, and I was wondering if you could tell me what the differences are and why they're there. How does the joint still function when I can feel the ends of both bones separately?

  41. Hi, I was diagnosed with this as a child (I have five shortened metacarpals between my hands, and two in my feet) I have a weakened grip, and I'd probably break my hand if I tried to punch something due to the angles of my fingers, but fortunately boxer was never on my careers list. One thing I've always been curious about though, and I can't see it even in the x-rays, is the cause of the indented knuckle. Although aside from being behind the muscle of my palm, it works like a normal joint, it feels disconnected, and I was wondering if you could tell me what the differences are and why they're there. How does the joint still function when I can feel the ends of both bones separately?

  42. hello Charles,

    My son is 10 years old. he was born with his toes and fingers the same length, however recently I have noticed that his pinky is left pinky is slightly shorter in length and his right toe is also slightly shorter in length. Does this mean that as he grows the difference will become more apparent in your opinion? any suggestions.

  43. Hello. Thank you for writing. It is honestly difficult for me to know. But, I doubt the difference will become worse and the % difference should stay about the same. And, thankfully, the digits don't have too much growth remaining.

    I hope that helps.

  44. I didn't even know this had a name. I've been search for years. No one in my family has this issue but me. It affects both hands and feet. All i was ever told was some of my growth plates stopped growing. When looking at pictures when i was younger it didn't become noticeable until i was 6 on my feet an 10 on my hands. Can the toes ever be corrected

  45. I have the exact same hands! Missing knuckles on both pinkies and on my right middle finger. It feels amazing to not be the only one with hands like mine

  46. Oh wow! Thank you so much for this article.
    I was born with missing 2 knuckles on my left hand on my pinkie and ring finger, based on what you wrote short metacarpals. On my right hand, only my pinkie finger is affected.
    Also both my thumbs are very short and broad at the nail.
    I seem to be a rare case based on recent readings thanks to your article.
    In the last 2 weeks though (hence my sudden research into this, I am having a rather painful left hand where my knuckle should be. I can barely bend / close my hand and wondered if in your opinion this could be related at all.

  47. Melonlemon,
    Thank you for sharing. It is difficult to know. Pain is uncommonly related to the short metacarpals but has been reported. Hopefully time and perhaps immobilization will allow this to calm down. If not, a hand surgeon who treats both kids and adults will be most helpful. Good luck.

  48. I am 68 and always new my pinky fingers were different, as though they were missing the knuckle. I now, have a problem with the ring and middle fingers pulling towards my pinky finger. The shorter metacarpal was visible on an x-ray I had of my hand. I was just given a brace to wear and exercises to do. I also have some Scottish in me! I have difficulty typing, playing piano, grasping etc. Does anyone know the name of the surgery that can be done to alleviate the tendon issues related to the shortened metacarpal 5th finger? I have no other anomalies (that I know of!). nam

  49. Nam- thanks for writing in. It is unclear to me what might help you. It is certainly unusual that this birth condition would start causing problems after all of these years. I would recommend that you see a hand surgeon. Good luck!

    Charles Goldfarb

  50. Hi,

    I believe that the 5th metacarpal on both of my hands is shortened. I did not notice this until I was 17, because my hands are symmetrical. Have you ever seen a case like this, where the 5th metacarpal is shortened on both hands? Also none of my immediate or extended family members have it (including my parents, my sister, and my grandparents). Although I'm assuming both of my parents have the gene and that it just happens to be recessive, is it common for this to not be obviously genetic? Additionally, my fingers are not as flexible as other people's are (ex: if I put my hand up and then try to push my fingers back, they move maybe a centimeter as compared to other people who can bend their fingers back several centimeters). However, my family members are all unable to bend their fingers back as well. Is this related to symbrachydactyly?

  51. Hello. Thank you for writing. Yes, both 5th metacarpals can be affected and this is a form of brachydactyly (note, not symbrachydactyly). Presumably, there is a genetic component and possible endocrine abnormality (pseudohypoparathyroidism or pseudopseudohypoparathyroidism).

  52. All of my fingers on both hands are short. Is this brachydactyly? I’m a 39 year old male and have always noticed most other males hands are much bigger than mine as well. Never really bothered me until I recently started learning guitar. I worry I will run into issues not being able to play certain things. Most guitarists seem to have really long fingers.

  53. Thanks for the question Steve. While it is impossible for me to answer your question, this is unlikely brachydactyly. Brachydactyly often affects different fingers differently rather than symmetrical shortening of all fingers. Good luck with the guitar!

  54. I’m hoping you can shed some light on what may be going on and where to look for answers. I’ve been looking through countless articles but run into dead ends as most available to me online are little more than the syllabus of one’s findings…

    Both my children have shortened 5th metacarpals (looks just like above; “missing knuckles.”)

    For history, their paternal grandfather has many formation mutations. Not only does he have this but he also has clubbed thumbs, brachymetatarsia on his 4th toes, short stature, Craniosynostosis (type I’m not sure but it’s visibly evident,) diabetes, and more (but to specify and put a name to them, I don’t have those answers.)
    He had 3 sons, one of whom is my children’s father and they all have notable mutations only, they all differ.
    One has quite a few noticeable conditions, like his father above but they don’t present in all the same ways;
    One is short in stature but has only broad big toes and smaller than average hands/feet to be seen;
    And my children’s father only has smaller hands and feet than average and broad big toes. He is of average height.
    Two of the 3 son’s have also been diagnosed with diabetes in adulthood (not my children’s father.)

    As for my children, they both appeared to have skipped what ever gene is causing all this at birth.
    It wasn’t until they were each around 4-5, when their bone structure began to be more prominent that things were noticed.
    Both my children were born of average weight/height however, when one was around 3, they began to fall below for height and are now (years later) quite small for their age. This child has also had dental issues with enamel formation and early decay, and asp has a deviated septum.
    My other child has no other notable developmental things going on (aside from brachydactyly) however, it should be noted that they were born with an accessory tragus (ear tag.) That of course could have no connection but given that it’s also rare and we’re dealing with other “rare” things, it may be part of whatever gene mutation is causing these things.

    I’ve pointed these things out and expressed my concerns over the years to pediatricians, general MD’s and their dentist but aside from their acknowledgement in the “unusuals,” I’ve not been given any info or direction on what may be going on, or where to find answers.

    Aside from some physical differences, my children appear healthy in all ways however, if there’s something health wise we should be aware of, even if it’s down the road, because of whatever their mutation may be, I want to be sure we’re knowledgeable of it so we can do all we can to help keep them truly healthy.

    I thank you in advance for your time and any help you may have. It’s truly appreciated.

  55. Hi Meg. Thank you for the question. I am unaware of general health issues and would defer to those that have examined your children. I wish I could provide guidance or direction but unfortunately cannot. I posted so that perhaps a reader may weigh in.

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