A Dictionary for Birth Anomalies of the Upper Extremity

As much as I try to write for the non- physician, there are still medical terms throughout my blog posts. So, in an effort to simplify the terms and explain some basic concepts in the field of congenital hand, I will provide a dictionary of sorts.  I hope this helps simplify the terms and ideas. […]

Extra Digits- What Happens After Treatment

Postaxial polydactyly is the medical term for an extra digit on the pinky side of the hand.  It is far and away the most common location for an extra digit.  It is much more commonly seen in African Americans compared to whites (the reverse is true with radial polydactyly– thumb side).  There is a definite […]

Short Fingers- Treatment Choices

Symbrachydactyly means short and webbed fingers but the term really includes a wide range of presentations.  I have previously posted on symbrachydactyly a number of times and this Post summarizes the 7 different types of hand appearance.  I have also written that I prefer certain techniques to lengthen the fingers such as bone lengthening or web space […]

Inspiration

I am fortunate.  Each day I am inspired by the kids (and families) that I am able to treat. These children are born with differences and, therefore, they do not know any other way.  But they must learn to exist in the everyday world with functional and social challenges.  And succeed they do.  Each child […]

Great Toe Polydactyly (extra toes)

It might seem odd that I am writing about extra toes.  Typically, hand surgeons don’t take care of the foot but, in many situations, the hand surgeon is the perfect person to help take care of certain foot problems including extra toes, toe syndactyly (toes joined together), and even things like cleft foot. The reason […]

Arthrogryposis: Arm position and elbow flexion

Kids with arthrogryposis are smart and are able to figure out how to accomplish many of life’s tasks despite their functional limitations.  We, as surgeons, can sometimes help children with arthrogryposis by releasing and/ or repositioning tight joints.  We cannot make the arms or hands normal but little changes can make for big improvements. It […]

Early Outcome for Pollicization (creation of a thumb)

Pollicization is the name of the surgery which entails the creation of a new thumb, a “Pollex” (Latin for thumb).  For those of us who regularly care for children born with anomalies of the upper extremity, this is perhaps our favorite because it dramatically helps both appearance and function.  I have previously blogged about pollicization […]

Shark Tank

Proud to post about my wife and her business, Myself Belts.  Talia and her sister created a patented belt that allows kids and adults to fasten a belt with one hand!  The belt has been really helpful for many of my patients. Check out her Website! The exciting news is that Talia and Myself Belts will […]

Small finger polydactyly, extra fingers

Extra fingers can be on the thumb side of the hand, the central part of the hand, or the small finger (pinky) side of the hand.  The location of the extra digit is important because it relates the risk of other conditions such as syndromes or other abnormalities.  Small finger polydactyly is the most common […]

Ulnar Deficiency and Syndactyly

Ulnar deficiency (or ulnar longitudinal deficiency) is much less common that radial deficiency, possibly only 1 case of ulnar deficiency per 10 of radial deficiency.  And it is much different in the problems that it may cause.  The forearm abnormality can include a deficient or absent ulna and flexor muscles BUT, it is much better […]

St Louis Shriners Hospital Does Great Things for Kids

I am very fortunate to work at the St Louis Shriners Hospital.  The first Shriners Hospital opened in 1922 in Shreveport, Louisiana and more soon followed to care for children with polio.  The St Louis Shriners Hospital opened in 1924 on the main campus of Barnes Hospital and moved to the current location on Lindbergh […]

Patient TV Interview Regarding 3D Printed Prosthesis

Check out this great interview with a wonderful patient/ family regarding our 3D printed prosthesis.  Go Sydney! Interview with Sydney and family Charles A. Goldfarb, MDMy Bio at Washington Universitycongenitalhand@wudosis.wustl.edu

Central Polysyndactyly

Polydactyly means that more than the normal 5 digits.  Typically patients have either an extra thumb or an extra pinky. A patient with radial polydactyly (extra thumb). Syndactyly is the abnormal joining of the fingers.  It is most common between the middle digits but can affect any of the fingers. Syndactyly of the fingers. While […]

Scarring after Syndactyly

Syndactyly, or the fusion of digits, is a condition present at birth and is related to the failure of the fingers to separate in utero.  I have previously blogged about this condition, as seen here.  There are different surgical techniques to correct syndactyly and generally good results are obtained, no matter the technique.   Scarring is […]

More on 3D Printing

I have shared my thoughts on 3D printing with several previous posts 3D link Second 3D link In addition, I have recently been working with a reporter from veja.com- the largest magazine in South America about 3D printing and medical applications.  I look forward to this article- the more press, the better for the progress […]

Form versus Function. Can we have both?

Orthopaedic surgery is the branch of medicine that focuses on movement and function.  In orthopaedics, we work with bones, joints, muscles, and tendons, as well as nerves and vessels.   Hand surgery is a subspecialty of orthopaedics (and also a subspecialty of both plastic surgery and general surgery) that addresses all of the same issues […]

Best Scientific Publication on Birth Anomalies of the Upper Extremity

I have been fortunate to learn from a number of wonderful hand surgeons over my career.  One of the most impactful was Paul Manske, a hand surgeon and, more specifically, a congenital hand surgeon.  He spent the majority of his career here at Washington University School of Medicine.  I am not alone in this sentiment […]

Type 2 Radial Longitudinal Deficiency

Bayne and Klug wrote what is now a classic scientific article on radial longitudinal deficiency in 1987 Classic Article.  This article described 4 types of radial longitudinal deficiency: Type 1- Short distal radiusType 2- Radius in miniature (short proximal and distal)Type 3- Absent distal radiusType 4- Absent entire radius More recently, we added a Type 5- […]

Popular Press News Stories

I have attached a few links that I believe you might like to see.  These are stories relating to birth anomalies of the hand and upper extremities.  These stories were in the popular press. World Cup Soccer  Interesting link which is also thought provoking.  Thanks to Terry Light. Phantom Limb Pain  Link regarding birth anomalies […]

Cerebral Palsy, Thumb Deformity

Cerebral palsy (CP) is defined as a permanent limitation in physical function which does not change or get worse over time.  Most commonly, it is a disorder with spastic muscles and limitations in motion but kids can present in a variety of different ways.  I have not previously blogged on this topic and will start […]

Diagnosing Distal Arthrogryposis

Making the Diagnosis and Maximizing Function Arthrogryposis is a challenging disorder although, thankfully, our understanding about it has grown over the last 10 years.  Previous Blog Posts and Great site While there are many thousands of subtypes of arthrogryposis (and several names with some differences, including the commonly used amyoplasia), basic treatment options are increasingly accepted.  We now […]

Symbrachydactyly of the Hand: Diagnosis and Presentation

Confirmation of a diagnosis of symbrachydactyly can be challenging.  Most patients who present to my office with symbrachydactyly come in with a different diagnosis- typically amniotic constriction band (also known as constriction band syndrome, amniotic band syndrome, etc)- Amniotic Constriction Band Blog 1; Blog 2.   In fact, most patients with any upper extremity diagnosis present with […]

Hand Camp 2013

So, I am a little late with this post.  I originally wrote this summary about 9 months ago.  Somehow I neglected to post it. The 6th Annual Shriners St Louis Hand Camp was a clear success.  As always, the site was Camp Lakewood in Pitosi, Missouri- a YMCA camp.  This year, there were 15 families […]

Rare Syndromes: Duane Syndrome with Radial Ray Anomaly

Duane Syndrome is an rare birth anomaly of the eyes in which the patient can’t move the eye outward. It has been know to exist for more than 100 years.  But more recently it has been linked to a defect of the SALL4 gene and related to miswiring of the eye muscles or a missing […]

Congenital Radial Head Dislocations: Elbow or forearm problem?

I have previously blogged about congenital radial head dislocation at least several times Previous posts . However, like most upper extremity anomalies, not all patients with a congenital radial head dislocation present alike.  Consider first that most of these dislocate so that the radial head moves in the posterior and lateral (outside) direction.  A smaller number dislocate in […]

Bone/ cartilage tumors/ MHE (multiple hereditary exostoses)

Multiple hereditary exostoses (MHE) is a genetic condition in which a patient has many bone/ cartilage tumors.  It is also know as multiple hereditary osteochondromatosis.  These are “tumors”- unregulated growths- but these are not malignant tumors (since they don’t go anywhere- they don’t metastasize). This condition differs from a condition I have previously posted: isolated osteochondroma. […]

Macrodactyly- Big fingers

Large digits are also called macrodactyly.  This uncommon condition can be quite dramatic in appearance.  I have previously blogged on the topic of macrodactyly- here is the previous Post.  I want to share a few pictures from a single case as a way to demonstrate a typical progression. This child presented to us a 8 months […]

Newsworthy

Robohand I previously blogged about Robohand 2.0  Previous Robohand Post The group has now fitted one great patient with an unfortunate injury.  She now has a powered prosthetic and she loves it!  Check out this news story and video.  Fox-2 News Story Here is another link with more information on the story from Washington University News […]

Recent Publications, April 2014

I have been asked to regularly add to my blog recent publications which are important for children with congenital hand anomalies.  Here are 3 publications from the last few months.  These 3 publications are all in in the Journal of Hand Surgery. Transverse Bone in Cleft Hand  This manuscript details our findings in comparing two […]

Symphalangism (stiff fingers)

Symphalangism is a rare birth anomaly of the fingers which literally means: joined bones.  Most commonly, it refers to an ankylosis (bony union) or fibrous tissue union of the finger bones preventing finger motion.  It can be nonhereditary or it can be hereditary.   Nonhereditary symphalangism occurs without known family history.  It can be associated […]

Severe Madelungs Deformity

I have posted several times on Madelungs Deformity but a recent follow- up visit with a happy patient led me to post again.  One previous post was on More typical Madelungs and one on Madelungs after trauma. Patients with an inherited Madelungs are much more common in my practice (compared to Madelungs following trauma) even though both are […]

Bony Outgrowth, osteochondroma

Bone growths in children come in many different forms.  In the upper extremity, there are relatively few growths on the surface of the bones; one of these is the solitary osteochondroma.  The solitary osteochondroma is, as its name implies, a single bony and cartilage growth.  It differs from multiple hereditary exostoses, or osteochondromatosis, which is […]

Popular Press on Prosthetics

Prosthetics have been in the press lately.  I have found two issues particularly interesting; one is a note a caution and the other an important step forward. The first article nicely presents a reality check towards much of the excitement regarding myoelectric prostheses.  While there is good reason to be excited about technology and prosthetics, […]

Wrist Deviation

Radial deficiency and ulnar deficiency are, for most children, easily distinguished.  Radial deficiency, a condition about which I have blogged about on numerous occasions- see here – presents with a problem on the radial (thumb) side of the forearm and hand (mainly the thumb).  The radius bone can be absent or limited and the extensor muscles are […]

Hemangiomas and vascular malformations a brief overview

When we consider congenital abnormalities of the upper extremity, most commonly, we think of extra bones or missing digits.  However, there are many other conditions which fall under this umbrella and, therefore, the care of the congenital hand surgeon.  The OMT classification (Oberg, Manske, Tonkin) has recently replaced the Swanson classification as the official classification […]

Robohand 2.0 (powered, 3D printed hand)

The Robohand has been getting an amazing amount of press in recent months.  I have previously blogged on the topic Previous Prosthetic post with basic information.  Since then, there has been a  Kansas City Star article on the topic.  As I previously mentioned, I had the opportunity to work with senior engineering students at Washington University, Biomedical Engineering […]

Thumb Deformity in Untreated Thumb Hypoplasia

Thumb hypoplasia is a part of the spectrum of radial longitundial deficiency (RLD).  Classically, there are three parts to the small thumb: looseness or laxity at the MCP joint, a tight first webspace, and poor muscles around the thumb.   I have previously written about the small thumb and these key points at Small thumb . Decisions […]

Ollier Disease, multiple enchondromas

Ollier Disease is a nonhereditary condition in which the patient develops multiple benign cartilage tumors, or enchondromas.  While isolated enchondromas are not terribly uncommon, Ollier Disease (or multiple tumors) is quite rare.  It has been estimated to occur in less than 1 in 100,000 births.  It is believed to be non- herditary and related to a spontaneous mutation. […]

Media

A couple of news stories over the last week have highlighted children at the Shriners Hospital and St Louis Childrens Hospital.  The first child is a Shriners Hospital patient and a part of a great family. Mom and all three children have thumb anomalies, although each individual is a bit different.  We have been able […]

Radial Head Dislocation in Ulnar Deficiency

Ulnar longitudinal deficiency, or ulnar deficiency, is much less common than radial deficiency.  And, it less commonly requires surgery.  I have previously written about different aspects of surgery for ulnar deficiency hand surgery in ulnar deficiency .  Additionally, I have previously written about different aspects of more severe ulnar deficiency severe ulnar deficiency There is a group of […]

The Hand in Arthrogryposis

Hand function is clearly vital for function.  As I have written about previously, the thumb is key for both fine manipulation (think picking up a coin) and large object grasp (soda can).  The fingers are key for grasp and strength in grasp.  https://congenitalhand.wustl.edu/2013/11/5-finger-hand-follow-up.html Hand function in arthrogryposis can be a challenge.  First, in order to […]

Amniotic Constriction Band

Amniotic constriction band is an uncommon condition about which I have previously blogged  ACB Blog Link .  There are numerous good general descriptions on the Internet including the following: Shriners LinkMedline Plus The difficulty is that there is little precise information on the upper extremity and hand finding in Amniotic Constriction Band.  There are numerous reasons […]

Macrodactyly/ Large digits

Macrodactyly, which literally means large digit, is an uncommon condition that affects the fingers more commonly than the toes.  Macrodactyly almost always affects only one extremity, often multiple digits. The index finger and long finger are affected most commonly, followed by the thumb.  In some cases, the enlargement that is present at birth stays proportionally […]