Finger Deformities Synostosis

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 with other nonhereditary conditions such as Aperts or Polands syndrome.  Sometimes the fingers can be short as well as stiff.

There are two main types of hereditary symphalangism: SYM1 (Cushing Symphalangism; OMIM #185800) which is stiffness of the PIP joints, the wrist and ankles and deafness.  It is passed in an autosomal dominant fashion (50% chance of passing it on) and has been localized on the genome at 17q22.  SYM1  There is also a SYM1b (OMIM #615298) has been localized to chromosomal 20q11 and relates to a defect in the GDF5 gene.  SYM1b

The other inherited type of symphalangism is SYM2 (Distal Symphalangism, OMIM %185700).  This includes stiffness of the DIP joints of the hands and feet.  Less is known about this condition but it is also autosomal dominant.  SYM2

Traditionally, attempts to surgically improve finger motion in symphalangism have had limited results.  However, recently, Baek, et al reported reliably improved motion with surgical release.  They also felt surgery in younger children may be more successful.  Baek paper

Patients with symphalangism present with a stiff finger (or more than one, finger or toe).  On examination, the stiff joint will not have the normal skin creases on the top or bottom.  X-rays may appear similar to the normal fingers but often the two bones are fused on x-ray so that there is no joint.

Here is one example of a child with symphalangism and a single, stiff joint.

Middle finger (long finger) symphalangism.  Note the lack of skin creases over the PIP joint.

Symphalangism.  Note the lack of finger flexion of the middle finger at the PIP joint.

The x- rays in symbrachydactyly look normal without clear evidence of the abnormality.


  1. I believe both of my boys have symphalangism and a single stiff joint. I had asked my children's doctor about their middle fingers and how they looked different than they should. The doctor seemed unconcerned and said it was something we could x-ray later in life. My sons' fingers look just like the fingers in the photo above of the small child. My older child has this on both hands and my younger child only seems to have it on one hand. No one in my family seems to have this condition, but both my boys do. My older child in 3.5 years old and the other is just 1 month old. I am concerned about the other conditions that can go along with this. How would I know if they have one of the conditions that can go along with this? My older son had hypospadias, which was corrected with surgery, and also is having issues with his eyes (crossed eyes, lazy eye)… are any of these conditions known to be connected with symphalangism? Since my children's pediatrician doesn't seem to be knowable on this topic I would love to hear from someone who is? Should I find a specialist of some kind and have my children seen by this person? If so, what kind of specialist should I see? What kinds of other things should I be looking for in my children to know if there are other related health issues going on with them? I can email you pictures of my children's fingers if you provide me a way to contact you. Thank You so much for your time!

  2. Mandy, thank you for your comments and question. We know that symphalangism can be passed along in an autosomal dominant way and so both kids having it makes sense. We know that there are very few associated conditions- this link highlights the genetic suspected cause- the noggin protein: I also understand that hearing loss can be associated. Questions
    1) A geneticist might be helpful. Their expertise will obviously depend on their experience but someone at a Childrens Hospital is typically somewhat knowledgable and can research the issue further.
    2) Again, there are no major associated conditions to my knowledge other than other stiff joints
    3) If I can help more, feel free to email at

    Thank you.

  3. My has 4 fingers on each hand with thumbs being normal. His father only has the fifth digit affected. Im concerned with him playing sports a risk of injury. Or even impaired circulation. His hand's are freezing. Color is normal. He is perfectly capable of writing, typing, and even trying to play a guitar.

  4. Jennifer,

    Thank you for the comment. In my experience, sports and other activities are safe. I am not sure why his hands are cold- does it vary based on the weather? Finally, I am glad to hear that he can participate in perform the listed activities- this is what really matters and most kids and adults function normally (they just might do things slightly differently).

  5. My daughter is 16 and suffering from this condition. She really wants to be a surgeon when she grows up and so the use of her hands is very important to her. Her hands work just fine now, but they are constantly stiff and sore. Is it possible for her to have her hands operated on at this age, even though the article said that the outcome was best in younger patients? And if so, do you have a name of a doctor that could perform this surgery?

  6. Kathryn,

    Thank you for your question. Surgery to restore joint motion in symphalangism is difficult even in a young child and I do not think possible in older patients such as you daughter. However, occasionally, there may be surgeries to put fingers in better functional positions which can both help function and decrease symptoms. This is difficult to clarify further as it depends on which joints, which fingers, etc. An experienced hand surgeon (ideally one with experience in birth differences) can likely give you advice. Good luck!

  7. My daughter is 4 weeks old and we have noticed she is unable and to flex (passively and actively) all of her PIP joints on both hands. I am suspicious she may have this. How early do you recommend surgical intervention if she is a candidate?

  8. Kayti,
    Thank you for the question and sorry for my delay. If you have a hand surgeon who specializes in this condition, it would make sense to seek intervention early. The one report by Baek reported surgery a bit older than I would prefer, 46 months on average. Earlier surgery allows earlier remodeling and I have operated at closer to one year of age. Better motion can make a difference to function. If I can answer more specific questions, feel free to email at

  9. Hello Mandy.
    I was born with my fingers like that too. I lived all 48 years of my life with no joints in my middle and ring fingers on both hands. As a child sometimes the fingers were in pain. My grandmother would put aspercreme to soothe the pain. I no longer have pain and I have 5 children that all have perfectly normal fingers. There were no other symptoms that occurred with my situation. Please feel free to call me if you have any other questions. You can reach my office at 9418934164. Just ask for Gina Medina. Thank you

  10. I have this condition. I have never met or heard of anyone else with it so it's interesting to see this, I now have a name for it. I have no DIP joint in both my index fingers and my pinky. It never gave me any problems growing up, my hands are never sore and I am healthy with no other illnesses or conditions, it was just always something that was unique to me that rarely crossed my mind. No one was ever concerned about it although any medical people who were aware of it had never seen it before. I now have three children, first has normal hands, the middle child has DIP joint missing on one index finger and my newborn baby has the DIP joint missing on both index fingers. I do not know of any other relatives with this and I come from a very large family. Great to see this, I must now keep researching this.

  11. I have no pip joints in any of my fingers. My toes are also effected but more severely. Furthermore, 2 of my 4 children have identical deformities. This has been passed down the family since at least the late 18th Century.

    We haven't considered surgery for the 2 affected children. It is only mildly disabling & doesn't affect day to day life very much. That being said we can't manage musical instruments & are more prone to dropping things!

    Any questions please feel free to email me @

  12. My son has this – he has fully fused PIP joints in his fourth and fifth fingers bilaterally, and immobile PIP joints in his third fingers (though the joint space looks more normal). He is six. His epiphyses for his fourth and fifth fingers seem to have fused to the fist phalanges – how often have you seen stunted finger growth in these kids as they get older? Or do their fingers usually grow to regular length? Thanks!

  13. Hello. Fingers are typically of nearly normal length as the growth plates are fine, only the joints do not develop. I do wonder when you state that the joint spaces look normal- often the growth plates are mistaken for joint spaces (which may not exist).

  14. Hello. I have Symphalangism in my hands and feet. Both my ring and pinky fingers stopped growing just before the middle knuckle. My ring finger being just over and inch, and my pinky just below an inch, both with no nails or nail beds (on both hands). Also, my index and middle fingers are one solid bone that bend only where the finger meets the hand. Both fuzed in a straight position. My thumbs are perfectly fine. The last 3 toes on both feet are just like my ring and pinky fingers. Both second toes are like my middle and index fingers. I only have 16 functioning joints in each foot, causing much muscle strain. I can't rotate my ankles, only move them up and down. I have somehow managed to teach myself how to play the guitar, and become better than I ever thought possible. But, as I wish to expand my abilities with the instrument, I'm running into walls caused by the lack of mobility in my fingers. If there is any advice anybody can give, it would be greatly respected and appreciated.

  15. Thank you for your comment and description. Unfortunately, there is no reliable way to restore motion of the fingers. Sometimes there are ways around specific functional challenges and it may be helpful to visit a congenital hand surgeon (and specialized hand therapist).

  16. Hello. My daughter is 6 months old and i think she's suffering from Symphalangism. she is hard to open her right thumb. her right hands looks like the first picture. What are the possible treatment for it? Thank you!

  17. Hello Mary Ann,
    Thank you for the question. I would take your daughter to a hand surgeon who has experience with birth differences. They can make the diagnosis (not always easy) and may recommend treatment. If this is symphalangism there is a surgery which can help restore motion. Good luck.

  18. my daughter has symphalangism.and short finger compared to the left hand..when i read comment i understand the surgery will improve the motion.. anything can happened to make length in finger

  19. Surgery MAY improve motion, especially when performed in younger children. Lengthening fingers can be done (see other blog posts) but is tricky in the fingers and we do not routinely perform. Problems include slow healing, stiffness (if there is motion), and the creation of fingers that look very narrow. We do sometimes lengthen the metacarpal (ie, the hand bones) as lengthening at this location has fewer challenges (but still can lead to stiffness). Good luck.

  20. Cool, now I have a name for something I've lived with my entire life! My dad, my sister and I all have PIP symphalangism. Our hands are totally normal in every other way – we just have absolutely no motion in our PIP joints and the skin over these joints are perfectly smooth – and our thumbs are normal. We are otherwise pretty much healthy and average.

    Anyway, we have noticed a few things are difficult for us such as making a fist, gripping ropes and thin metal bars, opening bottles of soda..

    However, all three of us are adept at things requiring fine motor skills – soldering, drawing, fine electrical work, needlepoint, pretty much anything that requires precision. We have always joked that our weird fingers make us natural artists and engineers haha. And in regards to musical instruments, I taught myself flute, piano and guitar with almost no problems – forming some chords on guitar was very difficult, but otherwise my guitar playing was pretty good, and flute and piano presented zero problems. I hope relating a few of my personal experiences will help any of you that have kids with hands like my family's! Just warn them not to punch any hard objects…hurts so bad haha! Any q's email me

    …as an aside I would be interested in discovering what caused our hands and the genetic background behind it.

  21. Thank you Alex. Very helpful and interesting. Most cases, we believe, are related to the NOG gene (noggin) or perhaps GDF-5. Reports of varied inheritance patterns but yours may well be a dominant inheritance pattern.

  22. Hi,
    One of my six children has symphalangism (not officially diagnosed, but definitely like the case above) in the ring and pinky fingers of both her hands. I've tried putting pressure on one of her ring fingers to bend for a few minutes at a time over the past few days, and already we can see a bit of play in the joint. Such an exercise helped me gain normal motion in the joints of my own pinkies, which had the same problem when I was a child. Is there any harm in doing these exercises on her, and could this technique help others in this situation?
    Thanks so much for posting about this; info is hard to come by.
    All the best,
    EG Edelson

  23. EG,
    Thank you for sharing your thoughts. I do agree that there is a role for early therapy as it can help provide some joint mobility. As long as the exercises are not too forceful, there is little risk of harm. However, in many patients with symphalangism, this won't be enough to overcome the anatomical differences in the joints.

  24. Im a 20 years old male with congenital stiffness in both my mcp joints of the big thumbs. My father has the same issue.

    This here is the most information i could find close to what i have. Is it that rare of a condition?(just to note, this didnt affect me at all or my father so far in day to day activities

  25. Andy,
    Motion of the thumb MCP joints varies dramatically from person to person. Some, like you and your father, have very little motion while others have up to 90 degrees of flexion. Thankfully, as you note, function is NOT affected. Thanks for sharing.

  26. Hello Dear Charles,
    I am writing you from Azerbaijan.
    We are also noticed that my niece (2months) has symphalangism and a single stiff joint on his both hands (3 fingers on each hand). His' fingers look just like the fingers in the photo above of the small child.

    But there no any doctor in our country who knows what is it and who are able to assist and make a surgery to this kind of problem.

    We would like to know are there the possible treatment for it? Physyotherapy or smth like that. Or we need a surgery.

    Also it possible to make a surgery and to restore fully the motion of the fingers? My niece is 2 motnhs old for the moment, is it the good time to make an involvemnt,or we need to wait for some time.

    Can I ask you for the help, may be you can recommend any good surgery or doctor in Turkey or Russia who can make a surgery. We will be very gratefull for your advices.

    Thank You so much for posting about this and for your time!

  27. Thank you for writing Gulshad. Congratulations on the birth of your niece. Therapy does not help in these conditions. There is, as described, an uncommon procedure which has been shown to help. Some congenital hand surgeons will offer this surgery but certainly not all. It has been shown to help motion but requires aggressive therapy after surgery. Unfortunately, I do not have surgeon recommendations in Turkey or Russia- I am sorry. Good luck.

  28. Hello,

    My son is 4 years ( 52 months) old. I just noticed last night his small finger is very stiff ,he has this symphalangism in both of this hands. We want this to be corrected so he can all normal things as usual . We live in Baltimore , can we meet you and do the suregery if needed . I tried the internet but could not get more information anywhere . Please help us

  29. Hello! I have symphalangeism as does my daughter, my sisters, dad, grandmother, the list goes on. It is prevalent in our family. I would say 95% of offspring in my family has this in one shape or form. Some just a few fingers…my daughter and I are affected on all fingers and toes.
    In our case…there aren’t many things that are a problem. We function just fine. I am a bit hard of hearing as is my dad and grandma. However, this isn’t a major issue where hearing aids are needed (except for my 88 year old grandma she has hearing aides because I her hearing is terrible…but she’s 88 😉 I would say overall someone with this condition leads a perfectly normal life! I can see how this could be concerning to people that aren’t aware of this condition. Maybe it is because this is so prevalent in my family and everyone leads a mostly normal life because of it, it’s not an issue. Just a unique characteristic :)))

  30. Stefkoerner,
    Thank you for your comment and sharing your family's experience. OMIM is a great website which gets into the genetics. Your experience will be helpful for our community.

    I think you are on to something regarding the impact of your family's significant number of affected members on the fact that the symphalangism is well tolerated. I might only add that the functional impact varies based on which fingers are affected.

  31. I believe my son has this but his pediatrician has diagnosed him with trigger finger. Of course, I don't believe that diagnosis, as he is missing the wrinkles on his pinky knuckle(s). I am pretty sure it is Symphalangism. However, there is another quirky issue he has on the same finger, which is two small nail beds at the tip slightly below his nail. I haven't found any text or anyone else online that has described such, so I am curious to know if anyone else has experienced this as well.

  32. Thank you for your comment. Trigger fingers are really uncommon in kids (of course, so is symphalangism). But your comment about appearance and wrinkles is important. Your son can also have a dorsal- volar (ie top of finger, bottom of finger) duplication. Feel free to send pictures and we can continue to talk.

  33. Hi, thanks for the reply.

    I am pretty sure there is no duplication, as his xray appeared to be normal with no extra bones visible. I will snap a pic and email it to you soon. Thanks again.

  34. Hi Dr. Goldfarb. Your post seems to describe my two month old daughter's right pinky finger. It doesn't bend at the PIP joint and doesn't have wrinkles on top or bottom. The DIP joint flexes like normal. Is it best to get this checked out immediately or is there nothing to do until she's a little older? Also, since symphalangism is so rare, should we be worried about orthopedists not being familiar with it or is it pretty well known? There are plenty of pediatric orthopedists in our area of central VA, but I wasn't able to find any that mentioned congenital birth differences specifically.

    Thanks so much for the work you've put into creating this resource.

  35. Hi Dr. Goldfarb, I have had immobile PIP joints on both thumbs (especially the right hand) since childhood, and I am trying to get a better understanding of the condition, and whether anything can be done to improve it. As perspective, I'm 61 and I have resumed piano study after a 40 year gap. The joint in question is very significant in piano technique.

    I'm fairly sure the condition is congenital, since both my parents have low mobility in these joints, though not as severely. Many thanks in advance.

  36. Julian,

    Thank you for writing. This is interesting to me because I have seen less of this particular issue in the thumb joints. Of course, it can happen and a lack of skin creases can confirm the joint issue. I would not have guessed there would be many (or any) functional issues but you are correct, it makes sense that it challenges how you utilize your thumbs with certain specific activities. Good luck and thanks for sharing.

  37. My daughter has this condition. She is 10 months old and has the defect on her 2nd digit MCP joint bilaterally. She has limitations in her pincer grasp and we are debating if soft tissue release would be wise.

  38. Thank you for sharing. Symphalangism is most common in the finger joints (the interphalangeal joints) rather than the MCP joints. If x-rays confirm the symphalangism, a joint surgery might make sense. Not all pediatric/ congenital hand surgeons perform these surgeries. Good luck.

  39. Thank you for your reply. She has many features of the disease including loss of skin crease at that joint and limited ability in flexion. She did have 3V XR which showed normal joint spaces bilaterally. She was seen by a pediatric plastic hand surgeon who suspected this diagnosis. During my research there appears to be very limited information in regards to the disease as well as treatments and thus am hesitant to have her undergo a procedure if it were to provide little benefit.

  40. In younger kids, the xrays can be misleading and a joint space can disappear as the cartilage turns to bone. The other confusing feature can be that the growth plates can look like the joint. No

    Nonetheless, you are correct. The literature is limited. Most surgeons have limited to no experience treating this surgically. We have some experience- I would consider it positive but certainly not perfect.

  41. Can this situation affect the metacarpophalangeal joint? I know a child with that joint affected in both hands, he must have at most 20-30 degrees of flexion. thanks

  42. Yuri- thank you for the question. I have not encountered MCP involvement in the patients I have treated with symphalangism. Certainly, it is possible. In addition, the described child does have some motion and most symphalangism patients do not have motion at all.

  43. my 3 month old daughter was diagnosed with symphalanigm by the doctor, 2,3,4 fingers can’t move at all. she says there is no way for her hand treatment. I hope to find a way out for my daughter. I’m really frustrated, I wish forward to your response to my anxiety. thank you

    1. Danestio- I am glad my post was helpful. I do believe that treatment can make a difference even though it does not make the fingers perfect. Good luck.

  44. Hello, my son was diagnosed with BILATERAL MULTI FINGER SYMPHALANGISM at the age of 3. He also has mild to moderate hearing loss in both ears and his ankles are also stiff at times. He is now 9 years old. My question is can this condition get worse or does it remain the same? Also is there any type of hand exercise or therapy he can do to help with his mobility? Would surgery be an option for him at an older age? Thank you in advance for any information you can give me.

    1. Elizabeth,

      Thank you for writing. The combination of multiple fingers with symphalangism + hearing loss does make me consider genetic conditions that include multiple synostoses (bones fused). NOG is a gene that may be involvedsee here.. So, a genetic assessment might make sense. Any surgery would consider function and how to make function better. So surgery will not restore motion but could be considered as needed based on specific limitations your son may have. I hope this makes sense.

  45. Hi I am so greatful to have found a blog where I can discuss my son’s condition. I came to know my son has stiff PIP joints in the last three fingers (middle, ring and pinky) of both hands quite immediately after he was born. I immediately consulted a hand surgeon for his condition and he advised of starting my son’s physiotherapy for his fingers (only very light pressure to create movement in joints). He was 8 months old when he underwent a microneedle surgery where they tried severing his contractures that were possibly adhering him from full range of motion. The range of movement improved after the surgery (plus with physiotherapy) but later on the fingers came back to where they were before (or very minute difference post surgery to say the least). He is now going to be 2 years old and the doctor prescribes a complete reconstructive surgery for his fingers (one hand at a time). My doubt is should I go for another rather invasive surgical process when the former didn’t really produce any difference? My son seems perfectly fine is holding objects and doing different tasks it is the later stages of life that worries me.
    I still do physiotherapy of his fingers by closing his fist forcefully multiple times. Please suggest what should I do. Desperately waiting for your answer.

    1. Hello and thank you for sharing your experience. I must admit that I am not familiar with “microneedle surgery”, especially in a young patient. Another surgery might help but depends on the specific issue- presumably bony connection between the proximal and middle phalanx bones. While this condition can create functional challenges, your son may be just fine as he is. Of course, with age comes different demands for motion/ function than he may have currently. If there is bony fusion, therapy is unlikely to help. Feel free to communicate further by email-

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