Hand Limitations in Ulnar Longitudinal Deficiency

My mentor, Paul Manske, clarified years ago that the hand is often the greatest limitation for children with ulnar longitudinal deficiency in this classic ARTICLE.  And, as I have previous blogged HERE, the hand limitations can manifest in many different ways.  There are many different ways this presents in ulnar longitudinal deficiency including: thumb and index finger webspace tightness, […]

Radial Deficiency, Doing Fine

As a surgeon, I have a bias that surgery can help most of the time.  And I feel this one because I have seen it help in so many children.  Surgery can help function and it can help appearance- both are important.  And as a surgeon, I feel fortunate to be able to offer surgery […]

Rare Bone Tumor- Fibrous Dysplasia

Fibrous dysplasia is a bone tumor which is related to a genetic abnormality leading to abnormal bone formation.  Normal bone is replaced by a fibrous tissue.  It can present at any age- young kids, adolescence, or even adulthood.  It is a bone tumor but it is benign growth. Rarely, the tumors can become malignant, but […]

Young Adult with Multiple Hereditary Exostoses

Multiple Hereditary Exostosis is an uncommon condition with the growth of multiple benign tumors or bone/cartilage growths.  These can be called osteochondromas or exostoses.  It has been estimated to be present in 1 in 50,000 children.  Here is a great reference- NLM site. The growths can present in several different ways.1. Bumps which are not […]

Finger Bump

There are many reasons for bumps, cysts and masses in the fingers.  I have previous blogged HERE on some of these growths.  There is another common finger bump that should be discussed, the retinacular cyst.  The retinacular cyst is a type of cyst- a fluid filled sac- that grows from the flexor tendon sheath. Here are a […]

Syndactyly Treatment: What’s Next?

The basic treatment of syndactyly has not changed in many years.  The essential surgical care includes the creation of a web space (the ‘commissure’) with a flap and zig- zag incisions to the tips of the fingers to allow separation without straight- line scars (which can contract).  There is no doubt that our understanding of […]

Amniotic Constriction Band

Amniotic Constriction Band commonly affects the hand and feet.  I have previously posted on the topic on several occasions as can be viewed HERE.  I wanted to share a few recent cases to demonstrate the different types of Amniotic Constriction Band. This young child has Amniotic Constriction Band affecting one foot and one hand as depicted […]

3D Progress

I have posted several times previously on our work with 3D Printed Prosthetics, the posts are compiled here.  Sydney is one of our patients who has been a big part of this process.  She recently received the latest prosthetic version, a 3D Printed, Myoelectric device and fabricated for about $110. Today, there was a great deal […]

More on Amniotic Constriction Band

I recently posted on a young child with Amniotic Constriction Band Here.  I wanted to update that post with additional information.  Prior to coming to me, the patient had been treated in an urgent way by Dr Erin Greer who performed a z- plasty and release of the tight band.  This surgery was done to help […]

Amniotic Constriction Band and the Hand

Amniotic Constriction Band is a common problem in our clinics.  Kids can have a diagnosis of amniotic constriction band and yet their hands can all look very different from one another as there are simply so many different presentations.  I have previously written about this topic here but I wanted to share a few more thoughts. We […]

Hand Surgery in Children

The timing and appropriateness of surgery of the hand and arm in children with  birth anomalies are difficult topics.  The problem for parents and doctors is that we don’t truly know how well any particular child will adopt to his limitations and how much those limitations will affect his/ her life.  We all hope for […]

Thumb position and the 3 digit hand

I have posted on thumb rotation and if you search the blog, you will find a number of posts on ulnar longitudinal deficiency.  Scrolling through the pictures, a pattern begins to develop in these kids with ulnar longitudinal deficiency– that is, many of the kids have a well developed thumb and 2 very good fingers. When we think […]

Outcome after Surgery for an Extra Thumb

The condition of a child born with two thumbs has many, many names but most commonly, we call it radial polydactyly, thumb duplication, or split thumb.  While all are utilized, radial polydactyly is the medical term and split thumb is appropriate as both thumbs are smaller than the other thumb.  I have posted about radial polydactyly previously […]

Multiple Hereditary Exostosis- Its Not Always about the X-rays

Multiple hereditary exostosis is an uncommon tumorous condition and is capable of causing significant functional limitations.  I have previously posted on MHE.  While multiple hereditary exostosis in the fingers can cause deformity and limitations of finger flexion (I need to post on this topic), we worry more about the forearm.  The problem is that if the two bones […]

Pollicization- concerns immediately after surgery

Pollicization, or the creation of a thumb, is a fantastic procedure that creates a hand that is more functional and looks better.  It is certainly a specialized procedure in that most hand surgeons don’t perform this surgery.  I do believe that this is a surgery that is best performed by surgeons that do at least […]

Finger Masses

I see a number of kids with growths on the fingers.  These growth vary tremendously in size and expectations but these are technically tumors. The good news is that almost all of these finger masses are benign- meaning that they don’t spread to other parts of the body.  They are still concerning to the family. […]

Exciting Times!!

The opening of a new hospital or major facility is unusual in our modern healthcare system.  It requires a great deal of planning, coordination, and plans for growth.  That is why it is so incredibly uncommon and exciting that TWO new pediatric facilities are opening right now in St. Louis.  TWO, both in the first […]

Stiff Fingers

Symphalangism is one type of finger stiffness;  I previously written about it here.  I wanted to share a few more thoughts.  In addition to the classification noted in my other post, I often think of symphalangism in terms of whether or not the fingers are short.  Whether the fingers are short or not, symphalangism is quite […]

World Congenital Forum

Once every three years, an international group comes together for approximately 3 days to discuss all things relevant to the care of children born with musculoskeletal differences.  In 2012, it was here in the United States, Dallas Texas to be specific.  In 2015, the 10th World Symposium on Congenital Malformations of the Hand and Upper […]

Triphalangeal Thumb

The normal thumb has two bones- 2 “phalanges”- which makes it different from the three bones of the fingers.  Occasionally, we see a thumb with 3 bones- 3 “phalanges”- and we call it a triphalangeal thumb.  I have previously blogged about different aspects of the triphalangeal thumb– 5- finger hand and another on the Five finger hand.  Also, […]

Underdeveloped Thumbs

Underdeveloped Thumbs  It is always interesting to me when I see an older child with underdeveloped thumbs, aka hypoplastic thumbs.   Most of the time, children with small thumbs are identified early in life as small thumbs are typically part of a larger issue, radial longitudinal deficiency (RLD).  However, when isolated, underdeveloped thumbs can be […]

Unusual Clinodactyly

I have written previously on clinodactyly with several posts.  Clinodactyly, the curved finger, is typically not a functional problem.  But, a more severe deformity is more likely to be a problem with activities and patients often complain of trouble with things like keyboarding and musical instruments.  Clinodactyly of the small finger is most common location and […]

The Short 4th Metacarpal

We will, from time to time, evaluate a patient presenting with a painless shortening of the 4th (and sometimes 5th) metacarpal.  Often, the complaint is of an absent knuckle or a different- appearing hand.  Here is one such 14 year old patient.  The primary issue is the shortening of the ring finger metacarpal bone although […]

The Big Thumb

The term ‘superdigit’ is utilized in congenital hand surgery to describe a digit that is larger than we expect. It is often related to the fusion of two digits into one and may be seen in cleft hand and central polysyndactyly among other conditions.  We also see large digits in other conditions such as Macrodactyly.  […]

Names Matter: Radial Polydactyly vs Duplicated thumb

There are a number of terms for describing the patient with two thumbs including, ‘duplicated thumb’, ‘extra thumb’, ‘radial polydactyly’, and ‘split thumb’.  While the particular term may not seem to matter, it does have important implications. ‘Radial polydactyly’ is a medical term describing the location and anomaly- it is not controversial.  ‘Split thumb’ may […]

Ulnar Deficiency- Thumb Rotation

I have posted a number of times about both ulnar longitudinal deficiency and thumb anomalies.     As previously noted, in ulnar longitudinal deficiency, we more commonly offer surgery for the hand compared to the forearm.  The forearm rotation abnormality is usually something that kids can adapt to as the shoulder offers so much compensatory motion.  The hand is, […]

Syndactyly Outcomes and Challenges

Most children treated for syndactyly have an excellent outcome with normal finger motion and good maintenance of the reconstructed web space.  However, there are times with the ideal outcome does not happen.  A less than perfect outcome includes challenges like:      prominent scarring,      an inability to spread the fingers as widely as […]

Radial Deficiency- Every Child is Unique

Every child with radial longitudinal deficiency is unique and therefore is treated individually. While there are general principles in treatment and these principles may be applied to most children, we begin care by working to understand each child and each family. In a child with radial longitudinal deficiency presenting for evaluation, we consider many factors as we […]

Nora Lesion

A Nora Lesion is also knows as a bizarre parosteal osteochondromatous proliferation.  This tumor is a bony outgrowth on the outside of the bone, typically found in the fingers and off of the phalangeal bones.  The sexes are affected equally.  There is an occasional history of trauma but this may not be truly relevant.   […]

Ulnar Sided Cleft Hand

I have previously posted on cleft hand with a number of discussions.  More to come on this topic in the future as well.  However, I wanted to share a less common type of cleft hand, the ulnar cleft hand. Dr Tonkin from Sydney Australia has written about this unusual condition in the Journal of Hand Surgery.  In this case […]

The Extra Thumb

An extra thumb, or radial polydactyly, can represent a difficult problem in congenital hand surgery.  The difficulty is that each child with an extra thumb is somewhat different.  There are certainly patterns (as we see with the Flatt Classification system) but not every thumb fits this classification system.  Zuidam and all (under the leadership of […]

Thumb Deformity after Polydactyly Reconstruction

Radial polydactyly, an extra thumb, can be more challenging to treat than other types of extra digits.   The surgeon cannot simply remove the extra thumb as ligaments need to be recreated and often bones and tendons need to be re- aligned as well.  Nonetheless, if the surgeon can create a stable, well- aligned thumb, […]