Central Deficiency (cleft hand) Rare Conditions

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 series, he reports on 3 children and describes ulnar cleft hand and reconstructive options.  Often the pinky needs to be re- aligned and stabilized.  The cleft can also be narrowed although, as with the more typical cleft hand, is not necessarily a function improvement.  It can be, however, an important appearance issue.

I have recently cared for a delightful family with adopted children from China- one has bilateral ulnar cleft hand.  As makes sense with adopted children, the family is taking a watch and see approach rather than jumping into surgery.  I think this is great.  Obviously, we want to really understand the child’s function before even considering surgery.  And, to this family, the appearance not such an important factor.

In ulnar cleft hand, there is usually a good thumb and at least one good finger.  That is the case below with this ulnar cleft hand.  However, in Dr Tonkin’s article, some kids had four digits and some had 5.

Notice the really deep cleft on the pinky side of the hand.  This is the case for both hands.  Note also the great thumb- index web space.   There is good alignment of the thumb.  The child has excellent pinch and large object grasp.  The pinky is not particularly useful on either side with the ulnar cleft hand.

Ulnar cleft hand, bilateral.

Ulnar cleft hand, left.  See deep cleft.

Right ulnar cleft hand.
x-ray of ulnar cleft hand.

x-ray of ulnar cleft hand, right side.

Charles A. Goldfarb, MD
My Bio at Washington University

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