A patient with a thumb and three normal fingers has a hand that functions at a near normal level and looks great. The narrow hand caused by a lack of a single finger (as long as the others are well aligned and no significant gaps exist) is not easily detected by others- it looks good. […]
Year: 2019
Hand Camp 2019- St. Louis Shriners Hospital
I realize that I post about Hand Camp nearly every year. Our St. Louis Shriners Hand Camp is really something special. But I do so for good reason- it is just so impactful for kids, families, staff, and me! Being outside the hospital setting allows a different kind of conversation and allows a different perspective for […]
Nerve Injury after Trauma
The blog is mostly about kids born with differences in the arms (and occasionally legs). However, my practice also includes kids with sports injuries and other traumas. I will occasionally post interesting findings on these topics as well. This is a child with a nerve that is not working correctly after an elbow fracture. Specifically, […]
Activity Specific Prosthetics
This is a brief post on activity- specific prosthetics. There has been much controversy on the timing and appropriate use of prosthetics in kids. I have previously blogged about this several times as can be seen HERE. I really appreciate activity specific prosthetics. The child is engaged in the process based on a demonstrated interest and the specially […]
Untreated Adult Hypoplastic (Small) Thumb
On occasion, an adult comes to my clinic for evaluation of one issue and a previously unrecognized issue is identified. This type of presentation can come in different varieties and, due to my particular practice type, often we find a birth anomaly that has not been recognized or treated. This patient is one very interesting […]
Distal arthrogryposis, before and after
Distal arthrogryposis is very different from AMC or other forms of arthrogryposis. By definition, distal arthrogryposis includes joint tightness (contractures) in the hands and feet. Here is an excellent Link from NIH. I have also previous posted on distal arthrogryposis, those links can be found HERE. I wanted to share some early results on a 5 year […]
Fixators for Lengthening. Fun?
External fixators are devices that rest outside of the skin. They can be used to stabilize broken bones (although not used very often for this purpose today) or to correct a short or angled extremity/ bone. We use fixators to lengthen small bones such as the thumb to allow pinch or to grow the forearm […]
Forearm Synostosis
The forearm typically has two bones, a radius and an ulna. The benefit of having two bones is that it allows the radius to rotate around the ulna. This means we can position the hand palm up and down. This is functionally helpful but not functionally mandatory as there are many ways to make up […]
Only a thumb. Amazing outcome!
A child with a single digit may have one of two primary diagnoses. If there is a single digit– most resembling a little finger, the diagnosis is likely ulnar deficiency– most resembling a thumb, the diagnosis is symbrachydactyly Other diagnoses affecting the fingers include amniotic band syndrome which typically affects the central digits and causes […]
Severe Camptodactyly
Severe camptodactyly can be a challenge as it will limit function and may cause pain. This is less common in childhood and more common for the adult with untreated camptodactyly. I have previously shared thoughts on camptodactyly HERE. Treatment of camptodactyly in the child begins with therapy. Depending on the nature of the camptodactyly, this may […]
Distal Arthrogryposis- thoughts and techniques for treatment
Distal arthrogryposis is defined as multiple contractures affecting the hands and feet. This can include the thumb, fingers (camptodactyly) or clubfoot. Our understanding of these conditions continues to expand and these sites each provide great information:Rare Disease siteGenetics siteOMIM While distal arthrogryposis may be lumped as a diagnosis, the diagnosis can also be subdivided into […]
Short arm and hand deficiency- phocomelia or longitudinal deficiency?
Phocomelia is Greek for ‘seal limb’, a descriptive term for a short, deficient arm (or leg). I have previously posted on this topic HERE. For many years, patients with a really short arm were diagnosed with phocomelia as it became a ‘wastebasket’ term for such patients. However, the term should be used in patients with an […]
Symbrachydactyly- The typical form defined
I have posted a few times on symbrachydactyly and those posts can be found HERE. In addition, there are several reasonable summaries at other sites including this free ARTICLE from a friend and colleague, Michelle James. Many hospital sites also offer a brief summary of the diagnosis. In my practice, it is not common that patients come […]
Sprengel Deformity Outcome
Sprengel deformity is the presence of a high- riding shoulder blade (scapula). I have previously blogged about it HERE (although it has been awhile). Sprengel deformity is uncommon although the exact incidence is unclear. It can be associated with a number of conditions including Klippel Feil (cervical spine vertebrae fusions), scoliosis, and other less common conditions (although all […]
Research Matters
The Paul R. Manske Award for Best Congenital Manuscript is named for my late partner who had such an important impact on the field. This Award recognizes the most impactful paper related to kids born with hand or arm differences, anomalies, etc. I am happy to say that our paper was selected for this award […]
Finger Deformity- What happens late?
Clinodactyly, bent finger, may present at birth, in childhood, or with the rapid growth of adolescence. If the bent finger is mild, it will not limit function and often may be treated with stretching or simply observed. However, a more notable bent position becomes a functional issue with large object grasp and with simple things […]
Madelungs Deformity Surgical Technique
I have posted a few times on Madelung Deformity, as may be seen HERE. While there have been a number of surgical techniques recommended over the years, I believe that the dome osteotomy of the distal radius is the best option. That procedure was described well in this important MANUSCRIPT. Below is a brief surgical technique video […]
A New Thumb: Early Pollicization Outcome
Pollicization is one of my favorite surgeries for kids born with hand differences. This child is several months out from the pollicization procedure. He is using the new thumb as demonstrated in this video and the family (and the surgeon:)) are all very pleased with the appearance of the hand and thumb. While kids begin […]
Madelungs Deformity- not always a problem
Madelungs Deformity is a common condition in my practice although uncommon in general. I have previously blogged about it a few times- you can read those posts HERE. In general, I see patients in my office with Madelungs who have symptoms including pain with activities, limited motion, and wrist deformity. Most commonly, we see patients in […]