A brief post with lots of pictures and videos on two conditions that may cause less than five fingers. As I have previously written, there are 5 common causes. Parents have given permission. Diagnosis 1. Symbrachydactyly. This patient has a great thumb and nubbins past the metacarpals. However function is excellent. The child will likely […]
Year: 2020
2 Common Types of an Uncommon Condition- Symbrachydactyly
When I consider all of the different patients with a birth anomalies that I have the privilege to evaluate and treat, there is no question that symbrachydactyly is the diagnosis most often misnamed or unnamed. Amniotic constriction band is perhaps most commonly given as the incorrect diagnosis for the patients. Symbrachydactyly literally means short, webbed […]
An Unusual Pollicization Procedure
Radial polydactlyly (extra thumb) is a relatively common problem for those of us who treat kids with birth differences/ anomalies of the upper extremity. Please see the following link for previous posts on the topic LINK. Sometimes these can be treated by a “straightforward” procedure with excision of the extra thumb and stabilization of the primary […]
Early Action in Madelungs Deformity
Years ago, I met an 7 year young lady who came to my office with no complaints. Mom brought her even though she had no hand or wrist pain and no functional limitations. The reason for the visit was a strong family history of Madelungs deformity (mom and sister). There was no clinical evidence of […]
Syndactyly as part of a syndrome
Syndactyly is most commonly an isolated finding which we believe is “simply” related to a failure of the cells to regress during development. This failure to regress means that the webspace does not develop ~ the 7th-8th week of gestation. We know that the apical ectodermal ridge is involved and signaling mechanisms including FGF-8. This […]
Tight First Webspace
The space between the thumb and index (pointer) finger is crucial for function. We say that the thumb accounts for 40% of hand function – much of that function is related to grasping large objects in this ‘first webspace’. The thumb-index webspace, or as it is also called- the first webspace, can be tight or […]
Pollicization Long Term
Hello all. I want to share a good result in a challenging pollicization procedure. This patient has radial longitudinal deficiency with a poor, very limited thumb (we call it type 4 hypoplastic thumb). The decision was made to excise the thumb and create a new one with the index finger (e.g., the pollicization procedure). We […]
Radial polydactyly- progress and patient follow up
I have shared my thoughts on radial polydactyly (extra thumb) a number of times- those other posts can be found at https://bit.ly/3emosGU. Radial polydactyly is a common diagnosis for those children with birth differences but each child and each extra thumb is also very different. This makes comparing children difficult and results are limited in the […]
The Elbow in Birth Differences of the Upper Extremity
The elbow is not commonly discussed around the topic of birth differences of the upper extremity. We discuss fingers, wrist, and forearm most commonly. The shoulder is also occasionally involved but much less so compared even to the elbow. My goal in this blog post is to highlight some of the birth differences that may […]
Congenital Differences- Timing of Intervention in the era of COVID-19
March 28, 2020 We are in an unprecedented time. COVID-19, the coronavirus which began in Wuhan Province in China in late 2019, has impacted our world in many ways. Medical centers in the US and Europe are in a time of crisis as they prepare for or are in the midst of the pandemic. In […]
Radial Deficiency Outcome
Radial deficiency (or radial longitudinal deficiency, RLD) is one of the most challenging conditions that I treat. We classify patients with RLD based on their bone development but that does not capture the underlying muscle and joint abnormalities. Reports on treatment including surgery have been mixed and that has led hospitals and doctors to have […]
Syndactyly: The Type Matters.
Syndactyly, simply put, means joined fingers. However, there are a number of different types including:– cutaneous (or simple)- only a skin connection– Complex- with a bony connection– Complicated- with an associated syndrome– Partial vs complete (whether part way or completely to tip of finger).– Complex polysyndactyly. That is, extra bones and bony connections. The partial […]
Two different thumb birth differences
The thumb is our most important digit. In the adult, we estimate that it affects about 40% of hand function. So, a thumb that is not fully or normally developed may really affect our abilities- whether that be strength, motion, dexterity, etc. I have written a number of posts (See HERE) about the thumb but […]
Recurrent Syndactyly
Syndactyly is the abnormal connection between fingers- typically skin connection but sometimes bony connection (called complex). I have written much about it HERE. There is also information on the internet including some basic information on Wikipedia, NIH, and numerous hospital websites. While syndactyly is one of the most common congenital upper extremity diagnoses, treatment is not perfect and ‘failures’ […]
Cleft Hand: Beyond the Basics
I have posted numerous times on cleft hand. (See other posts.) In my world, this is a still an unusual diagnosis and can be challenging as each child is somewhat different than the next. The early and late treatment of cleft hand, therefore, has to be considered for each child. Late treatment in cleft hand is […]
Amniotic Constriction Band- how we can help function
Amniotic constriction band is a common condition which typically involves more than one extremity. While the belly and face can be involved in rare patients, the arms and legs are the classic sites. Every child with amniotic band is different. Totally. Sometimes, physicians refer to it as a syndrome but that is not really accurate- it is a random pattern of constriction rings, […]
Ulnar cleft hand, part II
My most recent post, from Dec 5th, was on a rare type of cleft hand, the ulnar cleft hand. Ulnar cleft hand is very different and even less common that the classic cleft hand which involves the central hand (classically with middle finger absence). There have been a few manuscripts on the topic of ulnar […]