Murderer’s Thumb

Murderer’s thumb is one name for brachydactyly, type D. The is a short, round distal phalanx of the thumb and may be one on side or both. The nail looks wide relative to the overall length of the thumb. Other common names include stub thumb and club thumb (not to be confused with the medical […]

Understanding the Specifics of Upper Extremity Birth Differences, Part 2

It has been far too long since my post on the “Why” of Birth Differences.  I apologize and I know at least some of you have been awaiting this post.  No excuses but I am now on a new platform and the transition took time. This is Part 2 in which I will review some of the […]

Part 3. Genetic Testing

This is the 3rd in an overview series on congenital differences (i.e., conditions present at birth) of the upper extremity. It might help to review Part 1 (Understanding the ‘Why’) and Part 2 (Specifics of Common Differences) before reading the following but each does stand on their own. My goal in this post is to […]

Syndactyly, Macrodactyly, and Keloid

The treatment of syndactyly is highly successful, no matter the preferred technique. That is the classic technique of Flatt (dorsal commissure flap and zig- zag incisions- ) or graftless techninques or hyalomatrix- all can work. Complications include web creep (maybe not a true complication as it is so commonly seen), wound healing issues, rare infections, […]

Understanding the ‘Why’ of Upper Extremity Birth Differences Part 1

Birth differences of the upper extremity have many different forms/ presentations. These can be a dramatic with a shortened or deviated extremity or very subtle/ mild with slightly short fingers or a subtle lack of muscle development. In my three decades of caring for kids, it has always been clear that our team is truly […]

Forearm Synostosis- Facts and My Approach to Treatment

 I have previously blogged about forearm synostosis HERE.  A few important points 1) It uncommon compared to other upper extremity anomalies but is perhaps the most common of the forearm birth differences. 2) It is really well tolerated by most children.  Especially because the rest of the upper extremity is typically normal (most importantly, the hand) […]

2 Reasons for Less than 5 Fingers

 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 […]

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 […]

Not the typical hand deficiency- ulnar cleft hand

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.  […]

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 […]

Myoelectric Prosthetic Training for Kids

It seems clear to me that 3D printed myoelectric prostheses are the future for upper extremity prosthetics in all age group but especially for kids.  These prosthetics can be customized, are developed/ fabricated quickly, can be replaced for a low price, and have so much potential.  I am hoping and expecting real progress over the […]

Severe Radial Deficiency, Before and After

I have posted numerous times on radial longitudinal deficiency.  The birth anomaly is common in my practice and I have been fortunate to meet many great kids and families with radial deficiency.  A few posts can be seen HERE. Early in my career, as influenced by my training, most patients with radial deficiency were treated with […]

Thumb Web Space in Amniotic Band

Amniotic Constriction Band is a common condition which affects each child differently.  It can lead to syndactyly (joining of fingers), amputations, or deep bands which limit function.  It often affects more than one extremity (ie, hands and feet) making efforts to maximize function really important.  I have posted many times on amniotic band- those posts […]

Severe Radial Deficiency- No slowing this kid down!

The absolute best part of my job is meeting so many great kids and great families.  What other job allows daily inspiration, with each day being a bit different with a new story, a new set of expectations exceeded, and many, many smiles. This is the abbreviated story of one amazing child and family with […]

Untreated Cleft Hand

Cleft hand is one of the most notable birth anomalies of the upper extremities.  The appearance is distinctive although function can be really well maintained.  One of the founding fathers of the discipline of hand surgery, Sterling Bunnell, labeled cleft hand, “a functional triumph and a social disaster”. There are other names for cleft hand.  […]

Radioulnar Synostosis

Radioulnar synostosis is the presence of a bony connection between the radius and ulna.  I have previously blogged a few times on it HERE.  While a synostosis can develop after a trauma, we typically discuss it when present from birth.  The synostosis prevents forearm rotation but does not affect elbow or wrist motion (these are […]

Unusual “Extra” Finger

I have posted many times on polydactyly- both on the thumb side and the pinky side- as can be seen HERE.  The following patient demonstrates an unusual presentation of what initial appears to be an extra finger, an ulnar polydactyly.  But, as a quick ‘count’ confirms, there are only 4 fingers with a thumb. Ulnar deficiency […]

Function in Radial Deficiency

Radial longitudinal deficiency is both a functional challenge and an appearance issue.  Different surgeons have developed different strategies based on these challenges and the lack of a ‘perfect’ surgery.  My philosophy is to consider different surgeries, based on the child.  I will consider centralization (typically with a period of external fixator distraction prior to the […]