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 […]
Author: Charles Goldfarb
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 […]
Trigger Thumb and Fingers
Trigger thumb is one of the more common reasons for kids to present to my office. While uncommon in the general population, for hand surgeons who treat children, trigger thumb is quite common. And, thankfully, kids do quite well with this condition. Some will improve on their own without surgical intervention and others require surgery […]
Extra Thumb Reconstruction
I have posted a number of times on radial polydactyly- aka split thumb, extra thumb, etc- HERE. This is a common birth anomaly and the decision for surgery is usually straightforward. Sometimes surgery is also straightforward while other times the reconstruction can be quite challenging. And, about one out of three patients with radial polydactyly will […]
Families, Choices, and Untreated Triphalangeal Thumbs
One of the benefits to my taking care of kids with birth anomalies of the upper extremity is the opportunity to really come to know the patient and the family, often over many years. This is magnified when more than one child is affected. This is one of the best things about my practice (and […]
Three thumbs
Radial polydactyly (duplicated thumb) is an uncommon condition in the general population- I have blogged about kids with extra thumbs a number of times. Those posts can be found HERE. Extra thumbs come in a wide variety of patterns, some of which are captured in the Flatt Classification (previously called the Wassel Classification) as shown in […]
Mission Trip
I wanted to share the experience of my first Mission Trip. I went with the World Pediatric Project (WPP), a wonderful organization with which I have a long relationship. I have cared for many of their patients in the US but have not traveled with them (or any other organization). Their website, which can be […]
Ulnar Deficiency Follow Up
Hand surgery is a great subspecialty. I am able to interact and treat many patients and I am rewarded in seeing my patients get better. However, there is a downside which is that I rarely follow patients long term. Typically, I am able to see them, provide treatment (whether that be therapy, injection, or surgery) […]
Surgery for Camptodactyly
Camptodactyly is the bent (flexed) position of a finger. I have previously blogged about camptodactyly HERE, but wanted to share my updated surgical strategy. Surgery is considered for camptodactyly when therapy is not expected to be effective or if therapy has failed to lead to improvement. It is absolutely my preference to always begin camptodactyly treatment […]
Macrodactyly, Syndactyly, and Keloid
Macrodactyly is very rare, even at centers such as ours that evaluate and treat many kids with birth anomalies of the upper extremity. Macrodactyly is a difficult condition to research as there is so much variability in presentation- fingers may be dramatically large, moderately large, or only slightly larger than the expected finger size. Treatment […]
Travel and News
Happy 2018! I hope it is a great one for you and your family. Well, I already have one resolution for 2018- blog more consistently. I am not meeting my goals and hope to do better in this new year. A few things to share. I had a wonderful trip to Japan as guest speaker […]
Adoption and Radial Polydactyly
In 2015 (the most recent year with statistics available), there were 5647 children adopted to parents in the USA. About half of those were from China. See link HERE. I am fortunate to see many families with newly adopted children. In addition, I often have the chance to assess x-rays and clinical information for families before […]
Syndactyly Revision Surgery
I enjoy performing surgery to correct syndactyly because it is a reliable procedure with high patient, family, and physician satisfaction. But, as with any surgery, there are complications and adverse events that can happen in the short term or at longer follow- up. The risk of complications related to syndactyly surgery is very low. It includes […]
First Pitch World Series
Hailey Dawson has been in the news over the last few months as she seeks to throw the first pitch in all the Major League Ballparks. Well, she took a big step tonight on the biggest stage- the World Series! World Series Story. What a great story which helps to raise awareness of birth differences of […]
The 5 Finger Hand
The 5 Finger Hand is a rare congenital hand difference which I have written about in this blog once before, HERE.. It is, as it sounds, the presence of 5 fingers, all in the same plane, instead of 4 fingers and a shorter (2 phalanx), palmarly placed thumb. The challenges of the 5 Finger Hand […]
Hand Camp 2017
One of the highlights of my year is Hand Camp. Each year (see previous posts), I have shared a brief post but for those of you without a Hand Camp experience, I will briefly describe. This is a camp run by the Shriners Hospital team including the occupational therapists, recreational therapists, social workers and nurses. […]
Cleidocranial Dysplasia
Cleidocranial dysplasia is a rare birth condition most notable for the lack of collarbones (or small collarbones- clavicles). While this is recognizable, other findings include abnormalities of the teeth as well as delaying closing of the fontanelles (skull bone deficits). This is an autosomal dominant condition related to the RUNX2 gene but importantly, it is […]
Hypoplastic Thumb Reconstruction
Patients with a small thumb- a hypoplastic thumb- often have functional limitations due to limited muscle development and a lack of joint stability. Therapy is always the first line of treatment but is often unsuccessful with this anomaly. We therefore often proceed with surgical reconstruction. I have previously blogged about the surgical choices and recently […]
Thumb Reconstruction in Action
My favorite day of the month is our ‘big’ clinic at the Shriners where my partner and I see patients all day (no surgery). It is such a pleasure to see new and followup patients with so many different rare conditions. I learn at each of these clinics because patients show me (and sometimes tell […]
Hand Anomalies and Adoption
Adopted Kids and Polydactyly In 2015 (the most recent year with statistics available), there were 5647 children adopted to parents in the USA. About half of those were from China. https://travel.state.gov/content/adoptionsabroad/en/about-us/statistics.html I am fortunate to see many families with newly adopted children. It is one of the most enjoyable parts of my practice. Sometimes I […]
Media Links
I would like to share a few media links which I have enjoyed. The first is from the New York Times- LINK– on the 3D printed prosthetic. Interesting read and highlights some of the information we have also shared: My Blog’s 3D printed information. Additionally, the St Louis Post Dispatch recently shared a great story about […]
Phocomelia
Phocomelia is defined as ‘seal limb’- a birth anomaly (i.e., congenital malformation) in which the hands are essentially attached to the chest. There may be a short bone connecting the hands to the chest, either a forearm bone or arm bone, but not both. Phocomelia is incredibly rare and really became a recognized abnormality in […]
Anesthesia- Do we know the risk in a child?
Recently, there has been much discussion regarding anesthesia in the child. The concern is appropriately about safety- do we know when it is ‘safe’ to allow anesthesia for children. There have been a large number of studies on this topic and recently the FDA voiced concerns. I will try to summarize the issues and our […]
Pediatric Hand Study Group 2017
I recently traveled to Philadelphia for the annual meeting of the Pediatric Hand Study Group (PHSG). This group is composed of hand surgeon and therapists who are committed to caring for kids born with hand differences. The meeting was excellent as usual and the hosts included the surgeons from Childrens Hospital of Philadelphia and the […]
The Hand in Multiple Epiphyseal Dysplasia
Multiple Epiphyseal Dysplasia (MED) is an uncommon anomaly of the bone and cartilage at the ends of the bones (epiphyses) in the growing child. There are 6 primary types of Multiple Epiphyseal Dysplasia. All are transmitted in an autosomal dominant fashion except type 4. EDM1 is caused by a heterozygous mutation in the gene encoding […]
The Crooked Thumb
The process of limb development is truly amazing and unbelievably complex. Developmental biologists and scientists help to explain these processes and our knowledge grows day by day. As I explain to parents, what is truly remarkable is not that there is a child born with a limb difference but rather that it happen so […]
The Arthrogryposis Thumb
I have previously written many times about arthrogryposis and several years ago focused on the thumb– see Link. As with every part of arthrogryposis, each child is affected differently. But the thumb is affected, the position of the thumb can really make a big difference. Consider these points: 1) The thumb normally provides about 40% of […]
Surgery for Macrodactyly
Macrodactyly is an uncommon birth condition of the upper extremity. I have posted several previous times on macrodactyly: Macrodactyly PostMacrodactyly Post 2 Macrodactyly means ‘large finger’ and sometimes is referred to as local gigantism. My other posts have discussed different facts about the diagnosis including why this may happen but here I would like to […]
Simple Surgery for Symbrachydactyly
I have posted on several times on symbrachydactyly, with one post HERE. Each child with symbrachydactyly, and really any birth difference of the upper extremity, is unique. No matter their bony and soft tissue deficit, their family situation and functional needs must also be considered. So even if two kids look similar, I believe that musculoskeletal […]
Clasped Thumb Follow Up
I have posted several times on clasped thumb, a rare condition in which the muscles that straighten the thumb are slow to develop and the thumb rests across the thumb. It must be differentiated from several other diagnoses included trigger thumb and spastic thumb (in which the tight muscles pull the thumb down). Here are […]
Patient Pollicization Testimonial
Gracie is an 11- year old who had a pollicization 3 months ago for her hypoplastic (small) thumb. Compared to the typical patient treated with a pollicization, Gracie is unusual because she was much older at the time of her surgery. Gracie’s age at the time of surgery does bring a few challenges mainly because […]
Surgery Ecosystem
There are many factors for families to consider as they choose a surgeon and a hospital. There is no perfect path to making these choices but some factors that I believe are important include: 1) Surgeon. I have previously blogged about choosing-your-childs-surgeon and this is a key factor for consideration. I believe that the surgeon […]
Buenos Aires IFSSH Meeting
It was my pleasure to attend the 50th anniversary meeting of the IFSSH- the International Federation of Societies for Surgery of the Hand. This international organization meets every three years (previous meetings in South Korea and India, next meeting in Germany) with a weeklong exchange and dialog on hand surgery. I was pleased to have […]
ASSH Annual Meeting 2016
I recently returned from Austin Texas, site of the American Society for Surgery of the Hand Annual Meeting. This was the first time the meeting was held in Austin but I am sure we will be back. I thought the overall meeting was really well done with a great mix of scientific content and review […]