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 […]

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 […]

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 […]

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 […]

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 […]

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 […]


I have been away from this blog for too long.  I have been traveling a bit and want to share some information about the meetings I have attended.  I hope and expect to get back to regular blogging this week! POSNA Annual Meeting 2016 POSNA is the Pediatric Orthopaedic Society of North America.  This organization […]

Hand Surgery in Children

The timing and appropriateness of surgery of the hand and arm in children with  birth anomalies are difficult topics.  The problem for parents and doctors is that we don’t truly know how well any particular child will adopt to his limitations and how much those limitations will affect his/ her life.  We all hope for […]

Arthrogryposis: Arm position and elbow flexion

Kids with arthrogryposis are smart and are able to figure out how to accomplish many of life’s tasks despite their functional limitations.  We, as surgeons, can sometimes help children with arthrogryposis by releasing and/ or repositioning tight joints.  We cannot make the arms or hands normal but little changes can make for big improvements. It […]

Diagnosing Distal Arthrogryposis

Making the Diagnosis and Maximizing Function Arthrogryposis is a challenging disorder although, thankfully, our understanding about it has grown over the last 10 years.  Previous Blog Posts and Great site While there are many thousands of subtypes of arthrogryposis (and several names with some differences, including the commonly used amyoplasia), basic treatment options are increasingly accepted.  We now […]

The Hand in Arthrogryposis

Hand function is clearly vital for function.  As I have written about previously, the thumb is key for both fine manipulation (think picking up a coin) and large object grasp (soda can).  The fingers are key for grasp and strength in grasp.  http://congenitalhand.wustl.edu/2013/11/5-finger-hand-follow-up.html Hand function in arthrogryposis can be a challenge.  First, in order to […]

Mild Camptodactyly

Camptodactyly comes in different types based on age and severity.  I have written several times about camptodactyly including http://congenitalhand.wustl.edu/2012/03/camptodactyly.html While there are different ways to consider camptodactyly, there are three basic types: infantile, adolescent, and camptodactyly associated with a syndrome (i.e., athrogryposis, etc.).  For most patients, camptodactyly affects the small fingers on both sides but may […]

Congenital Clasped Thumb

Congenital clasped thumb describes a condition present at birth (but potentially not recognized until 3-4 months of age or even later) in which the thumb is flexed into the palm.  Congenital clasped thumb may affect one or both thumbs but more commonly affects both.  Most newborns keep the thumb positioned in the palm for the […]

The Wrist in Arthrogryposis

Arthrogryposis is different in every child.  While there may be a classic appearance- internal rotation of the arms, elbow straight (extended), wrists flexed, and limited finger and thumb motion- the variability between kids makes treatment a challenge.  I have previously commented on arthrogryposis and general treatment concepts (my own thoughts guided by my experience and […]

Arthrogryposis: General Thoughts

Arthrogryposis– What Works and What Is Still a Challenge I want to restate how happy our arthrogryposis/ amyoplasia (AMC)(I use both of these terms together but these are very different diagnoses and may have different treatments) patients and families have been with three procedures.  1)  External rotation osteotomy of the humerus.  If the arms are really […]

Arthrogryposis Arm Rotation

I want to share several other photographs to relate how happy our amyoplasia patients/ families have been with an external rotation osteotomy of the humerus (obviously in situations in which the arms are markedly internally rotated).  In this procedure, we cut the arm bone and rotate it out of the internally rotated position and put […]

The Thumb in Arthrogryposis

Thumb posture is a common difficulty in children with arthrogryposis.   The thumb assumes a flexed (bent) posture at the metacarpophalangeal (MCP) joint and also may be adducted (tight towards the index finger).   As the thumb is positioned across the palm, grasping with the fingers is a challenge (which is especially troublesome given that finger motion […]


Patient with arthrogryposis after rotation of left arm but before surgery on right arm and before wrist surgery. One of the many challenges in the child with arthrogryposis is internal rotation of the arms (arms rotated towards body).  This can make functional activities like bringing the hands together difficult.   It can be tough to even […]