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 […]
Category: Finger Deformities
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 […]
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, […]
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 […]
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 […]
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 […]
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 […]
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 […]
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 […]
Fingernail Bump
As a hand surgeon, I am often asked questions about fingernails- whether related to irregularity (bumps, pain, swelling) of the nails or pain. Most of these are minor or temporary issues and there are several excellent reviews on the internet including bundoo, medscape, and others. Most of the issues on this list are infections including paronychia, felon, and […]
Thumb Deformity
The thumb is vital for high level hand function. The concept of the opposable thumb- the thumb that can meet the fingers for pinch and other high level function- has been said to separate man from at least some of our primate ‘relatives’. In the growing child, the thumb is key for exploring the world […]
Bent Finger: Surgery for Camptodactyly
I have blogged several times on camptodactyly as it is a common finger anomaly and I have received regular requests for information on the topic. Those posts can be found HERE and HERE and HERE and HERE. The popularity of the topic camptodactyly can be seen with the large number of comments and questions on the last link. The […]
Clasped Thumb.
Clasped thumb is an uncommon diagnosis in which the thumb is held in the palm. While there are several potential reasons for this positioning, in many cases it is simply due to a delay in muscle development of the thumb extensors. Over time, those muscles (EPB and EPL) can (but may not) strengthen sufficiently to allow […]
Surgery for Olliers Disease
Multiple enchondromatosis is also known as Olliers Disease. In this disease, at least 2 cartilage tumors known as enchondromas grow in different bones. Initially, we tend to watch the growths, but sometimes surgery is necessary. I have previously blogged about Olliers as part of a post on MACRODACTYLY. There are number of sites that provide good, […]
Camptodactyly- bent finger- treatment with splinting
Camptodactyly is the Greek word for bent finger- specifically flexed so that straightening the finger at the middle joint is not possible. I have blogged about camptodactyly several times before- read those posts HERE and HERE. Therapy is the first line treatment for camptodactyly. And it usually works. But therapy has its limits and if the finger is […]
Thumb position and the 3 digit hand
I have posted on thumb rotation and if you search the blog, you will find a number of posts on ulnar longitudinal deficiency. Scrolling through the pictures, a pattern begins to develop in these kids with ulnar longitudinal deficiency– that is, many of the kids have a well developed thumb and 2 very good fingers. When we think […]
Unusual Clinodactyly
I have written previously on clinodactyly with several posts. Clinodactyly, the curved finger, is typically not a functional problem. But, a more severe deformity is more likely to be a problem with activities and patients often complain of trouble with things like keyboarding and musical instruments. Clinodactyly of the small finger is most common location and […]
Syndactyly Outcomes and Challenges
Most children treated for syndactyly have an excellent outcome with normal finger motion and good maintenance of the reconstructed web space. However, there are times with the ideal outcome does not happen. A less than perfect outcome includes challenges like: prominent scarring, an inability to spread the fingers as widely as […]
Extra Digits- What Happens After Treatment
Postaxial polydactyly is the medical term for an extra digit on the pinky side of the hand. It is far and away the most common location for an extra digit. It is much more commonly seen in African Americans compared to whites (the reverse is true with radial polydactyly– thumb side). There is a definite […]
Short Fingers- Treatment Choices
Symbrachydactyly means short and webbed fingers but the term really includes a wide range of presentations. I have previously posted on symbrachydactyly a number of times and this Post summarizes the 7 different types of hand appearance. I have also written that I prefer certain techniques to lengthen the fingers such as bone lengthening or web space […]
Cerebral Palsy, Thumb Deformity
Cerebral palsy (CP) is defined as a permanent limitation in physical function which does not change or get worse over time. Most commonly, it is a disorder with spastic muscles and limitations in motion but kids can present in a variety of different ways. I have not previously blogged on this topic and will start […]
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 […]
Symbrachydactyly of the Hand: Diagnosis and Presentation
Confirmation of a diagnosis of symbrachydactyly can be challenging. Most patients who present to my office with symbrachydactyly come in with a different diagnosis- typically amniotic constriction band (also known as constriction band syndrome, amniotic band syndrome, etc)- Amniotic Constriction Band Blog 1; Blog 2. In fact, most patients with any upper extremity diagnosis present with […]
Symphalangism (stiff fingers)
Symphalangism is a rare birth anomaly of the fingers which literally means: joined bones. Most commonly, it refers to an ankylosis (bony union) or fibrous tissue union of the finger bones preventing finger motion. It can be nonhereditary or it can be hereditary. Nonhereditary symphalangism occurs without known family history. It can be associated […]
Thumb Deformity in Untreated Thumb Hypoplasia
Thumb hypoplasia is a part of the spectrum of radial longitundial deficiency (RLD). Classically, there are three parts to the small thumb: looseness or laxity at the MCP joint, a tight first webspace, and poor muscles around the thumb. I have previously written about the small thumb and these key points at Small thumb . Decisions […]
Radial Head Dislocation in Ulnar Deficiency
Ulnar longitudinal deficiency, or ulnar deficiency, is much less common than radial deficiency. And, it less commonly requires surgery. I have previously written about different aspects of surgery for ulnar deficiency hand surgery in ulnar deficiency . Additionally, I have previously written about different aspects of more severe ulnar deficiency severe ulnar deficiency There is a group of […]
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 […]
Amniotic Constriction Band
Amniotic constriction band is an uncommon condition about which I have previously blogged ACB Blog Link . There are numerous good general descriptions on the Internet including the following: Shriners LinkMedline Plus The difficulty is that there is little precise information on the upper extremity and hand finding in Amniotic Constriction Band. There are numerous reasons […]
Macrodactyly/ Large digits
Macrodactyly, which literally means large digit, is an uncommon condition that affects the fingers more commonly than the toes. Macrodactyly almost always affects only one extremity, often multiple digits. The index finger and long finger are affected most commonly, followed by the thumb. In some cases, the enlargement that is present at birth stays proportionally […]
Challenges with Cleft Hand Reconstruction
When surgery is required for cleft hand, the goal is to create a maximally functional hand that is as “normal” appearing as possible. While each child with cleft hand is different, usually we can create a hand that works well and looks good. However, certain challenges exist after surgery related to hand anatomy. A cleft […]
Trigger Thumb, Video
Most children with trigger thumb have a thumb stuck in a position of flexion. It does not hurt but the thumb will not straighten. While most kids function just fine, some activities may be difficult. I have covered the basic in a previous post: http://congenitalhand.wustl.edu/2013/08/trigger-thumb-trigger-finger.html In these cases of a locked trigger thumb, we typically, […]
Severe Radial Longitudinal Deficiency
As with most medical conditions, different children will be affected at different severities. These differences can be notable such that two kids labeled with the same congenital difference may look completely different. While this obviously matters to the family, it also matters to the physicians because once we sort out a diagnosis (sometimes easy, sometimes […]
Short Fingers- Brachydactyly
I have written several times about symbrachydactyly– that is short, webbed fingers. This common condition is distinctive in appearance (although there are multiple different types). I have actually written 10 posts that relate to symbrachydactyly. http://congenitalhand.wustl.edu/search/label/Symbrachydactyly Brachydactyly, or short fingers, is a different condition as there are the normal 5 digits with shortening of […]
Even More Thoughts on Pollicization
Pollicization is the surgical procedure in which the index finger (typically) is used to create a thumb. It is most commonly performed for children born without a thumb or with a markedly small, unstable thumb but can also be performed in post- trauma situations in the adult. The importance of a good thumb can not […]
Trigger Thumb/ Trigger Finger
Trigger digits are common in the adult population. It can be called different things including stenosing tenosynovitis but we really do not understand who gets it and why they get it. The only population that seems to get trigger fingers more than everyone else are diabetics. Adults with trigger finger (and it really can be […]
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 […]
Camptodactyly, Unusual Cause
Camptodactyly is a flexion deformity of the finger, typically the small finger, and is typically caused by an imbalance between the flexors and extensors of the PIP joint. There have been a number of specific causes identified including abnormal muscle insertion, a tight flexor digitorum superficialis tendon, and weak extensor tendons. Most patients with camptodactyly […]
Clinodactyly Minimally Invasive Treatment
Clinodactyly is defined as a deviation of a finger. Most commonly, it involves the 5th finger curved towards the ring finger but can also involve the thumb or any other finger. We have reviewed clinodactyly previously http://congenitalhand.wustl.edu/2013/01/clinodactyly.html In an established clinodactyly in an older child, treatment is based on functional limitations. Therapy has never been proven […]
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 […]
Trisomy 8
There are number of different varieties of chromosomal disorders in which there is an extra chromosome, leading to a total of 47 chromosomes instead of the typical 46 (23 pairs). The most notable trisomy is Downs Syndrome, Trisomy 21. The more common other trisomies include Trisomy 18 (Edwards syndrome) and Trisomy 13 (Patau syndrome). Finally, […]
Clinodactyly
I have previously posted on clinodactyly but recently performed several surgeries so I though adding a few more pictures and thoughts might be helpful. There are two types of clinodactyly: isolated and associated with a syndrome. Isolated clinodactyly is common in the general population but is very well tolerated and usually ignored. In fact, many […]
Clinodactyly
Clinodactyly is a curvature of a finger (or thumb). The bend is in relation to the next finger rather than towards the palm or towards the top of hand. This is not to be confused with camptodactyly as we discussed in a previous post, http://congenitalhand.wustl.edu/2012/03/camptodactyly.html . Additional information, as always, is available from our website, http://ortho.wustl.edu/content/Patient-Care/3220/SERVICES/Hand-Wrist/Congenital-Hand-Disorders.aspx Small finger […]
Camptodactyly
Camptodactyly is the position of flexion of the proximal interphalangeal (PIP) joint. Translated from Greek, camptodactyly means “bent finger.” It may be first noted in the newborn, as a congenital camptodactyly, or it may present or progress in adolescence. There are a number of anatomical structures that have been described as “causing” camptodactyly including abnormal […]