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) […]

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 […]

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 […]

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 […]

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 […]

Congenital Radial Head Dislocations: Elbow or forearm problem?

I have previously blogged about congenital radial head dislocation at least several times Previous posts . However, like most upper extremity anomalies, not all patients with a congenital radial head dislocation present alike.  Consider first that most of these dislocate so that the radial head moves in the posterior and lateral (outside) direction.  A smaller number dislocate in […]

Bone/ cartilage tumors/ MHE (multiple hereditary exostoses)

Multiple hereditary exostoses (MHE) is a genetic condition in which a patient has many bone/ cartilage tumors.  It is also know as multiple hereditary osteochondromatosis.  These are “tumors”- unregulated growths- but these are not malignant tumors (since they don’t go anywhere- they don’t metastasize). This condition differs from a condition I have previously posted: isolated osteochondroma. […]

Severe Madelungs Deformity

I have posted several times on Madelungs Deformity but a recent follow- up visit with a happy patient led me to post again.  One previous post was on More typical Madelungs and one on Madelungs after trauma. Patients with an inherited Madelungs are much more common in my practice (compared to Madelungs following trauma) even though both are […]

Bony Outgrowth, osteochondroma

Bone growths in children come in many different forms.  In the upper extremity, there are relatively few growths on the surface of the bones; one of these is the solitary osteochondroma.  The solitary osteochondroma is, as its name implies, a single bony and cartilage growth.  It differs from multiple hereditary exostoses, or osteochondromatosis, which is […]

Wrist Deviation

Radial deficiency and ulnar deficiency are, for most children, easily distinguished.  Radial deficiency, a condition about which I have blogged about on numerous occasions- see here – presents with a problem on the radial (thumb) side of the forearm and hand (mainly the thumb).  The radius bone can be absent or limited and the extensor muscles are […]

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 […]

Congenital Radial Head Dislocation

Congenital radial head dislocation is an unusual congenital anomaly of the elbow.  It is undoubtably present at birth but is rarely discovered until children get a bit older.  This is mainly because the limitations of radial head dislocation are not life- altering for most (including the motion limitations).  X- rays are usually the best way […]

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 […]

Traumatic Madelungs Deformity

Madelungs is a deformity of the wrist related to abnormal growth.  It is typically an inherited condition but may appear without any family members being affected.  I just realized that I have not posted on this condition and will blog more on the topic soon.  Today I want to write about one variety of Madelungs– […]

Radioulnar Synostosis, revisited

Radioulnar synostosis has been previously discussed in this blog  https://congenitalhand.wustl.edu/2012/06/radioulnar-synostosis.html In that post, I discussed that in most cases, surgery was not necessary because kids typically function very well. However, sometimes that is not the case.  Most kids with radioulnar synostosis are diagnosed around age 7.  Sometimes it is picked up earlier but around age […]

Pseudarthrosis of the Forearm

Pseudoarthrosis or, more commonly, pseudarthrosis literally translates to “false joint.”  The term Pseudarthrosis is used commonly in the situation of a fracture nonunion.  For example, if the shinbone, the tibia, does not heal after a fracture, a nonunion develops.  Eventually the nonunion will develop into a pseudarthrosis– related to motion between the bone ends.  There is fluid […]

Ulnar deficiency, considerations for surgery

I have previously written several times about ulnar deficiency.  I would like to provide some additional thoughts on function, limitations, and possible ways that a surgeon can help.  First, I want to state again that most kids with ulnar deficiency do not need surgery.  Function is typically good although there can be some notable limitations. […]