Symphalangism is an uncommon diagnosis related to lack of joint motion at one or more joints in the fingers or toes. It can be associated with other diagnoses such as brachydactyly but in my experience is most often an isolated diagnosis. It is not painful. Depending on the joint involved, it can be frustrating when […]
Category: General
Hand Camp 2024
In early September, we had Hand Camp in Pitosi, Missouri. It’s amazing so share that this camp has been changing lives since 2008 (we did miss a few pandemic years). The impact of the camp is difficult to share in this blog but I do want to share a few things. The camp is so […]
Amazing Mittens
mimiTens All, if your child has a limb difference and you live in a climate where mittens can help, consider a product from Canada called “mimitens”. These are mittens designed for limb difference hands that are intentionally created to stay ON. The clever design is certainly going to help an important issue for our children. Check them out […]
Hand Camp 2023
The St Louis Shriners Hospital began hand camp in 2008 and it has taken place in early autumn each year in Pitosi, Missouri (except during COVID when it was virtual). This year the camp was October 13-15, a bit later than usual and, also, a bit chillier than usual. But the energy and love was […]
Hand Society (ASSH) 2023 Travels
The ASSH Annual Meeting was in Toronto this year. As usual, it was a fabulous meeting and its always great to connect with friends from across North America and the world. There were very good pediatric sessions throughout the week! We had a fantastic Pediatric Hand Study Group (PHSG) meeting. The group continues to grow with a goal […]
Digital Lengthening
Shortened digits are a common concern of parents when their child is born with a difference. For most kids, lengthening does not make sense as it will not improve function or appearance. However, for some kids, the procedure can make a big difference. The most common situation is amniotic constriction band in which digits are […]
Building Community in the Congenital Hand World
There is remarkable value in a medical community. There are a wide variety of such communities, each with important benefits. While this blog will not discuss all such communities, I want to share thoughts on some of these. One very important community is the patient- to- patient community with a sharing of experiences, outcomes, and […]
Hand Camp 2022
I am so excited that we were able to host Hand Camp in 2022. This camp is supported by the St Louis Shriners Hospital and organized by the amazing hand therapy team. We had our first hand camp back in 2008 with only minor interruptions since (COVID). This year we hosted 19 families (including affected […]
Rare Condition of Patient with 3- arms, Special Relationship
It has been more than 10 years since I first met a special child from Central America. He had a condition which is incredibly rare, with only a few reports ever. You see, Erickson was born with 3- arms. His right side was normal but, on the left, he two arms. The upper one had […]
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 […]
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 […]
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 […]
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’ […]
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 […]
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 […]
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 […]
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 […]
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 […]
Choosing Your Child’s Surgeon
Choosing a surgeon for your young child with a birth difference of the upper extremity can be challenging, stressful, and confusing. There is no simple equation to simplify this process but there are a few factors which might help. Bedside manner. When a family chooses a surgeon for their child with a birth difference of […]
Skin Contracture and Z-plasty Correction
The field of hand surgery was developed around the time of World War II combining the fields of orthopedics (care of bones, joints, tendons, muscle), plastic surgery (care of skin, soft tissues, and nerves) and vascular surgery (care of blood vessels). Given the very complex anatomy of the hand, wrist, and forearm, the concept of […]
Meetings
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 […]
Prosthetics: 3D Printed vs Task Designed
The Shriners Hospitals have long been known for Prosthetics. Each hospital in the system has expertise for both upper and lower extremity prosthetics. As I have mentioned in previous blog POSTS, there is a great deal of new, exciting progress in the field. We continue to work here at the Shriners Hospital in St Louis and St […]
A New Year filled with Hope
Happy New Year! My hope for 2016 is much progress towards our understanding of birth differences of the upper extremity. My primary resolution is to continue our research in St Louis at Washington University, St. Louis Childrens Hospital, and the Shriners Hospital for Children. We have a number of exciting projects underway including: The CoULD […]
3D Progress
I have posted several times previously on our work with 3D Printed Prosthetics, the posts are compiled here. Sydney is one of our patients who has been a big part of this process. She recently received the latest prosthetic version, a 3D Printed, Myoelectric device and fabricated for about $110. Today, there was a great deal […]
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 […]
World Congenital Forum
Once every three years, an international group comes together for approximately 3 days to discuss all things relevant to the care of children born with musculoskeletal differences. In 2012, it was here in the United States, Dallas Texas to be specific. In 2015, the 10th World Symposium on Congenital Malformations of the Hand and Upper […]
Inspiration
I am fortunate. Each day I am inspired by the kids (and families) that I am able to treat. These children are born with differences and, therefore, they do not know any other way. But they must learn to exist in the everyday world with functional and social challenges. And succeed they do. Each child […]
St Louis Shriners Hospital Does Great Things for Kids
I am very fortunate to work at the St Louis Shriners Hospital. The first Shriners Hospital opened in 1922 in Shreveport, Louisiana and more soon followed to care for children with polio. The St Louis Shriners Hospital opened in 1924 on the main campus of Barnes Hospital and moved to the current location on Lindbergh […]
Patient TV Interview Regarding 3D Printed Prosthesis
Check out this great interview with a wonderful patient/ family regarding our 3D printed prosthesis. Go Sydney! Interview with Sydney and family Charles A. Goldfarb, MDMy Bio at Washington Universitycongenitalhand@wudosis.wustl.edu
More on 3D Printing
I have shared my thoughts on 3D printing with several previous posts 3D link Second 3D link In addition, I have recently been working with a reporter from veja.com- the largest magazine in South America about 3D printing and medical applications. I look forward to this article- the more press, the better for the progress […]
Form versus Function. Can we have both?
Orthopaedic surgery is the branch of medicine that focuses on movement and function. In orthopaedics, we work with bones, joints, muscles, and tendons, as well as nerves and vessels. Hand surgery is a subspecialty of orthopaedics (and also a subspecialty of both plastic surgery and general surgery) that addresses all of the same issues […]
Best Scientific Publication on Birth Anomalies of the Upper Extremity
I have been fortunate to learn from a number of wonderful hand surgeons over my career. One of the most impactful was Paul Manske, a hand surgeon and, more specifically, a congenital hand surgeon. He spent the majority of his career here at Washington University School of Medicine. I am not alone in this sentiment […]
Newsworthy
Robohand I previously blogged about Robohand 2.0 Previous Robohand Post The group has now fitted one great patient with an unfortunate injury. She now has a powered prosthetic and she loves it! Check out this news story and video. Fox-2 News Story Here is another link with more information on the story from Washington University News […]
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 […]
Popular Press on Prosthetics
Prosthetics have been in the press lately. I have found two issues particularly interesting; one is a note a caution and the other an important step forward. The first article nicely presents a reality check towards much of the excitement regarding myoelectric prostheses. While there is good reason to be excited about technology and prosthetics, […]
Hemangiomas and vascular malformations a brief overview
When we consider congenital abnormalities of the upper extremity, most commonly, we think of extra bones or missing digits. However, there are many other conditions which fall under this umbrella and, therefore, the care of the congenital hand surgeon. The OMT classification (Oberg, Manske, Tonkin) has recently replaced the Swanson classification as the official classification […]
Robohand 2.0 (powered, 3D printed hand)
The Robohand has been getting an amazing amount of press in recent months. I have previously blogged on the topic Previous Prosthetic post with basic information. Since then, there has been a Kansas City Star article on the topic. As I previously mentioned, I had the opportunity to work with senior engineering students at Washington University, Biomedical Engineering […]
Media
A couple of news stories over the last week have highlighted children at the Shriners Hospital and St Louis Childrens Hospital. The first child is a Shriners Hospital patient and a part of a great family. Mom and all three children have thumb anomalies, although each individual is a bit different. We have been able […]
Social Media
The last 6 weeks have been a little hectic and I have not been as timely as I would like with my posts. My goal is 1- post/ week and while that may not seem too difficult, it can be a challenge. I will add a few new posts in the next week or so […]
Symbrachydactyly, now what?
I have posted on symbrachydactyly several times in the past. http://congenitalhand.wustl.edu/search/label/Symbrachydactyly There are, by different symbrachydactyly classifications, 7 types: short finger cleft type (thumb and small finger present) peromelic (nubbins) monodactyly (only the thumb present) wrist bones present (but nothing more distal) wrist bones absent (ie, arm ends at the end of the forearm) transforearm […]
The Future of Prosthetics??
A National Public Radio (NPR) story has brought attention to 3-D printing and the world of prosthetics. http://www.npr.org/blogs/health/2013/06/18/191279201/3-d-printer-brings-dexterity-to-children-with-no-fingers Prosthetic limbs are tricky for any age patient and especially for children. First, prosthetics are expensive and the growing child needs new prosthetics on a regular basis due to growth. Second, prosthetics can be a challenge to […]