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 […]
Category: Radial Deficiency
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 […]
Radial Deficiency Outcome
Radial deficiency (or radial longitudinal deficiency, RLD) is one of the most challenging conditions that I treat. We classify patients with RLD based on their bone development but that does not capture the underlying muscle and joint abnormalities. Reports on treatment including surgery have been mixed and that has led hospitals and doctors to have […]
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 […]
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 […]
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 […]
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 […]
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 […]
Not the Typical Thumb and Wrist
Radial Longitudinal Deficiency (RLD) has a wide range of presentations from a small, unstable thumb to major bone and soft tissue problems of the entire upper extremity. And yet, despite this wide range, most kids have a somewhat predictable appearance within a couple of different categories. I have shared my thoughts on these variations HERE, numerous […]
Radial Deficiency, Doing Fine
As a surgeon, I have a bias that surgery can help most of the time. And I feel this one because I have seen it help in so many children. Surgery can help function and it can help appearance- both are important. And as a surgeon, I feel fortunate to be able to offer surgery […]
Underdeveloped Thumbs
Underdeveloped Thumbs It is always interesting to me when I see an older child with underdeveloped thumbs, aka hypoplastic thumbs. Most of the time, children with small thumbs are identified early in life as small thumbs are typically part of a larger issue, radial longitudinal deficiency (RLD). However, when isolated, underdeveloped thumbs can be […]
Radial Deficiency- Every Child is Unique
Every child with radial longitudinal deficiency is unique and therefore is treated individually. While there are general principles in treatment and these principles may be applied to most children, we begin care by working to understand each child and each family. In a child with radial longitudinal deficiency presenting for evaluation, we consider many factors as we […]
Type 2 Radial Longitudinal Deficiency
Bayne and Klug wrote what is now a classic scientific article on radial longitudinal deficiency in 1987 Classic Article. This article described 4 types of radial longitudinal deficiency: Type 1- Short distal radiusType 2- Radius in miniature (short proximal and distal)Type 3- Absent distal radiusType 4- Absent entire radius More recently, we added a Type 5- […]
Rare Syndromes: Duane Syndrome with Radial Ray Anomaly
Duane Syndrome is an rare birth anomaly of the eyes in which the patient can’t move the eye outward. It has been know to exist for more than 100 years. But more recently it has been linked to a defect of the SALL4 gene and related to miswiring of the eye muscles or a missing […]
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 […]
Hand Society 2013
Last week was the annual meeting of the American Society for Surgery of the Hand in San Francisco. As usual, it was a great meeting with an amazing collection of speakers giving paper presentations and courses on a variety of topics. There were two presentations of congenital research from our institution (along with a number […]
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 […]
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 […]
Pollicization at 15 years
Pollicization, or the creation of a thumb from an index finger, is one of my favorite surgeries. I like it so much because it allows me to accomplish my 2 primary goals for a child- making his or her hand function better and look better with a single operation. I have written several blog entries […]
Small thumbs
Small thumbs are a part of radial longitudinal deficiency– the official name is hypoplastic thumb meaning underdeveloped thumb. Sometimes this is an isolated problem and sometimes it is associated with abnormalities of the forearm and wrist (radial longitudinal deficiency)- http://congenitalhand.wustl.edu/2011/07/radial-longitudinal-deficiency.html A small thumb can be on one hand or both but most of the time the […]
September 2012 Travels
It has been too long since I last blogged. Several catch- up blogs are on the way. In the meanwhile, I have been to several interesting events in the last month. First, we had our annual St Louis Shriners Hospital Hand Camp. There were approximately 18 children with their families, 10 junior counselors, and […]
Recurrent Radial Longitudinal Deficiency
The best treatment for the forearm/ wrist deformity in Radial Longitudinal Deficiency remains uncertain as I have previously outlined in a previous blog posting http://congenitalhand.wustl.edu/2012/05/form-and-function-in-radial-deficiency.html . The problem is that the anatomical deficiencies in Radial Longitudinal Deficiency limit our ability to sufficiently correct the underlying deformity. There is a lack of muscles to extend (bend back) the wrist and a […]
Fixator for Radial Longitudinal Deficiency (RLD)
We continue to favor a two- stage centralization procedure for RLD. In the first stage, we apply a circular fixator to allow a slow, painless stretching of the soft tissues. We know that in RLD, all of the radial (i.e., thumb) sided structures are abnormal and often tight. By using the fixator before surgery, we […]
Form and Function in Radial Deficiency
There are a variety of factors which affect appearance and function in patients with radial deficiency (RLD). Some of the major factors to consider include (not necessarily in order as it will vary from patient to patient): Factors affecting appearance […]
External Fixator- Piece of Cake
There are two different types of fixators that we use in the care of kids with upper extremity differences. One is a unilateral frame and is just on one side of the bone. It usually has 4 pins sticking into the bone and a rail outside the skin. It is useful for lengthening bone- done […]
Radial Longitudinal Deficiency
What is Radial Longitudinal Deficiency (dysplasia)?Radial longitudinal deficiency (RLD) is a lack of formation of the thumb side of the upper extremity. It can affect the hand only (usually the thumb) or, more commonly, the hand and forearm. It is a lack of bone, muscle, tendon, nerves, and blood vessels. The severity is different in […]