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 […]
Category: Small Thumb
Pollicization Long Term
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 […]
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 […]
Two different thumb birth differences
The thumb is our most important digit. In the adult, we estimate that it affects about 40% of hand function. So, a thumb that is not fully or normally developed may really affect our abilities- whether that be strength, motion, dexterity, etc. I have written a number of posts (See HERE) about the thumb but […]
Untreated Adult Hypoplastic (Small) Thumb
On occasion, an adult comes to my clinic for evaluation of one issue and a previously unrecognized issue is identified. This type of presentation can come in different varieties and, due to my particular practice type, often we find a birth anomaly that has not been recognized or treated. This patient is one very interesting […]
A New Thumb: Early Pollicization Outcome
Pollicization is one of my favorite surgeries for kids born with hand differences. This child is several months out from the pollicization procedure. He is using the new thumb as demonstrated in this video and the family (and the surgeon:)) are all very pleased with the appearance of the hand and thumb. While kids begin […]
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 […]
Hypoplastic Thumb Reconstruction
Patients with a small thumb- a hypoplastic thumb- often have functional limitations due to limited muscle development and a lack of joint stability. Therapy is always the first line of treatment but is often unsuccessful with this anomaly. We therefore often proceed with surgical reconstruction. I have previously blogged about the surgical choices and recently […]
Thumb Reconstruction in Action
My favorite day of the month is our ‘big’ clinic at the Shriners where my partner and I see patients all day (no surgery). It is such a pleasure to see new and followup patients with so many different rare conditions. I learn at each of these clinics because patients show me (and sometimes tell […]
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 […]
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 […]
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 […]
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 […]
Pollicization- concerns immediately after surgery
Pollicization, or the creation of a thumb, is a fantastic procedure that creates a hand that is more functional and looks better. It is certainly a specialized procedure in that most hand surgeons don’t perform this surgery. I do believe that this is a surgery that is best performed by surgeons that do at least […]
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 […]
Names Matter: Radial Polydactyly vs Duplicated thumb
There are a number of terms for describing the patient with two thumbs including, ‘duplicated thumb’, ‘extra thumb’, ‘radial polydactyly’, and ‘split thumb’. While the particular term may not seem to matter, it does have important implications. ‘Radial polydactyly’ is a medical term describing the location and anomaly- it is not controversial. ‘Split thumb’ may […]
Ulnar Deficiency- Thumb Rotation
I have posted a number of times about both ulnar longitudinal deficiency and thumb anomalies. As previously noted, in ulnar longitudinal deficiency, we more commonly offer surgery for the hand compared to the forearm. The forearm rotation abnormality is usually something that kids can adapt to as the shoulder offers so much compensatory motion. The hand is, […]
Early Outcome for Pollicization (creation of a thumb)
Pollicization is the name of the surgery which entails the creation of a new thumb, a “Pollex” (Latin for thumb). For those of us who regularly care for children born with anomalies of the upper extremity, this is perhaps our favorite because it dramatically helps both appearance and function. I have previously blogged about pollicization […]
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 […]
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 […]
5- finger hand, follow- up
I have previously posted on the topic of the 5- finger hand. This previous post summarized many of the key issues with this diagnosis. http://congenitalhand.wustl.edu/2013/03/the-5-finger-hand.html Here is the preoperative picture of one such child with a 5- finger hand. Note the small extra thumb and the digits all aligned in the same plane. 5 […]
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 […]
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 […]
More thoughts on Pollicization
More thoughts on Pollicization The decision to proceed with pollicization is not easy. It is most straightforward when the thumb is completely absent and is most difficult when the child has any thumb, as families very reasonably would like to keep and improve the small thumb rather than excise it and pollicize the index finger. […]
Pollicization- Creating a New Thumb
Pollicization is the hallmark congenital hand surgery. It is performed for patients with absent or severely diminished thumbs. The thumb is vital for overall hand function and in adults, it is estimated that the thumb provides 40% of hand function. A normal or reconstructed thumb allows for grasp of large objects (think: soda can), a […]