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 […]

Short arm and hand deficiency- phocomelia or longitudinal deficiency?

Phocomelia is Greek for ‘seal limb’, a descriptive term for a short, deficient arm (or leg).  I have previously posted on this topic HERE.   For many years, patients with a really short arm were diagnosed with phocomelia as it became a ‘wastebasket’ term for such patients.  However, the term should be used in patients with an […]

Unusual “Extra” Finger

I have posted many times on polydactyly- both on the thumb side and the pinky side- as can be seen HERE.  The following patient demonstrates an unusual presentation of what initial appears to be an extra finger, an ulnar polydactyly.  But, as a quick ‘count’ confirms, there are only 4 fingers with a thumb. Ulnar deficiency […]

Ulnar Deficiency Follow Up

Hand surgery is a great subspecialty.  I am able to interact and treat many patients and I am rewarded in seeing my patients get better.  However, there is a downside which is that I rarely follow patients long term.  Typically, I am able to see them, provide treatment (whether that be therapy, injection, or surgery) […]


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 […]

Hand Limitations in Ulnar Longitudinal Deficiency

My mentor, Paul Manske, clarified years ago that the hand is often the greatest limitation for children with ulnar longitudinal deficiency in this classic ARTICLE.  And, as I have previous blogged HERE, the hand limitations can manifest in many different ways.  There are many different ways this presents in ulnar longitudinal deficiency including: thumb and index finger webspace tightness, […]

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 […]

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, […]

Ulnar Deficiency and Syndactyly

Ulnar deficiency (or ulnar longitudinal deficiency) is much less common that radial deficiency, possibly only 1 case of ulnar deficiency per 10 of radial deficiency.  And it is much different in the problems that it may cause.  The forearm abnormality can include a deficient or absent ulna and flexor muscles BUT, it is much better […]

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 […]

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 […]

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. […]

Severe Ulnar Deficiency

Ulnar deficiency, as described in a previous post has characteristic findings at the elbow, forearm, and hand. Most classifications describe 4 types of ulnar deficiency (or ulnar longitudinal deficiency- ULD).  These classifications only address the bony deficiency (and not the important other issues such as muscles, tendons, nerves, etc).  While there are a number […]

Great Function in Ulnar Deficiency

Take a look at this amazing 5 year old with a marked, bilateral ulnar deficiency.  While he has good shoulder motion, he does not have an elbow joint on either side.  He has great wrist motion which helps make up for his lack of elbow motion.  He has 2 fingers on the right hand and […]

Ulnar Longitudinal Deficiency: The Basics

What is Ulnar Longitudinal Deficiency (dysplasia)? Ulnar Longitudinal Deficiency (ULD) is a lack of formation of the pinky side of the upper extremity.  It usually affects the forearm but can affect the hand, forearm, and upper arm.  It can affect bone, muscle, tendon, nerves, and blood vessels.  The severity is different in each affected child. […]