I recently wrote (with help) an article for Hand Clinics on Cerebral Palsy treatment. While I generally write scientific papers (that review patients to help with future care), occasionally I will write a review that summarizes our knowledge- that is this chapter regarding tendon transfers. Thank you to my coauthors of this manuscript, Anchal Bansal […]
Fingernail Bump
As a hand surgeon, I am often asked questions about fingernails- whether related to irregularity (bumps, pain, swelling) of the nails or pain. Most of these are minor or temporary issues and there are several excellent reviews on the internet including bundoo, medscape, and others. Most of the issues on this list are infections including paronychia, felon, and […]
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 […]
Bent Finger: Surgery for Camptodactyly
I have blogged several times on camptodactyly as it is a common finger anomaly and I have received regular requests for information on the topic. Those posts can be found HERE and HERE and HERE and HERE. The popularity of the topic camptodactyly can be seen with the large number of comments and questions on the last link. The […]
Clasped Thumb.
Clasped thumb is an uncommon diagnosis in which the thumb is held in the palm. While there are several potential reasons for this positioning, in many cases it is simply due to a delay in muscle development of the thumb extensors. Over time, those muscles (EPB and EPL) can (but may not) strengthen sufficiently to allow […]
Finger Flexion Deformity
I have previously posted several times on camptodactyly, a condition with a stiff, bent finger. Those posts can be viewed HERE. Camptodactyly is relatively common compared to other birth differences of the hand and upper extremity as it can be seen in isolation (i.e., not associated with any other conditions) or in association with cleft hand, […]
Amazing Function in Arthrogryposis
I have blogged many times on arthrogryposis as can be seen HERE. Our goal as upper extremity (hand) surgeons is to use therapy and surgery to improve function. The real purpose of our interventions is to allow independent function such as eating, writing, toileting, etc. There are a series of surgeries which we have found helpful […]
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 […]
Finger at Risk- Amniotic Constriction Band
I have previously posted on Amniotic Constriction Band. I post again on the topic as it is common and sometimes early surgery can be helpful. This child was born with an abnormality of the hand including a markedly swollen finger. There are several important findings in these 2 pictures. Amniotic constriction band with swollen finger. Amniotic […]
3D Printed Prosthetic Design
The 3D printed prosthetic( 3DPP) has captured the attention and the imagination of both the general public and the parents of kids with birth and acquired limb loss. In my opinion, the public envisions the 3D printed prosthetic (3DPP) as a futuristic solution which will eventually become completely life- like. The parent sees it as a practical, […]
Surgery for Olliers Disease
Multiple enchondromatosis is also known as Olliers Disease. In this disease, at least 2 cartilage tumors known as enchondromas grow in different bones. Initially, we tend to watch the growths, but sometimes surgery is necessary. I have previously blogged about Olliers as part of a post on MACRODACTYLY. There are number of sites that provide good, […]
Camptodactyly- bent finger- treatment with splinting
Camptodactyly is the Greek word for bent finger- specifically flexed so that straightening the finger at the middle joint is not possible. I have blogged about camptodactyly several times before- read those posts HERE and HERE. Therapy is the first line treatment for camptodactyly. And it usually works. But therapy has its limits and if the finger is […]
Separating joined fingers: A Case Demonstration of a New Strategy
Surgery to separate joined fingers has been largely unchanged for 40 years. This post is meant to share case pictures and details on this new strategy. Syndactyly, or the abnormal joining of the fingers, is one of the most common birth anomalies of the hands and feet. In our recent assessment of birth anomalies in NY […]
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 […]
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 […]
More on Amniotic Constriction Band
I have posted several time previously on Amniotic Constriction Band as can be found HERE. There is also reasonable information on the web as can be found at Wikipedia and NORD and HERE. However, I do believe that it is helpful to share case examples. Here is a 6 month old with Amniotic Constriction Band that was urgently treated for a […]
Cleft Hand Reconstruction
I have posted a number of times on cleft hand, or central deficiency as can be found HERE. To me, cleft hand is one of the most interesting diagnoses as kids with it may look and function very differently from each other despite have the same diagnosis. Some of my other posts highlight these differences between […]
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 […]
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, […]
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 […]
Rare Bone Tumor- Fibrous Dysplasia
Fibrous dysplasia is a bone tumor which is related to a genetic abnormality leading to abnormal bone formation. Normal bone is replaced by a fibrous tissue. It can present at any age- young kids, adolescence, or even adulthood. It is a bone tumor but it is benign growth. Rarely, the tumors can become malignant, but […]
Young Adult with Multiple Hereditary Exostoses
Multiple Hereditary Exostosis is an uncommon condition with the growth of multiple benign tumors or bone/cartilage growths. These can be called osteochondromas or exostoses. It has been estimated to be present in 1 in 50,000 children. Here is a great reference- NLM site. The growths can present in several different ways.1. Bumps which are not […]
Finger Bump
There are many reasons for bumps, cysts and masses in the fingers. I have previous blogged HERE on some of these growths. There is another common finger bump that should be discussed, the retinacular cyst. The retinacular cyst is a type of cyst- a fluid filled sac- that grows from the flexor tendon sheath. Here are a […]
Syndactyly Treatment: What’s Next?
The basic treatment of syndactyly has not changed in many years. The essential surgical care includes the creation of a web space (the ‘commissure’) with a flap and zig- zag incisions to the tips of the fingers to allow separation without straight- line scars (which can contract). There is no doubt that our understanding of […]
Amniotic Constriction Band
Amniotic Constriction Band commonly affects the hand and feet. I have previously posted on the topic on several occasions as can be viewed HERE. I wanted to share a few recent cases to demonstrate the different types of Amniotic Constriction Band. This young child has Amniotic Constriction Band affecting one foot and one hand as depicted […]
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 […]
More on Amniotic Constriction Band
I recently posted on a young child with Amniotic Constriction Band Here. I wanted to update that post with additional information. Prior to coming to me, the patient had been treated in an urgent way by Dr Erin Greer who performed a z- plasty and release of the tight band. This surgery was done to help […]
Amniotic Constriction Band and the Hand
Amniotic Constriction Band is a common problem in our clinics. Kids can have a diagnosis of amniotic constriction band and yet their hands can all look very different from one another as there are simply so many different presentations. I have previously written about this topic here but I wanted to share a few more thoughts. We […]
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 […]
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 […]
Outcome after Surgery for an Extra Thumb
The condition of a child born with two thumbs has many, many names but most commonly, we call it radial polydactyly, thumb duplication, or split thumb. While all are utilized, radial polydactyly is the medical term and split thumb is appropriate as both thumbs are smaller than the other thumb. I have posted about radial polydactyly previously […]
Multiple Hereditary Exostosis- Its Not Always about the X-rays
Multiple hereditary exostosis is an uncommon tumorous condition and is capable of causing significant functional limitations. I have previously posted on MHE. While multiple hereditary exostosis in the fingers can cause deformity and limitations of finger flexion (I need to post on this topic), we worry more about the forearm. The problem is that if the two bones […]
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 […]
Finger Masses
I see a number of kids with growths on the fingers. These growth vary tremendously in size and expectations but these are technically tumors. The good news is that almost all of these finger masses are benign- meaning that they don’t spread to other parts of the body. They are still concerning to the family. […]
Exciting Times!!
The opening of a new hospital or major facility is unusual in our modern healthcare system. It requires a great deal of planning, coordination, and plans for growth. That is why it is so incredibly uncommon and exciting that TWO new pediatric facilities are opening right now in St. Louis. TWO, both in the first […]
Stiff Fingers
Symphalangism is one type of finger stiffness; I previously written about it here. I wanted to share a few more thoughts. In addition to the classification noted in my other post, I often think of symphalangism in terms of whether or not the fingers are short. Whether the fingers are short or not, symphalangism is quite […]
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 […]
Triphalangeal Thumb
The normal thumb has two bones- 2 “phalanges”- which makes it different from the three bones of the fingers. Occasionally, we see a thumb with 3 bones- 3 “phalanges”- and we call it a triphalangeal thumb. I have previously blogged about different aspects of the triphalangeal thumb– 5- finger hand and another on the Five finger hand. Also, […]
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 […]
Unusual Clinodactyly
I have written previously on clinodactyly with several posts. Clinodactyly, the curved finger, is typically not a functional problem. But, a more severe deformity is more likely to be a problem with activities and patients often complain of trouble with things like keyboarding and musical instruments. Clinodactyly of the small finger is most common location and […]
The Short 4th Metacarpal
We will, from time to time, evaluate a patient presenting with a painless shortening of the 4th (and sometimes 5th) metacarpal. Often, the complaint is of an absent knuckle or a different- appearing hand. Here is one such 14 year old patient. The primary issue is the shortening of the ring finger metacarpal bone although […]
The Big Thumb
The term ‘superdigit’ is utilized in congenital hand surgery to describe a digit that is larger than we expect. It is often related to the fusion of two digits into one and may be seen in cleft hand and central polysyndactyly among other conditions. We also see large digits in other conditions such as Macrodactyly. […]
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, […]
Syndactyly Outcomes and Challenges
Most children treated for syndactyly have an excellent outcome with normal finger motion and good maintenance of the reconstructed web space. However, there are times with the ideal outcome does not happen. A less than perfect outcome includes challenges like: prominent scarring, an inability to spread the fingers as widely as […]
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 […]
Nora Lesion
A Nora Lesion is also knows as a bizarre parosteal osteochondromatous proliferation. This tumor is a bony outgrowth on the outside of the bone, typically found in the fingers and off of the phalangeal bones. The sexes are affected equally. There is an occasional history of trauma but this may not be truly relevant. […]
Ulnar Sided Cleft Hand
I have previously posted on cleft hand with a number of discussions. More to come on this topic in the future as well. However, I wanted to share a less common type of cleft hand, the ulnar cleft hand. Dr Tonkin from Sydney Australia has written about this unusual condition in the Journal of Hand Surgery. In this case […]
The Extra Thumb
An extra thumb, or radial polydactyly, can represent a difficult problem in congenital hand surgery. The difficulty is that each child with an extra thumb is somewhat different. There are certainly patterns (as we see with the Flatt Classification system) but not every thumb fits this classification system. Zuidam and all (under the leadership of […]
Thumb Deformity after Polydactyly Reconstruction
Radial polydactyly, an extra thumb, can be more challenging to treat than other types of extra digits. The surgeon cannot simply remove the extra thumb as ligaments need to be recreated and often bones and tendons need to be re- aligned as well. Nonetheless, if the surgeon can create a stable, well- aligned thumb, […]