Connections » Dr. Wint: Finger, Hand and Wrist

Hypoplastic Thumb

(20 posts)

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  1. sara
    Member

    My daughter was born about 3 weeks ago with a hypoplastic right thumb. The thumb looks smaller than her pinky. A bone survey showed that the thumb has all the bones in it, not sure whether the muscles and tendons are properly working. What type of surgery is typically done with this. Can she keep the thumb and have use of it? Do you know any good pediatric hand surgeons in the South Florida area?
    Thank you.

    Posted 5 years ago #
  2. Dr. Wint
    Moderator

    sara,

    Congratulations on your daughters birth.
    Its hard to know "how" hypoplastic your daughters thumb is based upon your description.

    There is a range of options for treatment depending upon the bone, muscle, ligament and tendon structures present. Treatment is pretty much typically by where the thumb falls into 5 distinct categorties if it is "hypoplastic" thumb. There are several other types of short or thin thumbs that are not the typical hypoplastic variety which would not be treated according to this scheme

    A thumb that is a little smaller but with good ligaments and muscles typically does not need much. A thumb with decreased or absent thumb muscles on the rounded part of the thumb palm surface ( the thenar muscles) and a loose ligament in the thumb knuckle where the thumb meets the palm but with a stable joint where the thumb meets the wrist is usually treated with surgery designed to improve the thumb. A thumb that does not have a good bone suport or joint where the thumb meets the wrist is very difficult to improve to the point where it adds function to the hand and most surgeons advocate removing this type of thumb and doing a procedure known as a pollicization where the index finger is turned into a thumb. The hardest thing for parents is when the thumb looks pretty good and has all the bones ( not saying that this is your scenario) but the bone a the base of the thumb where it meets the wrist is inadequate and a surgeon reccommmends remvoing it. There are some thumbs that truly just "float" or hand by a skin attachment and these are removed and a pollicization is done. Finally some thumbs just dont appear at all and the child has no thumb just 4 fingers.
    Id check the ASSH web site a www.assh.org to find a hand surgeon in your area. then spend time looking at their information. Most large university hospitals that have a childrens hospital or pediatric orthopedic dept have a hand surgeon

    Overall the children do well. those with surgery to augment or add to the thumb ( that are candidates based upon type) do very well despite what seens to be a smaller thumb. Those that get pollicizations and have the inadequate thumb do very well too. The ctegry where the much too small unstable thumb is attempted to be saved tend to make everyone feel better intitially in that youve "saved the thumb" but functionally these do poorly. (thats whay it is recommended not to save a thumb of that type) Even with that... you will likley hear of those who kept their very small unstable thumb and state they "DID well".
    .

    But ...remember its the lost potential to "do better" that we want to give the kids . It is hard to evaluate a young child especially a newborn or even a toddler in the context of what they could do as an adult.

    Posted 5 years ago #
  3. sara
    Member

    We recently were told our daughter has Type 3a Hypolastic Thumb and Type 0 of Radial Deficiency. He said all of the thumb bones are there but smaller than normal. Her metacarpal is smaller however wider at the base as it should be. Muscles are all underdeveloped as well. In addition, her wrist deviates slightly to the side as well. What is the typical prognosis for these types of deficiencies? At what age is surgery recommended? Also, it seems that because our daughter cannot use her thumb on her right hand, she already has begun to use her index finger to grab and suck on, etc. Can she re-learn to use thumb once corrected? Should we begin with OT?
    Thanks, (She is currently 5 months now)

    Posted 4 years ago #
  4. Dr. Wint
    Moderator

    This is a very common combination , 3a thumb and 0 radius. For the wrist nothing need be done. Though splinting can work for a slight bit of deviation. If there is more deviation than perhaps it is not type 0. Sometimes when the child is young it looks like a type 0 but it turns out it is not. For the thumb there are issue withthe thumb web, the joint movement and the presence or absence of what we call extrinsic tendons. The size of the thumb cannot be changed but the way the thumb works, the depth of the web space and whether there are functioning tendons that move the tip can be. A lot depends upon how flexible the tip is. If surgery successfully gets the web space enlarged such that the thumb is more of an opposed position than this alone may be sufficent to increase its use. Typically thumbs that are stiff still are used even if is is weaker. However if the tendon that flexes the thumb tip or extends it can be improved with transfering tendons then it may increase power and flexiblity and therefor is used more.
    Another issue that occurs is instability of the middle joint or the MCP or metacarpalphalangeal joint. If this joint is unstable it needs to be tightened up.
    Typically thumb issue are addressed at one year of age or greater. OT has little role. Remeber that a 5 month old with a normal thumb cannot "learn" to use it until he or she is developemntally ready. So OT likely has no real value at this time. After surgery sometimes an OT will provide splinitng to maintain position and keep surgical gains ( but splinting will NOT correct the thumb deficiency)

    Posted 4 years ago #
  5. sara
    Member

    Can you recommend any hand surgeons. We are in Florida however would travel in order to get the best care for our daughter. We did meet with a Dr Cornwall at Cincinnati Children's. Are you familiar with him or his "work"?
    Thank you.

    Posted 4 years ago #
  6. NubbinRespect
    Member

    "you will likley hear of those who kept their very small unstable thumb and state they "DID well"...But ...remember its the lost potential to "do better" that we want to give the kids."

    If a person with a limb difference is able to physically function without the involvement of a struggle, without the involvement of restrictions and last but by no means least without the involvement of any physical discomfort and all without any surgical modification of their limb's physical functioning then I respectfully suggest that priority be given not to the surgical modification of their existing physical functioning but to the respectful acceptance of their being differently-abled.

    To reiterate what I have said elsewhere on this website some well-meaning families and well-meaning surgeons mistakenly equate the concept of differently-abled with disability and disadvantage.

    If something is done differently it is nonetheless done and in view of that the "lost potential" and the ability to "do better", to which you refer, are therefore not applicable.For example, by simultaneously using a combination of the thumb and the palm of my symbrachydactyly hand I am able to carry grocery bags the weight of which are equal to the weight of any I am able to carry in my regular hand.A person with two regular hands may mistakenly assume that performing that task in the differenly-abled manner described involves an extraordinary effort or even a struggle when in actual fact it involves nothing of the kind.My regular hand doesn't do things "better" than my Symbrachydactyly hand, it does things differently and therefore my Symbrachydactyly hand does not lack the potential that my regular hand has.Similarly if I had no functioning thumb on my Symbrachydactyly hand or no hand at all I would carry grocery bags using the crook of my arm and if I had no such crook I would carry them on my shoulder and if I had no shoulder I would carry my groceries on my back and so on.

    I hasten to add that people with limb differences who reject surgery and/or prosthetics don't do so in order to be martyrs to their limb difference because martyrdom involves suffering and sacrifice and, regararding this issue, neither are involved even though some regular-handed people are led by their skewed perceptions to mistakenly believe that they are.

    Dr Wint the issue I highlight here in my message is a hugely important one and therefore I can only hope that I have articulated that issue to you in a manner that will facilitate you regarding it as a valid one.

    Posted 4 years ago #
  7. nancey2
    Member

    hi sara my baby boy just like your baby 5 month ago we decide to do asurgery to remove his thumb and insert the indez finger and the the day before that we heard there another thing to do for his thumb that is to grow abone and that is in clivland clinic in ohio so go to thier web site and read more about that and send your x-ray to the doctor his name is williams seitz . we didnt do this surgery yet but we r working on that so if need any help with that reply to me

    Posted 4 years ago #
  8. Dr. Wint
    Moderator

    Surgical "modification" is just that modification.

    No one says that someone must do these things.

    There as always potential to ovecome obstacles no matter how minor or how severe without bodily "modification"

    However whether we in our intact "unmodified" state "modify" our activities, Modify our approach to doing something, modify our environment. or modify our level of accepted function instead of modifying our bodies or our limbs there is no doubt that some interactions are going to be different.

    What is offered with surgery is a potential to do something differently. Each decision is different. Each child or adult or family is different. Thats the purpose of this discussion and others like it.

    Lastly just because someone is able to carry a bag or throw a ball with a hand with a congenital difference doesnt mean that the decision to have surgery or to not have the surgery was the thing that made the difference. we all tend to rationalize and accept our own limitations whether it relates to our hands or our bodies in general.

    Most hand surgeons who take care of children with congenital limb differences are acutely aware of these facts.

    Whether on is 100% against all surgery or for 100% surgery one absolute is not better than the other. The ideal situation is to know general treatment recommendations based upon established results and then individually tailor these options. Hand surgeons tend to have knowledge of surgical options. I, for one, continue to learn from patients and from discussions such as this

    Most importantly...All opinions are valid. Thus the beauty of a forum such as this.

    Posted 4 years ago #
  9. junkfoodjen
    Member

    Hi,
    My daughter was born in July 2007 with Type 3B Hypoplastic Right Thumb. I was devastated at first, and terrified, that she might have Holt-Oram or Fanconi's Anemia but we had those syndromes ruled out and it appears, so far, that her anomaly is completely isolated. We took her to a few specialists. The first was at Childrens Hospital in Seattle and the doctor we saw there recommended pollicization. We did not want to take such a drastic approach without first trying other options (which he did not even inform us of or suggest were a possibility.) We decided to get a second opinion with a specialist at Primary Childrens Hospital in SLC. Thank goodness because he recommended first trying reconstructive surgery (tendon transfers, etc) which he warned us might not work but it was worth a try. We decided to go for it and amazingly, now her thumb works! Before the surgery her thumb was floppy and useless. The doctor moved her thumb down creating more web space, moved some tendons around (one from her ring finger) and the results have been incredible. Hailey was only 15 1/2 months old when the surgery was performed... her hand was still so small... yet the doctor was able, in my opinion, to basically perform a miracle! I love my daughter so much and am so grateful we didn't just go with the first doctors recommendation. Pollicization would have been such a drastic first step and would have definitely altered her hand's appearance. Now, you can see her scars but otherwise, her hand looks very normal. No one ever notices that it is different. Her reconstructed thumb doesn't have the strength of her "normal" left thumb but it appears to function completely normally now. It's so amazing what doctors can do these days and I will be forever grateful to Dr. Hutchinson!!!

    Posted 4 years ago #
  10. rgibson5
    Member

    My daughter is now 5 yrs old. She was born with a "floating thumb" on her left hand, & her thumb on her right hand was non-functional & did not grow with the rest of her fingers. She had two thumb policizations done by Dr. Benjamin Chang @ The Children's Hospital of Philadelphia. In my daughters case Policization was necessary but maybe for your daughter it's not but they may have other options for you. The policization worked really well for her.

    Another great specialist is Dr. Dror Paley in West Palm Beach, @ St. Mary's Children's Hospital.

    Posted 4 years ago #
  11. sara
    Member

    Are there any exercises that can be done now to help lengthen tendons in my daughters thumb pre surgery (she has 3a hypoplastic thumb). Can this help prevent the tendons from shortening or does it not matter now if she is going to have tendon transfer surgery? Anyone hear of Dr Oulette in Florida or Dr Cornwall in Cincinnati for hand surgery? I will make an appointment with Dr Paley for consult.
    Also, will my daughters thumb continue to grow with her hand? I know it will always be smaller...but hopefully not the size it is now. It also seems that she has no feeling in her thumb because sometimes I see it bent in very odd positions that do not appear comfortable....but doesnt phase her.

    Posted 4 years ago #
  12. hello sir,
    I am frm India, my sistr gave birth to baby boy on 1july 2010 bt thumb finger is absent on his left hand.plz can u give me some suggestion for it or any remedy...rply as early as possible.

    Posted 4 years ago #
  13. NubbinRespect
    Member

    Dear Sakshi,

    I have lived for nearly 50 years with a limb difference and it has never involved a struggle for me and therefore your nephew will not have any problems.People have a habit to think that having not two thumbs but one thumb is a problem but the reality is that there is no problem.

    Posted 4 years ago #
  14. Dr. Wint
    Moderator

    Sara,

    There are no specific exercises to do now. Exercise ( or typically passive stretching ) is not used unless a joint is severely contracted or stuck in a poor position and a therapist or doctor thinks that passive motion will help. For example a club foot or a wrist that has turned in prior to surgery. However for your childs thumb it does not sound like this is the case
    Growth of short fingers or small hands are typically proportional. WHile the thumb will be smaller and thinner the width, girth and the length will be similar with respect to the rest of the hand. The "odd" positions are likely due to looseness of the ligaments in the joints and it does not hurt her.

    Posted 4 years ago #
  15. Dr. Wint
    Moderator

    Saksi
    Congratulations on the birth of your son.

    I suggest you consult a hand surgeon or pediatric orthopedic surgeon at a large hospital in your area

    Absence of a thumb can be addressed ,if you choose, with a procedure called pollicization. In this procedure a different finger is shortened and rotated into place and muscles are moved to give the new thumb power and motion. Most hand surgeons and most patients who have had this procedure are reported to be happy. And while many state they do "well" without this, we typically think that those who have had this done do "better" I admit though that in terms of measurable function dexterity it has been a very difficult question to answer.Especially as recent research has shown that the "normal" hand in a child with a missing thumb on the opposite hand may not be as dextrous as other age mathched "normal" children It may be that absence of thumb from birth is not as devastating as loss of thumb in an adult when compared to that childs other hand. The theme of doing "well" despite a difference, one of the major themes of most of these posts, should be recognized. Most importantly take time to evaluate the options presented to you.

    I suggest you consult a hand surgeon or pediatric orthopedic surgeon at a large hospital in your area

    Posted 4 years ago #

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