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Expert Care for Extra Fingers and Toes

Expert Care for Extra Fingers and Toes

by | Jul 25, 2023 | Hand Conditions

Published in Rite Up, 2023 – Issue 2. 

“Holden is very much the baby of the family,” says Ashley, his mother. “He likes being the center of attention and being constantly held. He’s also a little mischievous.” The youngest of three children, Holden, of Dallas, turned 1 in April and, according to Ashley, is into everything. “He’s in that ‘I now can get myself anywhere I want to be, so I’m going to explore anywhere I can’ phase,” she says. But, for the first nine months of his life, he could not wear a shoe on his left foot.

Holden was born with polydactyly, a condition in which a baby is born with extra digits. In Holden’s case, he had an extra pinkie finger on each hand and an extra toe on his left foot that sat on top of his other pinkie toe.

Ashley was prepared for the extra toe because her doctor had spotted it in her 20-week ultrasound. He said that they would have a pediatrician at her delivery who would put a clamp on it, and it would fall off like an umbilical cord. The two extra fingers were a surprise. “When Holden was born, the pediatrician said that given the number of extra digits and the way some of them were connected, they weren’t confident clamps would work,” Ashley says. Within 24 hours, they were referred to Scottish Rite for Children.

Hand surgeon Chris Stutz, M.D., evaluated Holden when he was just 3 weeks old. A leader in training hand surgeons from around the world, Scottish Rite was the first pediatric orthopedic facility in the nation to employ full-time hand surgeons. Dr. Stutz recommended surgery to remove the three extra digits at 9 months of age. The timing of surgery was scheduled late enough in Holden’s development to mitigate the risk of complication due to anesthesia and early enough to ensure that he could learn to walk.

“The idea of handing over your 9-month-old baby for surgery is terrifying,” Ashley says, “but it was so much easier knowing that he was with people who specialized in that.”

Holden came out of surgery with soft wraps on his hands and a hard cast on his foot. “As soon as the cast came off, we put him in a hard-soled shoe,” Ashley says. “His ability to stand and move around has been really great.”

“While this is a common procedure for our team, it is uncommon for the patient and family,” Dr. Stutz says. “We were happy to provide the comfort, confidence and expertise for this wonderful, sweet family.”

“We loved our Scottish Rite experience,” Ashley says, “and we’re glad that Holden can move on with being a 1-year-old who can wear shoes!”

Read the full issue.

Hand Camp Around the World

Hand Camp Around the World

by | Jun 28, 2023 | Hand Conditions

Scottish Rite for Children is world-renowned for its patient-centered care for children with orthopedic conditions, and our Center for Excellence in Hand is committed to caring for children with hand and upper limb conditions.

Focused on providing innovative treatment to help patients live active and independent lives, Occupational Therapist and Certified Hand Therapist Amy Lake, OTR, CHT, recently shared her knowledge at the 2023 World Symposium on Congenital Malformations of the Hand and Upper Limb. Working with a team from around the world, Lake served as co-chair. She shared her research and insight surrounding patient involvement in Hand Camp as well as the impact therapeutic camps have on children with hand differences. 

For more than 20 years, Scottish Rite has created a therapeutic and safe environment for patients with congenital hand differences through Hand Camp. Hand camp provides an opportunity for children with upper limb differences and their families to meet others facing the same challenges while enhancing confidence and self-esteem.

Lake’s research evaluates the positive benefits these camps provide to this patient population. Results showed that the participation in camp enhances their self-esteem and overall hand function, which promotes participation in extracurricular activities.

Her published study and passion for treating the whole child is inspiring hospitals all over the world to start their own hand camps. We are so proud to have Amy as part of our team sharing the incredible things happening at Scottish Rite.

What is Arthrogryposis?

What is Arthrogryposis?

by | Dec 20, 2022 | Hand Conditions

Arthrogryposis is a rare condition that occurs in one out of 3,000 births. It involves curved or hooked joints and limited range of motion for joints of the hands, wrists, knees, feet, shoulders and hips. Most children with arthrogryposis have normal intelligence and a sense of touch.

The full name is Arthrogryposis Multiplex Congenita.

  • Arthro = joints
  • Grypo = curved
  • Multiplex = different forms
  • Congenita = present at birth

Arthrogryposis is also known as Multiple Congenital Contractures.

  • Multiple = many
  • Congenital = at birth
  • Contractures = limited joint motion

In some cases only a few joints are affected and the range of motion is nearly normal. In severe cases many joints are involved, including the jaw and back.

The most common form is Amyoplasia.

  • A = absent
  • Myo = muscle
  • Plasia = abnormal growth or development

This condition involves multiple contractures in all of the limbs. The joint contractures are often severe and affect the same joint in both limbs.

What are the causes?
In most cases the cause cannot be identified. Joints that are unable to move before birth can result in joint contractures. When joints are not moved for a period of time, extra connective tissue develops. This fixes the joint in a stiff or locked position. It also causes the tendons connecting to the joint to not stretch to their normal length making normal joint movement difficult.

The causes for limitation of joint movement are:

  • muscles do not develop properly.
  • muscle diseases.
  • fever during pregnancy and viruses that may damage cells that transmit nerve impulses.
  • decreased amount of amniotic fluid.
  • the central nervous system and spinal cord do not form correctly.
  • the tendons, bones, joint or joint linings may develop abnormally.
  • a genetic cause in 30% of the cases.
    • Several genetic patterns have been recognized, but most cases are rare and recurrence varies with the type of genetic disorder.

What are the goals?
To assist your child in developing and achieving goals to maximize independence in activities of daily living and accessing his or her environment.

What is the treatment?
Treatment is tailored to the individual by a multi-disciplinary team of physicians (pediatrician, orthopedic surgeon, neurologist, geneticist), nurses, physical therapists and occupational therapists.

Treatments may include physical therapy, occupational therapy and/or surgery.

  1. The goal of physical therapy is to increase the range of motion and strength through functional activities and exercises. Assistive devices to help achieve goals may include splints, braces, crutches and wheelchairs. Parents are encouraged to become active participants in a therapy program and to continue therapy at home on a daily basis.
  2. The goal of occupational therapy is to learn activities of daily living such as feeding, bathing, toileting and dressing with assistive devices. These assistive devices include long handled utensils, hairbrushes, toothbrushes, bath brushes, toileting aids, etc.
  3. The goal of surgery is to correct the alignment of the upper and/or lower extremities so that the activities of daily living, such as standing and walking are possible. In some cases, tendon transfers are done to improve muscle function. For severely affected children, the extremities are positioned in a fixed standing or sitting position. The pros and cons for both positions will be discussed prior to scheduling surgery.

What to expect?
In most cases, the outlook is a positive one. The condition does not worsen with age. Therapy and other available treatments can bring about substantial improvement. The vast majority of children survive and live a normal life span. Many excel because they become experts at meeting and tackling challenges and are able to lead productive, independent lives as adults.

Polydactyly in Children and What Parents Need to Know

Polydactyly in Children and What Parents Need to Know

by | Nov 16, 2022 | Hand Conditions

Polydactyly is a word that means “many fingers.” There are many forms of this common diagnosis. Some extra fingers are on the thumb side, some on the pinkie finger side and some in the middle of the hand. Polydactyly of the feet is also common. Some forms of polydactyly run in families; others come as new “surprises.” It is rare for the extra fingers to be fully formed normal fingers. Some of these fingers may be very small, floppy and have nonfunctional fingertips. Others will have bones and joints, and some may even have tendons and some movement. Some forms of polydactyly are “isolated,” meaning that there is nothing else the matter with the baby. Other forms of polydactyly may have other conditions such as webbing, twisting or angling of other fingers. In rare cases, there may be problems in parts of the body other than the hand. Polydactyly is common, it is not painful and it is not an emergency to treat.

How can polydactyly be treated?

The treatment of polydactyly depends on the exact shape and form of the extra digit, whether there are other problems in the hand and whether there are other more general problems for the baby. If the extra finger parts are very small, the treatment may be simply tying off or putting clips on the base of the finger to allow it to dry up and fall off (similar to the way the stump of the umbilical cord dried up, separated and fell off on its own). Any finger that is too big for this will require surgery that will be done in the operating room and done with general anesthesia for your baby. Some polydactyly cases require delicate reconstructive surgery to rebuild the best parts to save for your child’s best hand function. There is no hurry in doing this, because it is safer to wait until the baby is older. The risk of anesthesia is higher for a little baby and lower for an older baby. Your doctor will discuss with you the exact plan for the polydactyly type of your child.

Learn more about our treatment for hand disorders.

On The Move: Unstoppable

On The Move: Unstoppable

by | Sep 26, 2022 | Hand Conditions

Article previously published in Rite Up, 2022 – Issue 2.

It is not uncommon to see Michael, of Redmond, Washington, posing like his favorite superheroes. He loves playing Minecraft™, riding his bike, swimming, wearing costumes, acting, dancing and singing. In January 2021, this highly active and vivacious young man had a life-changing surgery performed on his left forearm by pediatric orthopedic experts from our hand and limb lengthening and reconstruction teams at Scottish Rite for Children.

“I have no words to describe the blessing it has been for Michael and myself,” Berenice, Michael’s mother, says. “Scottish Rite is simply amazing.”

Michael was born premature at 23 weeks and stayed in the NICU for four months. At 3-months-old, the family realized he had a bump on his left arm and worked with Michael’s doctors to investigate the issue. Following a biopsy, it was determined that Michael had congenital pseudoarthrosis, which caused a deformity in the bones in his left forearm.There are very few teams that could successfully manage the complexities and intricacies of Michael’s treatment, but Scottish Rite for Children could. “To me Scottish Rite is a place where miracles happen, where the prayers of many parents come true,” Berenice says. “The doctors really care, and all the staff understand you and want to help in any way they can. Somehow you know your child is in the best hands, and you trust they are going to be okay.”

 

Watch Michael’s Story and learn more about Scottish Rite’s extraordinary care.

Read the enitre issue.

Thumb Fracture Q&A

Thumb Fracture Q&A

by | Sep 23, 2022 | Hand Conditions

Thumb injuries are common, especially in young athletes, and can occur from direct hits, falls on outstretched hands or hyperextensions. We see them often in football, basketball, baseball and soccer.

Pediatric nurse practitioner Courtney Schneidau, P.A.-C., shares information about thumb fractures and how to handle these types of injuries in young athletes.

Anatomy of the thumb
The thumb is made up of two major bones — the distal phalanx and the proximal phalanx. The distal phalanx starts at the tip of the thumb, underneath the fingernail and extends to the knuckle. The proximal phalanx runs from the knuckle to the base of the thumb, where it connects to the hand. 
 
How do thumb fractures typically occur? 
A thumb fracture can occur anywhere in the thumb and is generally caused by a direct trauma, like from a fall or a hit to the hand. For example, if a player hits his hand/thumb on the helmet of another player while playing football.  
 
What are the main symptoms of a thumb fracture? How do you know if the injury needs medical attention? 
Symptoms can include: 
–    severe pain
–    swelling and tenderness
–    limited motion or inability to move the thumb
–    visible deformity or deformed appearance
–    a numb sensation or coldness in the thumb 

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You should seek medical attention if you are experiencing pain, bruising or swelling. It is important for a professional to examine the injury to determine the best course of treatment.

How is a thumb fracture diagnosed and treated?
Your provider will take a detailed history, including the activity that caused the injury, as well as perform a physical exam. X-rays of the hand and injured thumb will be performed to better evaluate the injury and rule out other injuries.

A fractured thumb can be treated through casting or the use of splints, which limit movement while the bones heal. Surgery is sometimes needed, depending on the location of the break. There are different techniques that are used to hold the bones in place, including the use of pins, plates or screws. Following surgery, a splint or cast is worn to ensure proper healing.

What is the outcome following a thumb fracture? 
Thumb fractures generally have good outcomes, following proper treatment and rehabilitation. Once the fracture has healed, hand therapy may be required to help restore motion.

Should you see a pediatric orthopedic specialist for a potential thumb fracture? 
Scottish Rite for Children treats children who need complex reconstruction following trauma or have hand disorders related to neurological conditions or nerve injuries. That includes fractures (shoulder to fingers), nerve injuries, tendon injuries and complex injuries. Our Sports Medicine team treats the comprehensive needs of athletes and provides management for sport-related injuries and conditions. Young and growing athletes are highly competitive and have unique conditions that require care by a pediatric team of experts. Learn more about our centers for excellence in Sports Medicine and Hand and how board-certified pediatricians, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other specialists work side-by-side with each patient and their parents to develop the best game plan for treatment, rehabilitation and safe return to sport.

Learn more about our Facture Clinic.