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Absent Thumb

  • Absent Thumb

Description of disability:

Absent thumb or thumb retardia is a spectrum of congenital abnormalities of the thumb varying from small defects to absolute retardation of the thumb. It can be isolated, when only the thumb is affected, and in 60% of the cases it is associated with radial dysplasia (or radial club, radius dysplasia, longitudinal radial deficiency). Radial dysplasia is the condition in which the forearm bone and the soft tissues on the thumb side are underdeveloped or absent.

In an embryo the upper extremities develop from week four of the gestation. During the fifth to eighth week the thumb will further develop. In this period something goes wrong with the growth of the thumb but the exact cause of thumb hypoplasia is unknown. One out of every 100,000 live births shows thumb hypoplasia. In more than 50% of the cases both hands are affected, otherwise mainly the right hand is affected. 


Reconstruction should achieve 4 goals: widen the thumb-index webspace, stabilize the MCP joint, correct the abnormal extrinsic tendons and provide oppositional pinch. In order to create a deep and gentle-shaped webspace, 4-flap Z-plasty is commonly used. Stabilizing the MCP joint can usually be accomplished by imbricating the ulnar capsule. In cases of severe instability of the MCP joint, epiphyseal arthrodesis may be required. Abnormalities of extrinsic tendons include anomalous attachment or deficit of the FPL or EPL tendon. Tendon transfers using the flexor digitorum sublimis from the ring finger and extensor indicis proprius can be performed. Pollex abductus, if present, is incised because it hampers active motion of the IP joint and causes radial deviation of the MCP joint.

Transfer of the FDS tendon of the ring finger or the abductor digiti minimi muscle (Huber's procedure) are common opponensplasty procedures for the hypoplastic thumb. Because the FDS tendon has appropriate length and is powerful, it can be also used for simultaneous reconstruction of the ulnar collateral ligament of the MCP joint. However, hypoplastic thumb is occasionally associated with an absence or anomaly of the FDS tendons.

Post operative care: 

Immobilization, elevation and splinting of the part and follow up for regular physiotherapy.


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