A rare case of neglected clasped thumb of 5-year-old girl treated with simple z-plasty, two tendons transplantation, and followed up for 17 years

Abstract

Congenital malformations of the thumb greatly affect the performance of the hand and the upper limb. The conditions associated with atrophic thumb represent a wide spectrum of abnormalities, ranging from a complete absence to a mere small size of the thumb. A 5-year-old Caucasian female presented with congenital clasped thumb deformity with hypoplastic thumb and with an absence of extrinsic extensors extensor pollicis longus and brevis and with stable carpometacarpal joint. We managed this case by transferring the extensor indicis proprius tendon and flexor digitorum superficialis of digitus medicinalis (the ring finger)—which is not common—to compensate for the absence of extension and abduction tendons of the thumb. After 17 years, the result was satisfactory for the patient and her family. She was able to use her hand for writing and doing normal daily work without feeling any disability.

A fully capable pianist with a congenital bilateral agenesis of extensor pollicis brevis muscle

“…There is also an option of conservative treatment of splinting followed by manual therapy. Unfortunately, it is considered applicable only in very mild cases and with the youngest of patients -Al Smail in his case report described a five year old girl as too old for conservative treatment -it is also considered ineffective in cases of complete agenesis of EPB [1,8].…”

“…According to Ghani in 78% of cases of CCTS other dysfunctions are clearly noticeable during general examination [2] and considering existing research it would not be unreasonable to expect the isolated CCTS cases to be related to reduction or weakening of EPB rather than full agenesis. That being said, Al Smail describes a case of a 5-year-old girl with full agenesis of both extensors of the right thumb with full stability of the carpometacarpal joint of the thumb and lack of any other malformations or anomalies [1]. Hong on the other hand describes a case of a 10-year-old girl with full agenesis of Abductor Pollicis Longus, Abductor Pollicis Brevis, Opponens Pollicis and Extensor Pollicis Brevis in her right hand and a surprisingly efficient compensation by Extensor Pollicis Longus thanks to unusual placement of the insertion on the distal phalanx which allowed the abduction and extension movements to reach the neutral position.…”

“…Considering that the examined student's thumbs were capable of a full range of movement when moved passively, it would fall under type 1 both in Weckesser's and Tsuyuguchi's classification [13,14] which can be considered a mild case of CCTS. Yet both the age of the student and the fact of complete agenesis of EPB disqualify the idea of treatment through splinting and therapy, especially since such proceedings would ban the student from playing for a prolonged period of time with little to no reward in sight [1,8]. It is not possible to strengthen an absent muscle.…”

Characteristics of Congenital Clasped Thumb: A Case Report and Literature Review

“…The patient in this report was misdiagnosed with a trigger thumb, and after receiving the A1 pulley release, the flexion deformity gradually progressed. We attempted to evaluate the characteristics of the clasped thumb and review the literature ( 3 – 5 , 7 , 11 – 15 ).…”