Intended for healthcare professionals

Endgames Case Review

A child with a congenital hand anomaly

BMJ 2019; 365 doi: (Published 06 June 2019) Cite this as: BMJ 2019;365:l1847
  1. Jenny Wright, final year medical student1,
  2. Mark Pickford, consultant hand and plastic surgeon2,
  3. Asit Khandwala, consultant hand and plastic surgeon2
  1. 1The University of Nottingham Medical School, Queen’s Medical Centre, Nottingham, UK
  2. 2Queen Victoria Hospital, East Grinstead, West Sussex, UK
  1. Correspondence to J Wright jenny.a.m.wright{at}

A 5 month old infant attended a paediatric hand clinic with his parents. The presenting complaint was a duplicated thumb on his right hand. The anomaly was first detected on a routine baby check by a paediatric SHO, who referred the infant to a paediatric hand surgeon.

The child’s parents confirmed that the baby was born at term and was otherwise clinically well. There was no family history of congenital hand abnormalities.

On examination, the patient had two well formed thumbs on his right hand (fig 1); each with a nail plate. Both thumbs were reduced in size compared with the contralateral thumb and both had poorly defined interphalangeal joint creases (fig 1a), indicative of reduced mobility. The radial sided thumb was axially deviated (ulnarwards), whereas the ulnar sided thumb was well aligned.

Fig 1

Photograph of …

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