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

Abstract

Congenital clasped thumb is a progressive flexion and adduction deformity presenting with heterogeneous congenital abnormalities and syndromes. This deformity is usually accompanied by first web space narrowing and metacarpophalangeal joint (MPJ) laxity. Understanding the various features of the clasped thumb and making an accurate diagnosis is essential for treatment. Depending on the classification, treatment can vary from conservative to surgical. We describe the case of a bilateral clasped thumb with various characteristics, which were treated differently according to the disease type. The deformity of the clasped thumb was bilateral, and the patient had MPJ flexion deformity, flexor pollicis longus shortening, first web space narrowing, and MPJ instability, which were confirmed through a stress test. The left thumb was a complex type and was surgically treated, whereas, the right thumb was a flexible type, which was treated with splinting; the treatment showed promising results at 2 years post surgery. Diagnosis of the clasped thumb through thorough history taking, physical examination and considering its characteristics, and appropriate classification of the disease is essential for treatment. Furthermore, a stress test can identify MPJ instability in the congenital clasped thumb.

Management of Congenital Clasped Thumb in Patients with Distal Arthrogryposis 3 Years Follow-up

“…In their case report, Kim et al (11) discussed a case of bilateral congenital clasped thumb in which the left thumb had global instability as detected by stress test and stress radiograph that was treated with doublebreasting procedure and had good 2 years follow-up. However, according to Abdel Ghani et al (12) chondrodesis is the best way to achieve stability in cases of MCP global instability.…”

Trigger Thumb, Trigger Finger and Clasped Thumb

“…Clasped thumb, on the other hand, is a congenital deformity of the thumb characterized by a flexion and adduction deformity of the thumb associated with flexion of the IP and metacarpophalangeal (MCP) joints. Unlike trigger thumb, this condition is associated with an abnormal extensor mechanism of the thumb [ 5 , 6 , 7 ]. To avoid misdiagnosis and excessive and ineffective surgical procedures, clinical suspicion and correct diagnosis are key to appropriate treatment of these thumb deformities.…”

“…Congenital clasped thumb is a deformity of the thumb characterized by a flexion-adduction deformity of the thumb associated with flexion of the IP and MCP joints [ 5 , 6 ]. Clasped thumb is often bilateral, male predominant and is associated with an abnormal thumb extensor mechanism (extensor pollicis brevis (EPB), longus (EPL) or both) that prevents the thumb from being actively extended [ 5 , 6 , 7 ].…”

“…Congenital clasped thumb is a deformity of the thumb characterized by a flexion-adduction deformity of the thumb associated with flexion of the IP and MCP joints [ 5 , 6 ]. Clasped thumb is often bilateral, male predominant and is associated with an abnormal thumb extensor mechanism (extensor pollicis brevis (EPB), longus (EPL) or both) that prevents the thumb from being actively extended [ 5 , 6 , 7 ]. This deformity is often associated with other musculoskeletal diseases and approximately 68% are associated with various syndromes [ 7 ] (Freeman–Sheldon, Emery–Nelson, Moebius, Waardenburg, congenital contractural arachnodactyly, digitotalar dysmorphism, arthrogryposis and multiple pterygium) [ 5 , 6 , 7 , 41 , 42 ].…”

“…Clasped thumb is often bilateral, male predominant and is associated with an abnormal thumb extensor mechanism (extensor pollicis brevis (EPB), longus (EPL) or both) that prevents the thumb from being actively extended [ 5 , 6 , 7 ]. This deformity is often associated with other musculoskeletal diseases and approximately 68% are associated with various syndromes [ 7 ] (Freeman–Sheldon, Emery–Nelson, Moebius, Waardenburg, congenital contractural arachnodactyly, digitotalar dysmorphism, arthrogryposis and multiple pterygium) [ 5 , 6 , 7 , 41 , 42 ]. In these syndromic patients, it is common to see other congenital flexion finger deformities [ 5 , 6 , 7 , 41 , 42 ].…”