Camptodactyly is a fixed flexion deformity at the PIP joint of the little finger. The condition is an autosomal dominant trait involving permanent flexion of the little finger. Camptodactyly may also be bilateral affecting multiple digits. Unilateral 1/3 of the time and bilateral 2/3 of the time. Camptodactyly occurs in less than 1% of the population, and it may be associated with several congenital syndromes. Camptodactyly may be caused by abnormal lumbricals and flexor digitorum superficialis insertion. Severe camptodactyly may cause difficulty in grasping objects. Clinodactyly is congenital curvature of the digit in the radioulnar plane. Treatment should be done early with splinting, passive stretching, and physical therapy. Surgery may be needed if the deformity is flexible, the patient may need tenotomy or tendon transfer. If the deformity is severe and fixed, the patient may need osteotomy or arthrodesis.

Congenital Trigger Thumb

Congenital trigger thumb is a pediatric condition which results in flexion deformity of the thumb at the IP joint. There will be triggering and flexion deformity of the IP joint of the thumb and a nodule can be felt at the base of the thumb over the MCP joint of the thumb. The condition can be developmental or congenital. Congenital trigger thumb is bilateral in 25% of cases. The flexor pollicis longus tendon is thickened and its diameter is increased compared to the A1 pulley. Thickening of the tendon will interfere with normal gliding of the tendon and will cause some triggering which can lead to fixed contracture of the thumb. Spontaneous resolution of the symptoms is unlikely after the age of 2 years. It is a flexion deformity at the thumb IP joint. The flexor tendon may have a nodule called “Nota’s Node”. The patient may not be able to extend the IP joint due to fixed flexion deformity. X-rays are usually normal. Treatment is extension splitting in the first year. If the patient is less than one year of age, the treatment is observation, stretching, and splinting. Do passive extension exercises with intermittent extension splinting. There will be about 50% resolution of symptoms. Surgery is done if there is failure of conservation treatment or if there is fixed deformity after 1 year of age. If there is no spontaneous correction of the deformity by 1 year, do release of the A1 pulley. During the A1 pulley release surgery, you must protect the radial digital nerve which may cross the field. Avoid release of the oblique pulley because this may lead to bowstringing of the flexor tendon. Usually multiple fingers are affected. There will be distal triggering as the flexor digitorum profundus passes through the sublimus decussation at the level of the A2 pulley (not the A1 pulley). Treatment is usually excision of one sublimus slip to allow for smooth gliding of the FDP tendon.

Female Athlete Triad

Female athlete triad is a condition that affects female athletes such as gymnasts, dancers, or athletes with weight classifications such as body builders. It is a syndrome in which amenorrhoea, osteoporosis, and insufficient caloric intake affects certain groups of athletes. Each component of the female athlete triad can occur from mild to severe. Not all components need to be present, but if one component is found, the doctor should check for the others. If you find a healthy, young female with stress fractures, ask about her eating habits. The physician should examine the relationship between the different components of the triad. The athlete will try to restrict their diet in order to maintain lower body fat, and that may cause an imbalance of energy (low caloric intake). This restriction of the athlete’s caloric intake will lead to negative energy balance. Amenorrhoea results from energy imbalance. Insufficient caloric intake is the most common cause of amenorrhoea in female athletes, and it may or may not be associated with eating disorders. Eating disorders can affect the brain’s regulation of the ovaries. This may cause an absence of the menstrual cycle (amenorrhoea). It occurs in about 65% of athletes such as runners and ballet dancers. There are two types of amenorrhoea: primary and secondary. Primary amenorrhoea occurs when menstrual cycles never start. Secondary amenorrhoea occurs when there is no menses for 6 months or absence of 3 or more consecutive menstrual cycles. Osteoporosis will lead to bone fragility and often manifest as stress fractures. 90% of bone mineral content occurs by the end of adolescence. The first step in treatment is recognition of the disorder. Treatment includes prevention, correction of the energy deficit, increase dietary calcium and vitamin D, maintaining bone mass, resume normal menstrual function, and reduce training intensity. The patient will need a multidisciplinary team including an athletic trainer, a nutritionist, a psychologist, and a physician. Female patient with a history of stress fracture should undergo a workup. This includes obtaining a menstrual cycle history, nutritional consult, bone density, and psychological consult for eating disorder.