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Missing knuckle &severe joint pain.

Hello, I'm an 18 year old female with pretty bad joint pain (at least that's what I'm assuming it is.) When I was about 10 or 11, I discovered I was missing a knuckle on my right ring finger. My finger was then about the same size as my pinky, and seemed like it had a 'shrinking' effect, due to the fact all my other fingers were growing and my ring finger was not. I don't remember much about what the doctors said about it, as it was 8 years ago. But I do know I had many x-ray's and MRI's &they wanted to do surgery on it, by taking bone from my hip &placing it in my finger (I think ?) I didn't undergo the surgery tho, because I ended up moving from California to Las Vegas w| my parents. Now, this past year, I have been experiencing very bad joint pain in my hand &fingers.  Predominantly my pinky finger &ring finger, &directly under my ring finger where it would connect to the center of my palm. The pain is at times unbearable &extremely frustrating to the point that I want to cry. I am right handed, so it makes writing anything extremely difficult and ends up w| me in pain. Does anyone know what this could be or how I could believe the pain? I'm desperate at this point. Here are a few pictures of my hand. I try to keep long nails on so the difference in how short my ring finger is isn't as visible (Yes, I am very self conscious about it.)

http://i142.photobucket.com/albums/r114/rm lvr/77043a40.jpg
http://i142.photobucket.com/albums/r114/rm lvr/cba0be5e.jpg


Here's a pic of my left hand, the normal hand w| all knuckles in tact 
http://i142.photobucket.com/albums/r114/rm lvr/9ee64656.jpg

&here's my right hand, where my ring finger knuckle is missing. 
http://i142.photobucket.com/albums/r114/rm lvr/8505f536.jpg
http://i142.photobucket.com/albums/r114/rm lvr/089d8a9f.jpg
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replied May 20th, 2011
Especially eHealthy
Calibby,

You are not actually missing a knuckle, it is just not in the correct place. The picture of your right hand from the dorsal aspect (the back of the hand) tells the story. You have a short fourth metacarpal. It looks like the phalanges (finger bones) are actually all of the correct length.

If you look at the position of the MCPJs (metacarpal phalangeal joints) across the dorsum of the hand, you will notice that the Ring Finger (RF) MCPJ is more proximal (towards the elbow) than the rest. The MCPJs are marked by the dimple when the hand is flat and the big knuckles when you make a fist.

The reason you are having pain, is most likely because the short metacarpal is putting stress across the adjacent MCPJs. There are stout ligaments that connect the metacarpal heads together (the transverse metacarpal ligaments). Also there are several muscles within the hand, which produce the complex, fine motions of the fingers (writing, manipulating small objects like screws, nuts, beads, pins, etc. These muscles and their tendons are now out of balance.

So, for some reason, when you were young, the RF metacarpal stopped growing or grew a lot slower than the other metacarpals. The most common cause is damage to the growth plate in the metacarpal. It does not take a significant injury to cause enough damage for the growth plate to fuse too soon.

When you were younger, the surgery that was proposed was most likely a bone graft to lengthen the metacarpal. This is more difficult than it sounds. You can't just lengthen the bone willy-nilly, especially now that you have grown up, because the bone is not the only thing that is short, as the muscles, tendons, nerves, and blood vessels are also shortened. If you just stretch out the bone, the muscles and tendons will no longer be at the proper tension and may not move the finger joints correctly. The nerves are very, very touchy. Stretching them just a little can lead to total malfunction, where the nerve just quits working. You would then lose sensation and some motor function.

One thing that is not done in the hand is cosmetic surgery. Hand surgeons will not compromise function just for appearance.

But, there are some things that can be done, some options are better than others. As to which procedure is chosen, depends upon many things, such as what type of activities will be required of the hand in the future. For example, the demands of a professional musician are different from those of a manual laborer.

The ringer finger can be removed, by what is called a ray resection. This is where the whole ringer finger, metacarpal and all, is removed and the small finger is moved over to close down the space left by the ring finger. This is a very successful operation and is done quite often after trauma or tumor resection. It has the advantage of returning the patient to full activity (activities of daily living, employment, recreational activities, etc) very quickly. It has a proven track record with few complications.

Another procedure would be a distraction lengthening of the metacarpal. Here, an external fixator is placed on the metacarpal and it is cut in half. Then, very slowly, the two fragments of the bone are distracted (pulled apart). Since this is done very slowly (over weeks), the soft tissues have time to also lengthen. As the bone is separated, it actually lays down new bone in the gap, thus it essentially "grows" in length. This is a more complex procedure, but it is done fairly regularly. It does have a much higher risk and complications rate. Some problems include nerve dysfunction, pin track infection, breakage of the hardware, and the bone not healing properly.


You need to see a hand surgeon, so that a proper examination can be done. X-rays, and other studies as needed, are performed to determine exactly what the problem is. Then, you and the surgeon can discuss what your options are.

Good luck.
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replied September 12th, 2013
Same thing here ...only it is myt left hand. The ring finger aches right back to my wrist.
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replied April 6th, 2012
missing knuckle
I have the same thing and i am 12 yrs old,i have it on both hands though my left and the right.Do you know the real name for the missing knuckle?
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replied April 30th, 2012
Missing Thumb knuckles
My new foster daughter is apparently missing two knuckles in the upper portion of her thumbs. She cannot bend her thumbs and there isn't even a crease in them. They are shorter than normal, taper off at the tip, and bend only from the knuckle at the base - edge of the hand. Do you know what this is called or what may cause this? And can surgery help?
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replied May 7th, 2013
missing knuckle on thumbs and no creases
Hi, I have just read your post and have found my 7 year old has the same. She has no knuckle joints in either thumbs and no creases on the back. Did you find any information about the foster child. Any info would be appreciated. Thanks.m
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replied May 7th, 2013
Hi, I have just read your post and have found my 7 year old has the same. She has no knuckle joints in either thumbs and no creases on the back. Did you find any information about the foster child. Any info would be appreciated. Thanks.m
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User Profile
replied May 8th, 2013
Especially eHealthy
uknzukuser,

You would have to have a thorough evaluation of your daughter conducted by a pediatric orthopedic surgeon.

The fact that there are no flexion creases in the thumbs could mean a couple of things. She may have joints, but they are anklyosed (sort of scarred), so they do not move. Or, she might actually not have any joints. It is actually more common to have the ankylosis of the joints, rather than the absence of the joints. An x-ray of the hands (along with the exam) will usually be able to tell what is going on.

If the thumbs are smaller than normal, she could also be missing one of the phalanges of the thumb (one of the bones). This is a type of congenital amputation (longitudinal deficit).

A thorough physical evaluation is needed because these conditions (congenital thumb deformities) are often part of a syndrome, with other parts of the skeletal system involved, or even other organ systems. The fingers/toes develop around the fifth week of gestation. This is also the time that many internal organs are formed (heart, kidneys, etc). So, if something happened in utero at this time, it may also affect the internal organs as well.


As to whether or not anything can be done (or needs to be done) would have to be based on a thorough evaluation (both a thorough physical examination and an occupational therapy functional evaluation). Many patients can do very well with this type of “deformity”. But, again, it would take a thorough evaluation.


You might be interested in the following article.

Congenital thumb deformities and associated syndromes.
Ashbaugh H, Gellman H.
J Craniofac Surg. 2009 Jul;20(4):1039-44.


Good luck.
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replied June 2nd, 2014
Missing Pinky Knuckle
My daughter is 11 years old and has had a missing pinky knuckle for as long as I can remember. It first appeared as a 'pimple' on her knuckle when she was a baby. As a young mother at the time, I took her in at the doctor's office. The conclusion at the time was that she had a "cold" underneath the skin. I'm no doctor myself, but I thought to myself, "is that even possible". The doctor informed me it will go away in time and as she grows. Now, her knuckle is gone; when she makes a fist, her other knuckles show, however, where there's suppose to be the pinkie knuckle, there is a dent. Weird.
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