Triphalangeal thumb

X-ray TPT with polydactyly 2.tiff

X-ray delta shaped extra phalanx.tiff

Triphalangeal thumb (TPT) is a rare congenital anomaly where the thumb has three phalanges instead of the usual two. This condition can occur in isolation or as part of a syndrome, such as Holt-Oram syndrome or Townes-Brocks syndrome. The presence of an extra phalanx in the thumb can lead to various functional and cosmetic issues, depending on the severity of the anomaly and the degree of associated syndactyly, or fusion with other fingers.

Etiology

The exact cause of triphalangeal thumb is not fully understood, but it is believed to involve genetic mutations affecting limb development during gestation. These mutations can be inherited in an autosomal dominant manner or occur spontaneously. The condition has been associated with mutations in specific genes, such as the TBX5 gene in Holt-Oram syndrome, which plays a crucial role in the development of the heart and upper limbs.

Clinical Presentation

Individuals with triphalangeal thumb may present with a thumb that appears longer than normal and may have a range of motion that is either limited or excessive compared to a normal thumb. The extra phalanx can vary in size and shape, and in some cases, the thumb may resemble a finger. Other associated anomalies may include syndactyly, polydactyly (extra fingers), and anomalies of the heart and other organs, depending on the presence of related syndromes.

Diagnosis

Diagnosis of triphalangeal thumb is primarily based on physical examination and radiographic imaging. X-rays can confirm the presence of an extra phalanx and provide details about the bone structure, which is crucial for planning treatment. Genetic testing may be recommended if a syndromic cause is suspected.

Treatment

Treatment for triphalangeal thumb varies depending on the severity of the condition and the presence of associated anomalies. In cases where function and appearance are significantly affected, surgery may be recommended to remove the extra phalanx and reconstruct the thumb. The goal of surgery is to improve the thumb's function and appearance while minimizing complications. Occupational or physical therapy may also be beneficial to enhance hand function after surgery.

Prognosis

The prognosis for individuals with triphalangeal thumb largely depends on the severity of the condition and the success of treatment. With appropriate management, most individuals can achieve good functional outcomes and lead normal lives. However, those with associated syndromes may have additional challenges related to their other anomalies.