Hand involvement in MHE is common.  Fogel et al. observed metacarpal involvement and phalangeal involvement in 69% and 68%, respectively, in their series of 51 patients.  In their series of 63 patients, Cates and Burgess found that patients with MHE fall into two groups: those with no hand involvement and those with substantial hand involvement averaging 11.6 lesions per hand.  They documented involvement of the ulnar metacarpals and proximal phalanges most commonly with the thumb and distal phalanges being affected less frequently.  While exostoses of the hand resulted in shortening of the metacarpals and phalanges, brachydactyly was also observed in the absence of exostoses.


Diagnostic Procedures

  • The orthopedist will manually feel for exostoses in the hands and check range of motion (“ROM”) in different directions. X-rays or other imaging tests may be ordered.


Possible Treatment Options

  • Isolated lesions growing rapidly, or interfering with the smooth motion of tendons or joint motion may need to be excised. Multiple surgeries for small, insignificant lesions is usually not advocated.

  • Occupational therapy, physical therapy

  • Use of pencil grips, laptop computers, and other adaptive devices


What Parents Should Watch Out For

  • Complaints of pain when writing

  • Some children will not complain of pain, but will have poor penmanship, write slowly, avoid writing, etc.  Parents should also observe how the child holds writing and eating utensils.

  • Difficulty in rotating hand(s),

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Thank you to Nicole Wynn for designing our logos and contributing her original artwork to our website and our hand-outs.  Nicole is a talented graphic designer who just happens to be living with MHE... you can visit her website at nicolewynn.net

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