By: Ammie Ingwaldson
Level 2 Fieldwork at a hand therapy clinic is a fast paced and continuous learning experience. The perfect example of this occurred last week while observing a therapist provide a client with their home CMC arthritis program. The therapist was educating the client on how to oppose their thumb to their small finger. While we watched them practice, she stated, “you have the Linburg sign!” She quickly turned to me and had me oppose my thumb to the base of my small finger, then confirmed that I had it as well. I began to become slightly concerned. We had not reviewed this sign or condition in school. I began to wonder if it was treatable and if it would affect me. My worries were put at bay when she then showed that she had it as well and provided an explanation of what it entailed.
Linburg Comstock syndrome is an anatomical anomaly connecting the tendons of flexor digitorum profundus (FDP) of the index finger and flexor policis longus (FPL) (Puroshothaman & Powers, 2008). This connection of tendons leads to involuntary flexion of the index finger at the distal interphalangeal (DIP) joint with flexion of the interphalangeal (IP) joint of the thumb. The incidence of this anomaly is 37%, with higher distribution of unilateral sign than bilateral.
In most cases Linburg-Comstock syndrome is asymptomatic, but it can present as pain in the distal forearm, wrist, or hand. Median nerve symptoms, similar to carpal tunnel, can also be present due to tendon inflammation, presence of additional tendons, or synovitis with in the carpal tunnel (Puroshothaman & Powers, 2008). Individuals with repetitive thumb and finger movements, such as musicians, are more susceptible to pain or carpal tunnel like symptoms. Surgical release of the connection of FPL and FDP can be performed to relieve symptoms (Old, Rajaratnam & Allen, 2010).
References
Old, O., Rajaratnam, V., & Allen, G. (2010). Traumatic correction of Linburg-Comstock anomaly: a case report. Annals of the Royal College of Surgeons of England, 92(4), W1–W3. doi:10.1308/147870810X12659688852031
Puroshothaman, P., & Powers, D. (2008) A simple diagnostic test for symptomatic Linburg-Comstock anomaly (Linburg-Comstock test). The Internet Journal of Hand Surgery, 2(2), 1-3.
2 Comments
Leave a Comment
More To Read
Simple but Effective Ways Hand Therapists Address Psychosocial Impacts of Upper Extremity Injuries
Although psychosocial factors are often not formally assessed during an evaluation in those with upper extremity injuries, the therapist often informally assesses these during and after treatment sessions. Sustaining an upper extremity injury can be a physically and emotionally challenging experience. Beyond the physical pain and limitations, these injuries can profoundly impact an individual’s psychosocial…
Read More
5+ Common Mallet Finger Splints
Finger orthoses can be tough, and the mallet finger orthosis is no exception. The protocol for 15 degrees of DIP extension with mallet fingers is tricky to manage while making a splint. Small splints on little fingers are also tricky to get sized just right and with strapping in the right places. Ask any experienced…
Read More
Closed Pulley Injuries in Rock Climbers
Mechanism of injury Grades of pulley injury Treatment options for closed rupture Outcome measures Return to climbing Exercise considerations Resources Bollen S. R. (1990). Upper limb injuries in elite rock climbers. Journal of the Royal College of Surgeons of Edinburgh, 35(6 Suppl), S18–S20. Bosco, F., Giustra, F., Lusso, A., Faccenda, C., Artiaco, S., & Massè, A. (2022).…
Read More
Mirror therapy after a peripheral nerve repair in hand therapy
Rapid Review Paula, M. H., Barbosa, R. I., Marcolino, A. M., Elui, V. M., Rosén, B., & Fonseca, M. C. (2016). Early sensory re-education of the hand after a peripheral nerve repair based on mirror therapy: a randomized controlled trial. Brazilian journal of physical therapy, 20(1), 58–65. https://doi.org/10.1590/bjpt-rbf.2014.0130 The Skinny: Therapy is often provided following an…
Read More
Sign-up to Get Updates Straight to Your Inbox!
Sign up with us and we will send you regular blog posts on everything hand therapy, notices every time we upload new videos and tutorials, along with handout, protocols, and other useful information.
I love that great fun fact with a quick explanation, great visual representation of the UE possible problems, and treatment options that are available.
Thanks.
I have this issue but not just one or two fingers is every finger in both hands. if i bend thumb even my little finger goes with it. Just wondering how rare it is for that to happen?