The troubles with pinkies.

In my personal series of 3006 children with congenital hand abnormalities, the most common defect was extra digits (528 cases), next was webbed fingers (429 cases), and third was abnormalities of the little finger (354 cases). Any of the digits of a newborn may show deviations in alignment to the palm. However, it is the ulnar side of the hand, and usually the little finger, that most commonly shows skeletal and soft tissue changes. The fifth digit, affectionately known in North America as a pinkie (probably from the Dutch pinkje), is quite often in trouble in the sense that it may be permanently flexed at its proximal interphalangeal joint or may be deviated laterally to one side or the other at either interphalangeal joint. Clinically, a bending or curvature of the finger in the plane of the palm is described as clinodactyly, a word derived from the Greek kliner, “to bend,” and dactylos, “a finger.” A flexion deformity at the proximal interphalangeal joint is known as camptodactyly from the Greek “bent finger.” Only rarely do both abnormalities occur at the distal interphalangeal joint, a deformity first described by J. Kirner in 1927 and now named after him. There is an enormous lay literature concerning our little fingers, with discussions varying from palm reading to the works of 15th-century Dutch artists (1, 2) (Figure ​(Figure11). In Cheiro's Language of the Hand, the little finger, when well shaped and long, is said to indicate the power of the subject to influence others. When very long, it shows great power of expression in both writing and speaking; its owner is more or less the savant and philosopher (3). Fred Gettings, in his illustrated history of palmistry (4), reports that “when the little finger is quite obviously isolated from the others a difficulty in relationships must be immediately suspected.” If, in addition, there is a large, well-developed mount of Venus and a deeply marked long or broken girdle of Venus, then one can be certain that the root problem is too great a preoccupation with sex. If the little finger is long because the first phalanx is very well developed, it will, according to the old traditions, indicate a love of knowledge and of education. A square ending to the little finger “adds a love of research and logic to his oratory.” An extended survey of my colleagues' hands in the hospital lunchroom does not seem to agree with these observations! Figure 1 Camptodactyly seen in six different Renaissance artists' paintings in the Metropolitan Museum of Art in New York City. These bent fingers were probably not pathological but simply following the fashion of the time. Reprinted with permission from reference ... In the last decade, two physicians have published erudite books, both titled The Hand. One was written by Frank Wilson, a neurologist and the director of the Health Program for Performing Artists at the University of California School of Medicine in San Francisco (5). He describes how fossil records show that sometime after Lucy (the bones discovered by Dr. Donald C. Johanson and named “Lucy” based on the Beatles' song playing at the time), the basal joint of the fifth metacarpal developed mobility, allowing the little finger border of the hand to move towards the palm, creating with the thumb a cupping of the palm. Lucy is thought to have lived 3 to 4 million years ago, but no fossil specimens have yet been recovered to more accurately date this significant change in hand structure. In modern hands, the little finger has 40 degrees of motion towards the palm, accompanied by 20 degrees of similar motion of the ring finger metacarpal. The index and long finger metacarpals do not move and are the central pillar around which the thumb and ulnar fingers move towards each other. The other book titled The Hand was written by Raymond Tallis, a professor of geriatric medicine at the University of Manchester, England. He described the book as a “philosophical inquiry into human being” (6). His section on the little finger begins: “About the little finger there is little or nothing to be said. This is the little or nothing. End of Portrait. No, just wait one moment… .” He then spends a whole page describing how when he was a boy there was much talk of the “U” and the “non-U.” There were U and non-U ways of comporting oneself, especially in important social rituals such as drinking tea. The manner in which one held a teacup was a crucial marker of social position. To be “U,” the little finger should never touch the handle of the teacup; it should be “well free of the other fingers, waving in a space beyond the angle between cup and handle.” This grip is rather awkward, and the freely waving little finger is conspicuous and clearly “U”! Equally “U” is the British male's habit of wearing the family crest ring on the little finger and not the appropriately named adjacent digit (Figure ​(Figure22). Figure 2 My own left little finger, demonstrating what I insist is a “normal” clinodactyly and the British placement of family signet rings. Walter Sorell, when a faculty member of Columbia University in 1967, published his book, The Story of the Human Hand (7). His chapter on fingers and their positions has a different viewpoint. He states: “The elevated little finger bespeaks a deeply imbedded wish to distinguish oneself from others; it occurs in both male and female hands. In its allegorical translation, it is a finger which desires to be remarkable and pretends not to have anything to do with the other fingers. Since this gesture can be observed among both the poor and the rich, it is no criterion of social class.” Enough of this nonsense and on to sterner stuff. There is an equally large clinical literature about our little fingers, which unfortunately does not boil down to a single definitive cause for either clinodactyly or camptodactyly.