# Ultrasonographic Diagnosis of Finger Flexor Tendon Hypoplasia in a Child with Phalangeal Agenesis

## TL;DR

A child with missing fingers and underdeveloped tendons was diagnosed using ultrasound, revealing a rare condition.

## Contribution

This is the first report describing multiple flexor tendon hypoplasia alongside phalangeal agenesis in a single case.

## Key findings

- Ultrasound identified hypoplastic flexor tendons in the second to fifth digits of a child with finger agenesis.
- Phalangeal hypoplasia was observed in the third and fourth fingers, adding complexity to the deformity.
- Ultrasound combined with radiography is recommended for evaluating such rare hand deformities.

## Abstract

Agenesis and hypoplasia affecting multiple flexor tendons within the same hand represent an exceedingly uncommon occurrence, with no previous studies addressing this condition. This report details a 4-year-old girl with agenesis of the right third and fourth fingers, who sought consultation due to the inability to flex her seemingly unaffected second and fifth fingers. Ultrasound examination revealed substantial thinning of the flexor tendons in the second to fifth digits, with a notable absence of attachment to the middle phalanx. In addition to flexor tendon hypoplasia, hypoplasia of the third and fourth middle phalanges was observed. Hand deformities featuring both finger agenesis and flexor tendon hypoplasia across multiple fingers were exceptionally rare. In such instances, ultrasound, in conjunction with radiography, emerges as the recommended initial imaging tool for comprehensive evaluation of both the phalangeal bones and flexor tendons.