Analysis of Flexion Creases

The flexion creases of fingers reflect flexion at the interphalangeal joint; those of the palm reflect movement of the hand and the digits against the palm during early in utero development.

The flexion creases usually evaluated include those of the fingers and the major flexion creases of the palm. Each finger usually has three transverse

Analysis of Flexion Creases

Head Circumference

Figure 12.8 Normal flexion crease patterns. From Martin and Saller (1962), by permission.

Five finger crease

Three finger crease

Thumb crease

Figure 12.8 Normal flexion crease patterns. From Martin and Saller (1962), by permission.

creases of similar depth. If a crease is missing, or diminished, in utero movement of the underlying joint may have been absent or abnormal. There are usually three major creases in the palm (Fig. 12.8).

The five finger crease (FFC) This crease starts on the radial side of the hand near the insertion of the index finger and runs across the palm toward the ulnar side. If the FFC is long, it extends below the insertion of fingers 4 and 5. If it is of medium length, it extends below the insertion of the fourth finger, and if short it extends only to the third finger insertion.

The three finger crease (TFC) This crease starts on the ulnar side below the insertion of the fifth finger and runs across the palm distally, usually ending below the index and middle finger. The three finger crease is long if it reaches to the index finger insertion, of medium length if it reaches the interdigital area between the index and middle finger, and short if it only reaches the middle finger.

The thumb crease (TC) This crease starts together with the FFC from the radial side of the palm but runs proximally toward the mid-wrist. It is the consequence of oppositional flexion of the thumb. The thumb crease is long if it reaches down to the wrist crease.

Incomplete development of the FFC and the TFC may give rise to a single crease or simian crease (which may have different forms, being bridged or split). It may reflect alterations in the slope of the metacarpophalangeal plane of flexion or a short palm.

A single palmar crease (fusion of FFC and TFC) can be found unilaterally in 4 percent of the normal population and bilaterally in 1 percent of normal individuals. It is twice as common in males as in females. Single palmar creases are seen with increased frequency in Down syndrome.

A Sidney line is said to be present when the FFC extends all the way to the ulnar border.

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