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Myndi Smart
ENGL 1010-40
Sean M. George
8 November 2015
Piecing Together Polands Syndrome
What a sweetie. I understand she is your third? the nurse asked. The woman lying in
the hospital bed looked down at the small bundle curled up on her chest, smiled and nodded her
head. Yes, but she is my first girl. The nurse was just finishing her initial assessment of the
newborn. She paused as she examined the babys right hand. Well, it looks like she has a little
bit of webbing between the fingers on her right hand, but that is nothing to worry about. The
mother examined the hand for herself and noted that her new baby was also missing fingernails
on her pointer and pinky fingers of the right hand. Both the doctor and the nurse seemed
unconcerned about these details, so the woman decided it must be a fairly common birth defect.
The next day, as she was again examining her new babys hands the woman discovered
that the webbed hand, wrist and arm were also smaller than that of the babys left side. She
asked about it at the babys one-week appointment, but again the doctor seemed unconcerned
and diagnosed the baby with retardation of the right hand. He suggested that at the babys oneyear appointment they would take an x-ray of the hand, and if all the bones were present he
would pass the x-rays on to a pediatric surgeon when the baby was five. The mother began
wondering why the doctor wanted to wait so long to do surgery. Wouldnt it be less traumatic on
the child to do it before she learned to write? The woman began researching and found that there

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were many children receiving corrective surgery for webbed fingers before the age of two, but
she thought maybe the hand retardation was the reason for prolonging the surgery.
At the babys one-year appointment the doctor referred the baby to a radiologist. The
mother waited weeks, but never received the results of the x-ray. She called the doctors office
multiple times before a nurse finally told her that the baby was missing a bone in her hand, so
surgery was no longer an option. The mother was crushed. She imagined the insecurities her
daughter would have to work through as she grew and realized she was different from everyone
else. How would this limit her daughters abilities?
As the baby grew it became apparent that her birth defects would not hold her back. She
used her small right hand dominantly for most tasks, and if she found it impossible she would
simply switch hands, or use her left hand to assist in whatever mischief she was participating in.
The mothers fears began to fade.
When the baby was nearly eighteen months old, another discovery was made. While
bathing her baby one night, the mother noticed that her little girl seemed to be missing a muscle
in the right side of her chest near her collar bone. The mother began researching again, and
became eager to learn what this meant. Through the use of Google images, medical journals and
blogs she began speculating that her daughter had a birth defect known as Polands Syndrome,
but she was no doctor, so she couldnt be sure. She decided it was time to get a second opinion.
She called another pediatricians office and scheduled an appointment.
The pediatrician entered the room and asked why the mother and baby had come to see
him. The mother told their story and showed him the various birth defects she had noticed. When
she finished, the pediatrician told her that the baby had Polands Syndrome. He explained that it

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is not usually life threatening, but just to be certain he would order an ultrasound of the babys
kidneys. Within 48 hours the mother received confirmation that her baby was healthy and an
appointment was set up to meet with a pediatric surgeon to discuss the possibility of separating
the babys fingers. It had taken this woman two years to begin receiving answers to her questions
about her daughters condition.
Unfortunately, this story is all too common with Poland's Syndrome. Because it is not
generally a life threatening condition many remain undiagnosed until puberty when the absence
of the chest muscle becomes more apparent. It is believed that many men with mild symptoms of
this condition are never diagnosed because they don't feel the need to correct a missing pectoral
muscle. However, even mild cases should not remain undiagnosed. While there may not be many
outward appearances of Poland's Syndrome the internal effects can be life threatening.
The first documented explanation of Polands Syndrome was written by Alfred Poland in
1841. He defined it as a constellation of anomalies occurring on one side of the body. These
anomalies include an absence of the pectoral muscles; shortened fingers; retardation of the hand;
and webbing of the fingers and toes all occurring on the affected side. Later, researchers added
deformity or missing ribs, and missing hair on the chest and armpits to the list of possible
symptoms. Polands Syndrome is very rare, only affecting about 1 in every 100,000 live births.
It is most prominent in men, and tends to affect the right side of the body more often than the
left. Much like Cleft lip/palate, the exact cause of Polands Syndrome is currently unknown; it is
not a hereditary disorder and is extremely rare to occur in the same family. Researchers speculate
that many of the anomalies happen when blood supply to the embryo during the 6th week of
pregnancy is interrupted, but no one seems to know what causes this interruption or how to
prevent it.

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While the world is short on answers for this disorder, the list of effects seems to be
growing. Over the past 50 years, medical professionals have discovered an increased risk of
spina bifida, breast cancer, lung cancer, leukemia, lymphoma, epilepsy, and premature ovarian
failure in patients diagnosed with Polands Syndrome.
Rather than searching for cause and prevention, medical professionals appear to be
focused on correcting the anomalies. A patient with Polands Syndrome is overwhelmed with
options for filling in the chest cavity where the pectoral muscles should be. Procedures range
from fat injections or breast implants to latissimus dorsi transposition depending on the severity
of the cavity, and other anomalies occurring in that area of the body.
Surgery to correct the physical effects are not the only treatments a person with Polands
Syndrome is faced with. In her article Congenital Hand Anomalies, Grinne Bourke expresses
the importance of psychological treatment for both the patient diagnosed with Polands
Syndrome and their parents. She states, The attitude of the childs parents affects their longterm outcome. Their approach and method of coping with their childs [condition] will
significantly affect how the child adapts psychologically. This in turn will influence how the
child integrates into society. It is very difficult for a child to accept a physical challenge
especially if they are not receiving adequate support from their family members. (Bourke)
While it is important for medical providers to remain calm and professional when dealing
with their patients, it is critical that they take the time to really listen to their patients concerns
and be willing to learn about new conditions and treatment options for each individual that they
work with. Poland's Syndrome should not be ignored simply because doctors are uneducated
about the signs and possible complications that arise in patients that are unmonitored. By doing

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this, perhaps researchers will be able to obtain a better understanding of this condition, its
causes, and measures that can be taken to prevent it in the future.

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Works Cited
Beer, Gertrude M., Peter Kompatscher, and Klaus Hergan. "Poland's Syndrome and
Vascular Malformations." British Journal of Plastic Surgery 49.7 (1996): 482-4.
Web. 23 October 2015.
Bourke, Grainne. "Congenital Hand Anomalies." Orthopaedics and Trauma 25.2
(2011): 143-54. Web. 3 November 2015.
Carvalho, Antonio Carlos Pires, et al. "Neuroendocrine Carcinoma in Poland's
Syndrome." European Journal of Radiology Extra 55.3 (2005): 79-81. Web. 23
October 2015.
Derman, Orhan, and Melanie A. Gold. "Poland's Syndrome and Premature Ovarian
Failure." Journal of Pediatric and Adolescent Gynecology 17.6 (2004): 389-92.
Web. 23 October 2015.
Dineldein, Michael W., et al. "Simultaneous Costal Carilage-Sparing Modified Ravitch
Procedure and Latissimus Dorsi Transfer for Chest Wall Deformity Repair in
Poland's Syndrome." Journal of Pediatric Surgery 44.1 (2009): 29-32. Web. 23
October 2015.
Higgs, S. M., and J. F Thompson. "Poland's Anomaly: A Diagnostic Pitfall in Upper
Limb Trauma." Injury 31.10 (2000): 814-5. Web. 23 October 2015.
Kiraz, Aslihan, et al. "Points to Be Noted on Poland Syndrome." Journal of
Biotechnology 185.Supplement (2014): S88. Web. 3 November 2015.
McDermott, Francis, T. Fysh and J. Dunn. "Breast Cancer in a Reconstructed Breast
for Poland's Syndrome." European Journal of Surgical Oncology 37.5 (2011):
S32-3. Web. 23 October 2015.
Pinsolle, V., et al. "Autologous Fat Injection in Poland's Syndrome." Journal of Plastic,
Reconstructive & Aesthetic Surgery 61.7 (2008): 784-91. Web. 23 October
2015.