I - 5Th finger interphalangeal creases: single crease [Down syndrome hand sign 4-4: LOR = +4.87]
II - Palmar ridge line A: ends between pinky finger & distal transverse crease (both hands) [Down syndrome hand sign 5-4: LOR = +4.07]
III - Palmar axial triradius: atd angle 57o or larger [Down syndrome hand sign 5-10: LOR = +3.96]
IV - Hyper extensible finger joints [Down syndrome hand sign 7-1: LOR = +3.58]
V - Dysplasia: palmar ridge dissociation [broken skin ridges] [Down syndrome hand sign 5-15: LOR = +3.18]
VI - Hypothenar [mount of moon]: large ulnar loops [Down syndrome hand sign 5-14: LOR = +3.02]
VII - Simian crease (both hands) [Down syndrome hand sign 4-1: LOR = +2.69]
VIII - Abnormally short fingers [brachydactyly] [Down syndrome hand sign 3-1: LOR = +2.50]
IX - Fingerprints: radial loop on ringfinger [Down syndrome hand sign 5-2: LOR = +2.46]
X - Hypothenar [mount of moon]: 3 or more triradii [Down syndrome hand sign 5-12: LOR = +2.32]
This TOP 10 shows that the palmar dermatoglyphics play a key rol in recognizing Down syndrome (see hand signs II, III, V, VI & IX); 4 of these signs relate to the palmar hypothenar zone [in the field of palmistry a.k.a. the 'mount of Moon'].
NOTICE: Log Odds Ratios are calculated from the prevalence (%) among Down syndrome patients & controls.
- 29 Hand Signs in Down Syndrome -
Down syndrome is a genetic disorder, caused by a trisomy on the 21th chromosome. The result of many studies indicate that there are various hand sign that can be described as 'typical' for Down syndrome [log odds ratio statistics are sometimes above 4.0].
The result of hundreds of studies show that various (combinations of) hand signs display the presence of this genetic disorder.
Important: quite some of the most significant hand signs relate to the hypothenar of the palm!
How to make a Palm Reading Assessment for DOWN SYNDROME?
Key-elements of the hand in Down's syndrome in a nutshell: small hands with squarish palm shape, short fingers, short fingernails, palm & fingers display typical dermatoglyphics (usually featured with high positioned axial triradius on hypothenar), unusual palmar creases (very often featured with simian crease or Sydney line).
- Phantom picture for Down syndrome -
An advanced hand diagnosis for Down syndrome requires a person to have multiple significant hand markers that follow the MAJOR REQUIREMENT + the three additional requirements A, B & C as described below:
MAJOR REQUIREMENT: The person requires to have significant hand markers for Down syndrome in at least three dimensions of the hand
- ADDITIONAL REQUIREMENT A: The person requires to have four or more hand markers that relate to DERMATOGLYPHICS (= hand perspective 5)
- ADDITIONAL REQUIREMENT B: The person requires to have at least one hand marker that relates to the HANDSHAPE (= hand perspective 1) or FINGER MORPHOLOGY (= hand perspective 3).
- ADDITIONAL REQUIREMENT C: The person requires to have at least one hand marker in the palm + at least one hand marker in the fingers.
IMPORTANT: Only when all above REQUIREMENTS are fullfilled, then one can speak safely of 'confirmed' hand diagnosis for Down's syndrome!
Some of the 26 significant hand markers for Down syndrome that are listed below became known in medical science as a 'physical minor anomaly' (such as the simian crease & the Sydney line).
But in general all these individual hand markers can usually be described as harmless body characteristics.
And even when 'constellations' of two or more of these hand markers are observed in one perspective of the hand, these hand markers should not be recognized as suspicious - UNLESS each of both hands display such constellations in 2 or more perspectives of the hand.
- List of 29 hand signs for Down syndrome -
• Hand perspective 1 - HAND SHAPE:
1-1 - Small hands (hand length < 10 % of body length);
1-2 - High hand index: palm width vs. hand length (ratio > 47 %);
1-3 - Short palm length vs. palm width (squarish shaped: ratio > 85 %).
• Hand perspective 2 - FINGERNAILS:
2-1 - Very short fingernails [brachyonychia];
2-2 - Very small fingernails [micronychia].
• Hand perspective 3 - FINGER MORPHOLOGY:
3-1 - Abnormally short fingers [brachydactyly];
3-2 - Thumb: short (low set) position;
3-3 - Pinky finger: very short;
3-4 - Incurved pinky finger [clinodactyly].
• Hand perspective 4 - MAJOR LINES:
4-1 - Simian crease (both hands);
4-2 - Sydney line (both hands);
4-3 - Distal transverse crease (heart line): extended;
4-4 - 5Th finger interphalangeal creases: single crease.
• Hand perspective 5 - DERMATOGLYPHICS:
5-1 - Fingerprints: 10 ulnar loops;
5-2 - Fingerprints: radial loop on ringfinger (+ ulnar loop on index finger);
5-3 - Fingerprints: radial loop on pinky (+ ulnar loop on index finger);
5-4 - Palmar ridge line A: ends between pinky finger & distal transverse crease (both hands);
5-5 - Palmar ridge line B: ends between pinky & ring finger (both hands);
5-6 - Palmar ridge line C: ends between ring- & middle finger (both hands);
5-7 - Palmar triradius C (left hand): missing or 'abortive;
5-8 - Palmar ridge line D: radial exit [between pointer finger & thumb];
5-9 - Alignment of ridges over the distal palmar area: 'transverse';
5-10 - Palmar axial triradius: atd angle 57o or larger;
5-11 - Palmar axial triradius: distally displaced (t") [(distance between axial triradius and the triradius below middle finger is typically smaller than distance between triradius below index finger and triradius below the pinky)];
5-12 - Hypothenar [mount of moon]: 3 or more triradii;
5-13 - Hypothenar [mount of moon]: whorl;
5-14 - Hypothenar [mount of moon]: large ulnar loops;
5-15 - Dysplasia: palmar ridge dissociation [broken skin ridges].
CONTRA-INDICATOR:
5C-1 - Pattern on thenar [mount of venus].
• Hand perspective 6 - SKIN QUALITY:
- (No elements identified yet)
NOTICE: About 0.1% of the world population has Down syndrome. But in Down syndrome the occurence of diabetes type 1 is much higher (estimates indicate almost 4x times), therefore it is interesting to notice that 8 of the 33 hand markers in Diabetes Mellitus are also seen in the summary of hand markers for Down syndrome!
MORE DETAILS!!!
A 'phantom picture' for Down syndrome is presented below that describes 29 hand characteristics + details about the prevalence of these hand markers in Down syndrome populations AND the general population!
Additionally, there are two case studies available:
Many studies around the world have proven that the simian line is a very common hand characteristic in Down's syndrome.
But other studies have indicated that the simian line is also recognized as a (very) common characteristic in other genetic syndrome - and one should also not forget that simian lines can also be observed in about 3% of the healthy population.
This raises the question: 'how can the simian line serve as a diagnostic marker specific for Down's syndrome?'
In 1963 L.S. Penrose presented the first 'phantom picture' describing the typical hand characteristics in Down syndrome.
More detailed 'phantom pictures' were presented by Schaumann & Alter (1976), Rodewald (1981).
Combined with other sources, the author presents an updated comprehensive 'phantom picture' for the most typical hand-characteristics in Down syndrome.
'Phantom picture' of the hand in Down's syndrome: 27 typical characteristics.
During the 20th century quite a few studies have pointed out that in Down syndrome the simian line is always featured with a combination of other characteristics in 3 dimensions of the hand:
A - Hand lines (including: palms & fingers); B - Dermatoglyphics (including: fingerprints & palmar ridge patterns); C - Hand morphology (including: finger length & hand shape).
An overview of the details (see also the 'phantom picture' above):
HAND SHAPE & DOWN SYNDROME:
• 1-1 - Small hands (hand length < 10 % of body length)
Prevalence: Down patients: high (unknown %); controls: low (unknown %)
LOG ODDS RATIO: ? (unknown)
• 1-2 - High hand index: palm width vs. hand length (ratio > 47 %)
Prevalence: Down patients: high (unknown %); controls: low (unknown %)
LOG ODDS RATIO: ? (unknown)
NOTICE: It is important to notice that palm shape is an age dependent characteristic (children have more square-shaped palms than adults). In Down syndrome the handpalm is usually small, and especially short (compared to body length); but the width of the palm is relatively large.
• 1-3 - Short palm length vs. palm width (squarish shaped: ratio > 85 %)
Prevalence: Down patients: high (unknown %); controls: low (unknown %)
LOG ODDS RATIO: ? (unknown)
NOTICE: It is important to notice that palm shape is an age dependent characteristic (children have more square-shaped palms than adults). In Down syndrome the handpalm is usually small, and especially short (compared to body length); but the width of the palm is relatively large.
FINGERNAILS & DOWN SYNDROME:
• 2-1 - Very short fingernails [brachyonychia]
Prevalence: Down patients: often (unknown %); controls: low (unknown %) 12
LOG ODDS RATIO: ? (unknown)
NOTICE: In Down syndrome very short fingernails are often seen, sometimes the complete fingernail is very small (micronychia). Other typical characteristics of the fingernail in Down's syndrome are: no lunula - also in the thumb nail!
• 2-2 - Very small fingernails [micronychia]
Prevalence: Down patients: often (unknown %); controls: low (unknown %) 12
LOG ODDS RATIO: ? (unknown)
NOTICE: In Down syndrome very short fingernails are often seen, sometimes the complete fingernail is very small (micronychia). Other typical characteristics of the fingernail in Down's syndrome are: no lunula - also in the thumb nail!
FINGER MORPHOLOGY & DOWN SYNDROME:
• 3-1 - Abnormally short fingers [brachydactyly]
Prevalence: Down patients: 11 % to 72.3 % 10; controls: near 1 %
LOG ODDS RATIO: +2.50
NOTICE: It is important to notice that relative finger length is an age dependent characteristic (children have relatively shorter fingers than adults). In Down syndrome the fingers are usually short, frequently 'abnormally short' (according the Mehes scales 'abnormally short fingers' are defined as: middle finger length is shorter than 40% of full hand length; full length hand is measured from the tip of the middle finger to the distal flexor crease of the wrist).
• 3-2 - Thumb: short (low set) position
Prevalence - Down patients: 20%; controls: low (unknown %) 7,14
LOG ODDS RATIO: ? (unknown)
NOTICE: In Down syndrome the short, low set thumb is also featured with minor motoric hand gesture & closure inabilities.
NOTICE: In Down syndrome the (short) incurved pinkie is quite common. One should notice here as well that clinodactyly is not considered as a (severe) hand anomaly.
LOG ODDS RATIO: +2.69 (average for caucasian males & females)
NOTICE: Other studies 2 have indicated that the simian is also very significant when present only in the right hand; when present only in the left hand it is especially significant when combined with a Sydney line in the right hand.
LOG ODDS RATIO: +1.90 (average for caucasian males & females)
NOTICE: Other studies 2 have indicated that the Sydney line (= extended 'head line') is also very signficant if present in only one hand when combined with a simian crease in the other hand - especially when the Sydney line is present in the left hand.
Prevalence: Down patients: ? (unknown %); controls: rare (unknown %)
LOG ODDS RATIO: ? (unknown)
NOTICE: A study 2 has indicated that the extend distal transverse crease (= extended 'heart line') is signficant when observed in the left hand; in the right hand it is significant when combined with a simian crease in the left hand.
• 4-4 - 5Th finger interphalangeal creases: single crease
Prevalence: Down patients: 11.5 %; controls: 0 % 3
LOG ODDS RATIO: +4.87
NOTICE: Other studies from 7 different countries4 reported percentages in Down samples varying from 8.6 % to 37.7%.
LOG ODDS RATIO: +2.07 (average for 2 populations: UK, JP)
NOTICE: The ulnar loops in Down syndrome tend to be vertically oriented and L-shaped - with the 'open' side directed to the side of the pinky finger. Another common variant is: 9 (or 8) ulnar loops combined with a radial loop on the ring finger or pinky finger.
LOG ODDS RATIO: +2.46 (average for 6 populations: CA, IT, UK, JP, CH, GER)
NOTICE: In Down syndrome the radial loop is most frequently seen on the ring finger (the radial loops are usually vertically oriented and L shaped - with the 'open' side directed to the side of the thumb. A radial loop on the thumb, index finger or middle finger should be recognized as a 'contra-indication' towards Down syndrome.
• 5-3 - Fingerprints: radial loop on pinky finger
Prevalence (6 populations): Down patients - 0 to 9.0 % 4; controls: 0 % to 1.5 % 5
LOG ODDS RATIO: +2.14 (average for 6 populations: CA, IT, UK, JP, CH, GER)
NOTICE: In Down syndrome the radial loop on 5th finger (pinkie) is more frequently seen than radial loops on the middle finger (in the general population the reverse is always observed).
• 5-4 - Palmar ridge line A: ends between pinky finger & distal transverse crease (both hands)
Prevalence: Down patients: 29.3 %; controls: 0.7 % 6
LOG ODDS RATIO: +4.07 (average for 1 population: GER)
NOTICE: The 'palmar ridge line A' starts in the triradius below the pointer finger. In Down syndrome the path of the 'palmar ridge line A' ends often just above or close to the point where the 'upper transverse crease' (heart line) exits the palm. In the normal population the path of the 'palmar ridge line A' is usually found completely below the 'upper transverse crease'.
• 5-5 - Palmar ridge line B: ends between pinky & ring finger (both hands)
Prevalence: Down patients: 64.7 %; controls: 23.0 % 6
LOG ODDS RATIO: +1.81 (average for 1 population: GER)
NOTICE: The 'palmar ridge line B' starts in the triradius below the middle finger. In Down syndrome the 'palmar ridge line B' ends usually in both hands at the edge of the palm between the pinky finger and the ring finger. While in the normal population more variation is observed.
• 5-6 - Palmar ridge line C: ends between ring- & middle finger (both hands)
Prevalence: Down patients: 46.7 %; controls: 19.6 % 6
LOG ODDS RATIO: +1.28 (average for 1 population: GER)
NOTICE: The 'palmar ridge line C' starts in the triradius below the ring finger. In Down syndrome the path of the 'palmar ridge line C' usually creates an 'interdigital loop', and exits the palm at a point between the ring finger and the middle finger. In the normal population this is a common pattern as well, but other variation are much more often seen.
• 5-7 - Palmar triradius C (left hand): missing or 'abortive'
Prevalence: Down patients - 48.5 % to 54.9 %; controls: 14.1 % to 15.0 % 4
LOG ODDS RATIO: +1.73 (average for 2 populations: CH, JP)
NOTICE: The 'palmar triradius C' concerns the palmar triradius that is usually positioned below the ring finger. In Down syndrome this triradius is often missing in the left hand, or the related 'palmar ridge line C' is ending without researching the border of the palm. This characteristic is far less often seen in the righ hand (in both Down patients and the normal population).
Prevalence: Down patients - 3.0 %; controls: 0.5 % 4
LOG ODDS RATIO: +1.82 (average for 1 population: UK)
NOTICE: The 'palmar ridge line D' starts in the triradius below the pinky finger. In Down syndrome the 'palmar ridge line D' occasionally ends at the thumb side of the palm (while in the normal population the 'palmar ridge line D' usually ends somewhere between the fingers).
• 5-9 - Alignment of ridges over the distal palmar area: 'transverse'
Prevalence - Down patients: high (unknown %); controls: low (unknown %)
LOG ODDS RATIO: ? (unknown)
NOTICE: In Down syndrome the alignment of ridges over the distal palmar area is - partly due to the short, broad hand shape - nearly always rather 'transverse' (horizontal). This is usually indicated by the combination of a 'palmar ridge line A' which exits the palm above (or just below) the heart line, combined with a 'palmar ridge line D' which exits the palm between the pointer finger and the middle finger.
LOG ODDS RATIO: +3.95 (average for UK males & females)
NOTICE: It is important to notice that the atd angle is an age dependent characteristic (children have larger atd angles than adults). In Down syndrome adults a high displaced axial triradius (t") is often featured with a large AtD angle: 57o or higher.
Prevalence: Down patients - 44.5 % to 87.0 %; controls: 1.6 % to 11.8 % 4
LOG ODDS RATIO: +3.39 (average for 5 populations: US, CA, IT, JP, CH)
NOTICE: In Down syndrome the high displaced axial triradius (t") is often found in a position close to the center of the palm. Usually this high positioned triradius is featured with a pattern on the hypothenar [mount of moon] + another triradius (often postitioned near the wrist (t) or higher (t')).
• 5-12 - Hypothenar [mount of moon]: 3 or more triradii
Prevalence: Down patients: 4.9 %; controls: 0.5 % 6
LOG ODDS RATIO: +2.32 (average for UK males & females)
NOTICE: In Down syndrome quite often 3 or more triraii can be observed on the hypothenar [mount of moon] - due to the presence of various types of large loops, multiple loops, or whorls.
• 5-13 - Hypothenar [mount of moon]: whorl
Prevalence: Down patients - 3.9 % to 16.8; controls: 0.9 % to 4.7 % 1
LOG ODDS RATIO: +1.39 (average for various populations)
NOTICE: In Down syndrome a large hypothenar whorl is relatively common. The hypothenar whorl is particularly significant when observed in both hands; or when observed in one hand but combined with a large hypothenar ulnar loop in the other hand. Double loops are very rarely seen in Down's syndrome, and are more common in the general population (where they are rare as well).
• 5-14 - Hypothenar [mount of moon]: large ulnar loops
LOG ODDS RATIO: +3.02 (average for males & females)
NOTICE: In Down syndrome the large ulnar loops are by far the most common seen patterns on the hypothenar [mount of moon]; and especially when there is only 1 loop present on the hypothenar it is nearly always an ulnar loop. While in the general population hypothenar radial loops are much more common compared to hypothenar ulnar loops.
Prevalence: Down patients: 50.0%; controls: 4.0 % 4
LOG ODDS RATIO: +3.18 (average for 1 population: GER)
NOTICE: Ridge dissociation concerns poor formation of the palmar ridges, resulting in skin ridge lines of which the direction is difficult to follow. In Down syndrome ridge dissociation is a very common characteristic that is often found in large parts of the palms (sometimes the full palm).
DERMATOGLYPHIC CONTRA-INDICATOR:
• 5C-1 - Pattern on thenar [mount of venus]:
Prevalence: Down patients - 99.3 % to 96.0%; controls: 95.4 % to 88.3 % 4
NOTICE: In Down syndrome there are usually no loops or whorl observed on the thenar [mount of venus]; in the normal population those patterns are more common.
MOTORICS & DOWN SYNDROME:
• 7-1 - Fingers: hyperextensible finger joints
Prevalence: Down patients: 80 %; controls: rare (estimate: about 5 to 10 %) 11
LOG ODDS RATIO: +3.58
NOTICE: Hyperextensible finger joints are associated with a muscle condition named 'muscular hypotonia'.
How to use the Simian Line in hand diagnostics for Down syndrome?
It is important to notice here that not all hand characteristics are equally significant for recognizing Down syndrome.
Specific indications for the significance of specific hand characterstics are provided by the prevalence of these hand characterstics in the control groups: the most significant hand characteristics are found in those which show a relatively large %-difference between the Down patients and the control groups.
The following ten hand characteristics have frequently shown a 10-times higher prevalence percentage in Down groups (compared to the control group): no.1, no.4, no.8, no.12, no.13, no.14, no.15, no.18, no.19, and no.24. So, these hand characteristics belong to the most significant hand zones to focuss on for recognizing Down syndrome!
The simian crease (1) is included, but the combination of: the position of the 'palmar axial triradius' (14 & 15); plus the 'transversal' alignment of the palmar ridge lines A to D; plus the fingerprint of the pointer finger (and ring finger) are probably the most common significant hand characteristic in Down syndrome!
In general, if any hand presents a combination of multiple characterstics in EACH single of the 3 dimensions (hand lines, hand dermatoglyphics & hand shape), than it is very likely that the hand belongs to a person who has Down's syndrome.
For people who have the simian line in both hands, one can determine the significance for Down syndrome by studying the other hand characteristics.
Only when the hands are also featured with the following combination, one can make a hand-diagnosis for Down syndrome:
- (1) mulitiple characteristics from dimension B (hand dermatoglyphics no.5 to no.20: combinations of both palm- and finger characteristics are required),
- (2) plus multiple characteristics from dimenion C (hand morphology no.21 to no.27: combinations of both palm- and finger characteristics are required).
So, if those people have a simian line in both hands, they also need to have a 'wide' range of significant combinations - in both their palms AND their fingers - before one can speak of an thorough & complete 'hand diagnosis' for Down syndrome!!!
Estimate: those people have a statistical chance of about 99% that a chromosomal test [= genetic testing] will reveal that they have 'trisomy 21'! (= the genetic disorder which is responsible for the manifestation of Down's syndrome).
What is in 2010 the state of knowledge about simian lines? ...more.
FINAL NOTIFICATION:
Below are two illustrative cases - featured with high-resolution hand materials - of 2 men who have Down syndrome.
HAND SIGNS & DIAGNOSTICS:
