An 11 year old girl was seen for evaluation of finger contractures. She had been noted at birth to have finger contractures and a “puffy face” (fig 1). Her birth weight was 4077 g and her length was 51 cm. At 11 months of age she had “trigger finger” releases of her fifth digits with some improvement. She was diagnosed at the age of nine with attention deficit disorder and treated with Ritalin. At the age of 10 she was treated by release of contracture and tendon balancing procedure of the right little finger. The left little finger was treated with a splint. There was no clinical evidence of neurological or muscle disease. She was at the 50th centile in height until 9 years when the rate of growth decreased.