Introduction Congenital digital stiffness that comes in two forms hereditary symphalangism nonherediatry symphalangism Epidemiology Anatomic location more common in ulnar digits Etiology Pathophysiology failure of IP joint to differentiate during development Genetics inheritance pattern (hereditary type) autosomal dominant Associated conditions syndactyly (nonhereditary type) Apert's syndrome (nonhereditary type) Poland's syndrome (nonhereditary type) correctable hearing loss (hereditary type) Presentation Physical exam inspection absence of flexion and extension creases motion stiff digits Imaging Radiographs IP joint space may appear narrow Treatment Nonoperative observation no indication for surgery in children Operative capsulectomy outcome limited success IP joint arthroplasty outcome limited success angular osteotomy indications rarely needed due to adequate digital function arthrodesis indications may be considered during adolesence to improve function and cosmesis rarely needed due to adequate digital function