Four Finger Furrow

By | June 10, 2022

The four- finger fossa is a palmar line that commonly occurs in people with some form of trisomy. The presence of a four-finger crease has no pathological value in and of itself, since the line of the hand does not affect the function of the hand. For this reason, four-finger furrows do not have to be specifically treated in healthy people or in trisiomy patients.

What is a four finger furrow?

The palm of the hand has different hand lines, which are also referred to as hand furrows. In alternative medicine, there is a widespread belief that illnesses and dispositions can be read from the creases of the hand. In fact, a form of scientifically based palmistry exists. For childbed fever explanation, please visit

The lines of the hand really reveal something about possible diseases under certain circumstances, such as rare hand creases like the four- finger crease. The transverse palmar crease, as it is also known, is a flexion crease located on the palm of the hand that runs perpendicular to the longitudinal axes of the fingers and parallel to the metacarpophalangeal joints.

The furrow runs from the index finger to the little finger and can be symptomatic of various diseases. However, the four-finger furrow is not always to be understood as an indication of a disease. In the general population, cleavage occurs in at least 1 in 100 people. The term four-finger furrow has replaced that of the monkey furrow or barrier line. Monkey furrow refers to the fact that higher order primates often bear such a furrow.


All people have ridges in the palms of their hands. In most cases, these are rounded furrows that run in an individually curved arc. Four-finger sulcus is not common in the general population and is considered an anomaly rather than the norm. Possible causes for the line are, for example, different trisomies.

While the four-finger sulcus occurs in only one in 100 healthy people, it is present in 75 percent of all people with trisomies. Trisomies are triplets of chromosomes or chromosome sections, such as Down syndrome, Patau syndrome, Edwards syndrome, trisomy 16, trisomy 8 and Zellweger syndrome, Aarskog-Scott syndrome, C trigonocephaly Syndrome, Noonan Syndrome and Smith-Magenis Syndrome.

Also, patients with Wolf-Hirschhorn syndrome, Smith-Lemli-Opitz syndrome, De Grouchy syndrome and Schinzel-Giedion syndrome, as well as cat cry syndrome, carry the cleavage more often than individuals without chromosomal abnormalities. As a result, a chromosomal abnormality can be the cause of the phenomenon. However, there is no compellingly pathological connection.

Symptoms, Ailments & Signs

In principle, the four-finger furrow is not an impairment. The mobility and function of the affected hand are fully preserved. The only clinical relevance of the furrow is through the possible context of chromosomal disorders. If the four-finger crease actually occurs as part of a chromosomal aberration, there is usually a single crease of the fifth finger in addition to the crease.

Both furrows together raise the suspicion of a pathological peculiarity. The four-finger furrow alone has no pathological value. Even if a four-finger crease and a single hand crease on the fifth finger are present at the same time, a pathological basis is not automatically confirmed.

Only in the case of manifest clinical symptoms of the patient can one speculate about a trisomy due to the peculiarities of the palms of the hands. The symptoms of a trisomy depend on the length and type of the tripled chromosome segment. In most cases, with chromosomal abnormalities of this type, different malformations of tissues or organs occur, which can differ significantly in severity.

Diagnosis & course of disease

The presence of a four-finger furrow does not necessarily have to be of diagnostic value. Since the furrow can also occur in perfectly healthy people, a four-finger furrow alone should under no circumstances be used to indicate a chromosome anomaly. Trisomies are usually diagnosed based on the characteristic symptoms, organ-specific diagnostics and molecular genetic analysis.

Abnormal hand markings such as the four-finger furrow can be recognized visually and can be included in the case description if a trisomy has already been diagnosed. The prognosis for patients with a trisomy depends on the type and length of the tripled segment of the chromosome. If the four-finger furrow is independent of trisomies, it does not affect the function of the hand or the health of the patient.


A four-finger furrow does not always have to lead to complications or complaints. The disease can also occur without any symptoms or restrictions, so that those affected can move their hand without further ado. However, the repeated occurrence of a four-finger furrow can lead to problems with movement and thus to restrictions in everyday life.

In many cases, those affected by the disease also suffer from malformations of the internal organs, so that various examinations are necessary. However, these malformations can be very different, so that a general prediction is not possible. Four-finger sulcus can also cause aesthetic discomfort, making those affected feel uncomfortable or ashamed of the discomfort.

In children, the condition may also lead to bullying or teasing, which can also cause depression and other mental health problems. The quality of life of the affected person is generally reduced by the four-finger furrow. The treatment also depends on the exact symptoms and can limit them.

There are no particular complications either. In most cases, the symptoms can be alleviated. The life expectancy of those affected by this disease is only limited when severe malformations of the internal organs have occurred.

When should you go to the doctor?

The four-finger furrow is an optical change in the human palm. This can be perceived immediately after birth through visual contact. In principle, the hand line does not represent a disease value. It is by no means an independent disease. Rather, the four-finger furrow is a symptom of an existing health disorder and can indicate a trisomy. The perception of the optical abnormality should therefore be discussed with a doctor immediately. The affected person is naturally unable to react, so parents should consult a doctor immediately as soon as they notice the peculiarity of the hand line.

In most cases, birth takes place in an inpatient environment or in the presence of a midwife. Since a comprehensive health examination of the newborn takes place immediately after delivery, the four-finger furrow is noticed by the medically trained staff under optimal conditions. Further steps are decided in consultation with the parents and medical tests are carried out.

A need for action therefore only exists in a large number of cases if the optical change in the palm of the hand goes unnoticed during the first examinations after birth. If there are any abnormalities or peculiarities in behavior or appearance in the further growth process of the child, a doctor should be consulted.

Treatment & Therapy

A four-finger furrow alone is not an indication for therapy. Even in the context of trisomies, the four-finger furrow is not treated further, since the abnormal hand drawing does not cause any impairment of the motor function. In the larger context of trisomies, however, numerous other symptoms occur that urgently require therapy.

In this case, treatment depends on the type of trisomy and the symptoms present. Causal treatments are not yet available for patients with trisomies. Since the cause of the diseases lies in a multiplication of the genetic material, only advances in gene therapy over the next few decades can open up causal treatment options.

So far, the therapy of trisomy patients has been purely symptomatic. The focus is initially on the correction of organic dysplasia, which in the context of various trisomies of a certain degree of severity represents a vital therapeutic step. In addition to invasive measures, conservative drug and, above all, supportive therapy steps are available for the symptomatic treatment of some trisomy symptoms. Only a cure cannot be achieved due to the lack of causal therapy so far.


A four-finger furrow cannot be prevented. In principle, prevention is not necessary either, since the anomaly as a singular phenomenon has no clinical significance. To prevent trisomies, genetic counseling can be useful in the family planning phase.


In general, the four finger furrow does not need to be treated. Accordingly, follow-up care is not necessary. Surgery may be an option for patients who suffer from hereditary diseases such as Zellweger syndrome or Aarskog syndrome. This depends on the severity of the four-finger furrow and any other malformations.

The four-finger sulcus itself is not a priority in treatment and follow-up care. The most important follow-up measure is to monitor the further symptoms of the underlying disease and to provide the patient or the parents with further measures to be able to cope better with the clinical picture. The general practitioner takes over the follow-up care in the case of a four-finger furrow.

He determines the four-finger furrow and can refer the patient to a suitable specialist. Most of the time, hereditary diseases can be identified by other, more obvious symptoms. The four-finger furrow is a typical sign that must be included in the diagnosis. After the causative disease has been diagnosed, further therapeutic measures can be discussed.

Due to the large number of possible diseases that can be associated with a four-finger furrow, aftercare must always be selected individually. Follow-up care is determined by the doctor in charge. If the four-finger furrow occurs without a causative disease, no follow-up care is necessary.

You can do that yourself

A four finger furrow is not a physical impairment. Treatment of the external feature is not necessary unless the ridge is unusually pronounced and thereby restricts hand mobility.

Parents who notice a four-finger crease in their child are best advised to speak to their pediatrician. Further examinations can determine whether the four-finger furrow is based on a genetic change such as trisomy 21. In most cases, however, the external signs are sufficient to be able to diagnose or rule out such a disease yourself. If the four-finger furrow occurs independently of a disease, no further measures need to be taken. The child can later be informed about the cause of the four-finger furrow. If the four-finger furrow occurs as part of a disease, it must first be treated.

The monkey furrow itself does not require treatment. It occurs in up to four percent of the European population and has no further implications for the child’s health. Nevertheless, any abnormalities should be observed and, if necessary, a specialist should be consulted. Especially in the field of genetic diseases, research is ongoing and new findings that establish a connection between the quadruped furrow and physical diseases cannot be ruled out.

Four Finger Furrow