I was born with only thumb nails affected and my mom knew it was something genetic from my grandma's side. At 2 I had double hip dysplasia. At 19 was determined to have squared knee caps. My mom had a hysterectomy in her 50s and an xray tech noticed she had Iliac horns and elbows distended . he then informed her that she had NPS and we determine I as well. I have one daughter who has thumbs like us and distended elbows.