Dell Children’s Medical Center of Central Texas
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Hand and Upper Extremity Program
Hand and Upper Extremity Conditions Treated

CONGENITAL HAND ANOMALIES

Brachydactyly

Overview

Brachydactyly is a genetic condition that results is short fingers or toes, or both. This is due to abnormally short bones.

Symptoms

Typically brachydactyly is present at birth, with an obvious difference between finger and toe lengths. It may also become apparent over time with growth and development.

Treatment

In a large portion of cases, no treatment is necessary. In some cases where grip and range of motion (ROM) are affected physical or occupational therapy may be needed. In some cases surgery may be required if function is affected, or for cosmetic reasons.

Camptodactyly

Overview

Camptodactyly is a flexion deformity of the finger, usually affecting the second joint of the finger (the proximal interphalangeal joint). The condition often arises in early childhood, or sometimes in adolescence (in which case girls are more often affected).

Symptoms

The finger can bend easily, but cannot be straightened at the second joint. The condition is painless, but sometimes causes functional problems.

Treatment

For mild cases, no treatment is necessary. Moderate cases are treated with splinting and hand therapy. Surgery is performed for severe cases and for those who do not get better with splints or therapy.

Macrodactyly

Overview

Macrodactyly is the abnormal growth of underlying bone and soft tissue causing fingers and toes to grow abnormally large.

Symptoms

One or more of the fingers or toes on the child will be significantly larger than the other fingers and toes.

Treatment

For some mild cases simple observation, or shoe modification may be needed. In most cases surgery is required in order to correct macrodactyly.

Madelung's Deformity

Overview

Madelung’s Deformity is a rare congenital arm condition in which the wrist grows abnormally. Part of the radius, one bone in the forearm, stops growing while the ulna, the other bone in the forearm, continues to grow. This causes a misalignment of the wrist.

Symptoms

Pain and limited range of motion (ROM) may occur in the wrist. Visible changes in the appearance of the wrist are also a sign.

Treatment

For cases with no symptoms and only cosmetic differences, such as a small bump in the wrist, observation and monitoring are the prescribed treatment. In severe cases surgery is required to treat Madelung’s.

Polydactyly

Overview

The term "polydactyly" means "extra digit". It is a fairly common birth defect, and the most common congenital hand difference. It sometimes runs in families and sometimes occurs in conjunction with other hand problems.

Symptoms

The extra digit can vary in appearance from a small nubbin to a fully formed finger or thumb. It may appear "split" at the end of an otherwise normal digit, or there may be an extra digit that sprouts completely independently.

Treatment

Treatment forms vary from simple to complex. Nubbins can often be removed in the clinic. Reconstructive surgery may be required if the digit is rooted deep in the hand. Sometimes, in order to maximize the appearance and function of the remaining digits, a complex operation involving bone, joint, and tendons may be necessary.

Radial Dysplasia

Overview

Radial Dysplasia is a congenital condition in which the radius, one of the bones in the forearm, did not form correctly and is malformed or missing.

Symptoms

The condition is easily identified once the child in born and is confirmed with a physical exam and x-ray. The affected hand will appear to be bent inward toward the thumb side of the forearm.

Treatment

Usually a combination of splinting, casting and range of motion (ROM) exercises will be started during infancy in order to help the child extend the wrist and elbow. In some cases, surgery will be needed and may include lengthening and centralization in the wrist.

Syndactyly

Overview

The term "syndactyly" means "fused digit". It is a common congenital hand difference, occurring in about 1/2500 births.

Symptoms

  • Syndactyly is characterized by webbed, conjoined fingers or toes. There are four different types of syndactyly:
    1. Simple syndactyly: only the skin is involved
    2. Complex syndactyly: skin, bone, and/or nails are conjoined.
    3. Incomplete: only the base of the finger is webbed.
    4. Complete: the entire finger is webbed.

Treatment

Syndactyly is treated by separating the conjoined fingers surgically. The surgery is usually performed when the child is between 12-18 months old. There is almost never enough skin to provide coverage for both fingers, so skin grafts are usually required. A skin graft is a small piece of skin taken from another area of the body. For a few weeks after surgery, the child is placed in a protective cast to prevent motion and protect the repair.

Thumb hypoplasia

Overview

"Hypoplasia" means "under-developed". The degree of under-development can be anywhere from a slightly small but normally-functioning thumb, to complete absence of the thumb. The condition is sometimes associated with other problems, such as congenital heart defects.

Symptoms

  • Thumb hypoplasia is broken down into 5 types, depending on the degree of under-development.
    1. Small but otherwise normal thumb, with normal function.
    2. Short thumb, absent muscles at the base of the thumb (in the palm), and looseness of the joint connecting the thumb to the palm (metacarpophalangeal joint).
    3. As above, with lack of tendons that flex and extend the thumb, and looseness of the joint connecting the thumb to the wrist (carpometacarpal joint).
    4. "Floating thumb", where the thumb is attached to the hand by only a small skin bridge.
    5. Complete absence of the thumb.

Treatment

For small but otherwise normal thumbs, no treatment is necessary. Greater degrees of under-development require surgical reconstruction. For severely under-developed or absent thumbs, the treatment of choice is to move the index finger into the position of the thumb, a procedure called "pollicization". This procedure can produce a very natural-appearing and highly functional thumb.

Trigger Thumb

Overview

Trigger thumb is a condition in which the thumb catches in a bent position. It is caused by swelling in the tendon, which restricts gliding of the tendon through the tendon sheath.

Symptoms

Trigger thumb can affect both adults and children. In adults, the typical symptoms are pain at the base of the thumb (where the thumb meets the palm), and catching or popping of the thumb when it is moved like a trigger being pulled and released. In children, the condition is usually not painful and does not cause "triggering", but rather the thumb gets stuck in a bent position and cannot be straightened.

Treatment

Occasionally trigger thumb in children will go away on its own in a few months. For cases that persist, surgery is recommended to provide more space for the tendon to glide. The surgery is very quick and causes little pain.

Brachial Plexus Palsies

Overview

Brachial plexus birth palsy is an injury to the network of nerves to the upper extremity during birth. During delivery the nerves may be stretched, compressed or torn. This can result in loss of muscle function or paralysis of the arm affected.

Symptoms

The most prominent sign of a brachial plexus palsy is that one arm will lay at the side of the child and not move within a normal range in comparison with the child’s other arm.

Treatment

Most brachial palsies will heal on their own, typically within 3 to 12 months, and require observation only. In some cases physical and occupational therapy are required to help maximize usage of the arm and prevent muscle tightening. In cases where the child continues to have problems with no improvement 3 to 6 months after birth surgery may be needed.

PEDIATRIC HAND TRAUMA

Any hand trauma issues can be well managed and usually have a full recovery, but time to treatment is important. If your child has had a hand trauma bring them in to be evaluated by a doctor as soon as possible.

Fingertip Crush Injury

Nerve Injuries

Tendon Injuries

Hand Fractures

Overview

A fracture is a partial or complete break of the bone. A fracture can be open or closed. An open fracture occurs when the bone breaks through the skin. A closed fracture occurs when the bone breaks, but the skin is intact.

Symptoms

Symptoms of a fracture include: pain, swelling, bruising, weakness, numbness/tingling, decreased movement or bone/joint deformity. A doctor will perform a physical exam of the area and may need to use radiological tests such as an x-ray or MRI.

Treatment

Most fractures are treated with a cast or splint which help to immobilize the bone to reduce swelling and pain and promote healing. Surgery may be needed depending on the severity of the fracture.

OTHER HAND CONDITIONS

Hand Tumors/Masses

Ganglion Cyst

Overview

Ganglion cysts are the most common type of hand tumors/masses. A ganglion cyst is a fluid-filled sac that arises from a joint or from around a tendon. It is a benign mass. The most common location is the wrist.

Symptoms

Usually the cyst appears as a bump that increases in size. It is typically firm, round, and smooth. The bump may shrink spontaneously and then return sometime later. Some ganglion cysts are asymptomatic, while others cause pain.

Treatment

Rarely a ganglion cyst may go away on its own. The fluid can be aspirated (sucked out with a needle), but because the cyst remains connected to a joint, the fluid often reaccumulates. The treatment option with the least chance of recurrence is surgical excision, in which the cyst is removed and the connection to the joint is sealed off.

Juvenile Arthritis

Overview

Juvenile Arthritis is an autoimmune and inflammatory condition that occurs in children aged 16 and under. It primarily affects the joints, but can present in eyes, skin and gastrointestinal tract.

Symptoms

The most common symptoms include stiffness and swelling in the joints, limping or favoring one limb over another, fatigue and irritability and slow growth.

Treatment

Treatment usually begins with medications called NSAIDs, or nonsteroidal anti-inflammatory drugs which help to relieve swelling, pain and stiffness. Physical and Occupational therapy may also be used to help with muscle and joint function. In very rare cases surgery may be performed.

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