CONGENITAL HAND ANOMALIES
Brachydactyly
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 adolescents (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
Madelung's Deformity
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
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.
- Simple syndactyly: only the skin is involved
- Complex syndactyly: skin, bone, and/or nails are conjoined.
- Incomplete: only the base of the finger is webbed.
- 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.
- Small but otherwise normal thumb, with normal function.
- 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).
- 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).
- "Floating thumb", where the thumb is attached to the hand by only a small skin bridge.
- 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, causes little pain, and the condition is cured immediately.
Upper Limb Growth Disorders
PEDIATRIC HAND TRAUMA
- Brachial Plexus Palsies
- Fingertip Crush Injury
- Hand Fractures
- Nerve Injuries
- Tendon Injuries
OTHER HAND CONDITIONS
Ganglion Cyst
Overview
- 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.