Congenital Hand Deformity
Congenital anomalies are hand or finger deformities that are present at birth. Any type of deformity in a newborn can become a challenge for the child as he or she grows. Hand deformities can be particularly disabling as the child learns to interact with the environment through the use of his or her hands. The degree of deformity varies from a minor deformity, such as unequal or uneven fingers or thumb deformity, to a severe deformity, such as total absence of a bone.
Early consultation with a hand surgeon is an important part of the treatment process for the child born with a hand deformity. Even if reconstructive surgery is not possible, there are many different types of prosthetic devices that can be used to increase function.
Problems in formation of the parts. This occurs when parts of the body stop developing while the baby is in the womb. This causes either a complete absence of a part of the body, such as the hand, or a missing structure, such as part of the arm bone. In the case of the complete missing part, surgery is not done. Instead, these children may get a prosthetic devices early in their childhood. Types of these classification include:
RADIAL CLUBHAND – A radial clubhand is a deformity that involves all of the tissues on the thumb side (radial side) of the forearm and hand. There may be shortening of the bone, a small thumb, or absence of the thumb. Deformities of the wrist are usually operated on around 6 months of age.
ULNAR CLUBHAND – An ulnar clubhand is less common than a radial clubhand. This deformity may involve underdevelopment of the ulnar bone (the bone in the forearm on the side of the little finger), or complete absence of the bone.
Failure of parts of the hand to separate.
With this type of deformity, the parts of the hand, either the bones or the tissues, fail to separate in the womb. The most common type of this classification is syndactyly. Syndactyly is when 2 or more fingers are fused together. There is a familial tendency to develop this deformity. If the fingers are completely fused together, it is considered complete. There are 2 types of syndactyly:
Simple syndactyly – This involves fusion between only the tissues of the fingers.
Complex syndactyly – This involves fusion between the bones.
Another example of failure of the hand to separate is seen in contractures of the hand. Contractures of the hand may also develop as a result of a problem with the cells in the womb. A contracture is an abnormal pulling forward of the fingers of the hand. It is usually caused by problems with the muscles or skin. One of the common types of this classification includes congenital triggering. Congenital triggering occurs when one of the fingers is unable to extend. It is usually seen in the thumb. It may take some time in the child’s development before it is noted that the child can’t extend the thumb. Some of these cases improve on their own. Surgery is usually not done until the second year of life, but preferably before the age of 3.
DUPLICATION OF FINGERS
Duplication of fingers is also known as polydactyly. The little finger is the finger that is most often affected.
UNDERGROWTH OF FINGERS
Underdeveloped fingers or thumbs are associated with many congenital hand deformities. Surgical treatment is not always required to correct these deformities. Underdeveloped fingers may include the following:
The finger is small
Muscles are missing
Bones are underdeveloped or missing
There is complete absence of a finger
OVERGROWTH OF FINGERS
Overgrowth of fingers is also known as macrodactyly, which causes an abnormally large finger. In this situation, the hand and the forearm may also be involved. In this rare condition, all parts of the finger (or thumb) are affected; however, in most cases, only one finger is involved (usually the index finger). Surgical treatment of this condition is complex and the outcomes may be less than desirable. Sometimes, amputation of the enlarged finger is recommended.
CONGENITAL CONSTRICTION BAND SYNDROME
This occurs when a tissue band forms around a finger or arm, causing problems that can affect blood flow and normal growth. Ring constrictions are congenital (present at birth). This condition may be associated with other birth defects, such as clubfoot, cleft lip, or cleft palate. The cause of the ring constrictions is unknown. Some theories suggest that amniotic banding may lead to ring constrictions around a finger or limb. In a few cases, the finger may need to be amputated.
HAND & WRIST ANATOMY
Most of the congenital deformities are visible and easily identifiable and they include:
Abnormal appearance of hand, wrist and/or fingers
Abnormally bent fingers
Asymmetry in size and shape
Difference in alignment
A fetus’ arms and hands form between the fourth and sixth week of pregnancy. Any disruption of this process can lead to a congenital hand difference. There are many factors that can affect the development of the human hand. These factors are generally divided into genetic and environmental.
Genetic factors involve changes to the information contained within the genes responsible for hand and arm formation. Genes are the basic biological unit of heredity and are passed on to children from their parents. They contain instructions for the growth and function of each cell in the body. In the case of hand differences, the genetic changes generally occur for no apparent reason (spontaneous). Less common are changes that run in families.
Environmental factors include infections and certain drugs, such as thalidomide (a drug used to treat nausea) and some drugs used for chemotherapy. These factors may cause a breakdown in otherwise healthy tissue, altering the developmental process and leading to a difference in hand formation.
Some hand differences can be explained by these factors, while others have no known cause. In some cases, the hand difference is an isolated event. In other cases, the difference is part of a syndrome that affects multiple parts of the body.
Specific treatment for congenital hand deformities will be determined by your child’s doctor based on your child’s age, overall health, medical history, and extent of the condition.
It is also based on the cause of the condition, your child’s tolerance for specific medications, procedures, or therapies, expectations for the course of the condition, your opinion or preference.
Treatment may include:
Limb manipulation and stretching
Splinting of the affected limbs
External appliances (to help realign misshapen fingers or hands)
Physical therapy (to help increase the strength and function of the hand)
Correction of contractures
These involve replacing or attaching skin to a part of the hand that is missing skin or has been removed during a procedure.
These may be used when surgery is not an option, or in addition to surgical correction.
CONTACTING DR. PERLMUTTER
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