Congenital Hand and Wrist Deformities Q&A
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The term ‘congenital hand deformity’ refers to hand or finger anomalies that are present at birth. There are several kinds of congenital hand abnormalities and they vary greatly in how they affect the appearance and function of the hand. They develop early in pregnancy when the baby’s upper limbs are first forming and are sometimes detected by ultrasound during pregnancy. These differences can be particularly disabling for the child as they learn to interact with the environment through the use of their hands, but many children are able to adapt and function well without any treatment. Some children may need occupational therapy, surgery, or other treatments to enable them to function better and be more independent.
A deformity can sometimes run in families or be part of a medical condition but in many cases, doctors are unable to identify an exact cause.
There are two conditions that vie for the dubious honor of being the most common type of congenital hand deformities: Polydactyly and Syndactyly.
• Polydactyly describes the presence of one or more extra fingers. An extra finger may be small and non-functional, made of only skin and soft tissue, or it may be fully formed with its own bone. The extra finger is usually adjacent to the thumb or little finger; rarely is it seen between the other fingers. It often runs in families and is sometimes associated with other medical conditions or syndromes. Babies born with polydactyly will sometimes have syndactyly as well.
• Syndactyly is an abnormal fusing, or webbing, due to the fingers not separating normally during the baby’s development. Two forms of the condition are:
• Simple syndactyly – when the fingers are joined by either skin or other soft tissue. They may appear webbed, which may be either complete (extending from the base of the finger all the way to the tip) or incomplete (stopping at any point before the tip).
• Complex syndactyly – when the bones of the fingers are fused together. This is more difficult to treat because, in addition to bone, the fingers may also share other structures such as a nail, nerves, muscles, tendons and blood vessels.
Syndactyly is often hereditary and can occur alone or as part of a medical condition such as Apert syndrome or Poland syndrome.
In addition to polydactyly and syndactyly the other forms of hand deformities that babies can be born with are:
• Underdeveloped Hand (Symbrachydactyly) characterized by small or missing fingers with webbing or an undersized hand or forearm:
• Club Hand is caused by the partial or complete absence of one of the two long bones that make up the forearm – the radius or the ulna – resulting in the forearm being shorter than normal and the hand turning inwards.
• Cleft hand (ectrodactyly or split hand) is caused when the middle part of the hand develops abnormally, missing one or more central fingers.
• Small (Hypoplastic) Thumb – a thumb that did not fully form in the womb or was missing completely at birth.
• Trigger Thumb – an abnormality of the tendon in the thumb that makes it difficult to bend. Sometimes it disappears on its own before the baby’s first birthday, other times surgical correction may be recommended before the age of three.
The most important objective of any treatment is to help the child function as independently as possible, and specific treatment will be determined by the child’s doctor based on:
• The child’s age and overall health
• The type of condition
• The severity of the condition
• The cause of the condition
• The needs of the child and the objectives of the family
• The parents’ preference for a specific therapy or procedure
Treatment may include:
• Manipulation and stretching of the limb
• Tendon transfer
• External appliances: to help realign misshapen hands or fingers
• Physical therapy: to help increase function and strength
• Skin grafts: if skin has been removed during a procedure and needs replacing.
• Prosthetics: used when surgery is not an option, or in addition to surgical correction.
• Surgery: depends on the child’s age and specific condition. Procedures include:
• Separation of webbed or joined fingers
• Removal of extra fingers
• Finger reconstruction (or other parts of the hand)
If you or a loved one would like to know more about congenital hand deformities, contact Florida Hand Center today! We are an advanced medical facility dedicated to the treatment of hand and arm conditions with locations in Port Charlotte FL and Fort Myers FL and are proud to serve patients statewide. Call us or schedule an appointment today! We serve patients from Port Charlotte FL, Fort Myers FL, Punta Gorda FL, Cape Coral FL, Estero FL, Lake Suzy FL, Murdock FL, Harbour Heights FL, Charlotte Harbor FL, and Solana FL.
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