Congenital Hand Deformities

Congenital hand deformities are abnormalities of the hand which develop at birth. About one in twenty children is born with some form of deformity, which can become a challenge as the child grows and begins to use his/her hands. The deformity may vary from a minor disproportion in the digits to a severe case of the absence of a bone.

The types of congenital hand deformities include:

• Failure of development of certain regions of the hand: occurs when a part of the hand stops developing, leading to a shortening of a bone, missing part of the hand or the complete absence of the hand itself. Ex. radial club hand (missing radial bone in the arm) and ulnar club hand (missing ulnar bone in the arm).
• Undergrowth of digits: refers to underdeveloped digits including small or absent digits, or missing bones or muscles.
• Failure of bones/tissues of the hand to separate: appear as fused or webbed ex. syndactyly (two or more fingers are fused).
• Duplication of digits: also called polydactyly, and is most often seen in the little finger.
• Overgrowth of digits: also called macrodactyly and is characterized by an abnormally large digit.
• Constriction band syndrome: involves the constriction of a finger or arm by a band of tissue, which affects the blood flow and normal growth.

Causes

During embryo development, the upper limb is formed between 4 to 8 weeks after the fertilization of the egg. An arm bud is formed in the fourth week, after which, several steps follow to develop a normal arm. Failure in any of these steps can result in congenital hand abnormalities. Mutation plays an important role in the development of congenital hand deformities.

Symptoms

Some of the common symptoms for congenital hand deformities are presence of extra finger, missing digits, underdeveloped bone or muscles, shorter digits, fused fingers and overgrowth of digits.

Diagnosis

To diagnose congenital hand deformities, your child’s doctor will perform a thorough physical examination and assess the family history. Your doctor may also recommend an X-ray or CT scan to detect deformities in the bones.

Treatment

The treatment option for your child is based on the following criteria:

• Age
• Medical history and overall health
• Cause
• Extent of deformity
• Tolerance to medication and treatment procedures

Early correction promotes the normal development and functioning of your child’s hand and prevents permanent deformities. The treatment may include:

• Physical therapy: ­to strengthen the hand
• Splinting of the affected limbs: to stretch the finger in the right position
• Limb manipulation and stretching: helps to stretch and strengthen the limb, in order to regain the normal motion of a restricted region of the hand
• Tendon transfers: injured tendon is replaced by a tendon of a functioning muscle to regain normal function
• External appliances: to aid in the alignment of abnormal fingers or hands
• Correction of contractures: repairing the stiffness and constriction in muscles, ligaments and skin
• Skin grafts: removing skin from one part of the body and transplanting it to the other to correct the deformity
• Prosthetics: may be used in addition to surgical correction or when surgery is not an option
• Surgery: correction of the deformity by surgery within 2 years of life helps in the growth and development of the hand of your child

Your doctor will discuss the type of congenital hand deformity of your child and suggest a treatment that would provide the best outcomes.