What are Congenital Hand Problems?
Congenital anomalies are hand or finger deformities that are present at birth. Hand deformities can become a challenge as the child grows and can be disabling as the child learns to interact with the environment through their hands.
Early consultation with a hand specialist is an important part of the treatment process for children with hand deformities. From reconstructive surgery to prosthetic devices, there are different treatments available to increase function.
Causes of Congenital Hand Problems
There are a few factors that can affect the development of the human hand.
- Genetic factors
- Environmental factors – including infection and the use of certain drugs.
Types of Congenital Hand Problems
The classifications of hand deformities vary. There are currently 7 groups of deformities of the hand as accepted by the American Society for Surgery of the Hand.
Formation of the Parts of the Hand
These deformities occur when part of the body stop developing while baby is in the womb. This can cause a complete absence of a part of the body, like the whole hand, or a missing structure, like the part of the arm bone.
In these cases, surgery is typically not done. Instead, a prosthetic device may be used early in their childhood. The most common types of part formation deformities include:
- Radial clubhand – a deformity that involves all of the tissues on the thumb side of the forearm and hand. This may include a shortening of the bone, a small thumb, or absence of the thumb.
- Ulnar clubhand – a deformity that involves the underdevelopment of the ulnar bone or complete absence of the bone. This deformity is less common than the radial clubhand.
Separation of the Parts of the Hand
These deformities occur when the parts of the hand, either bones or tissues, fail to separate in the womb. The most common deformity of this kind is referred to as syndactyly, where two or more fingers are fused together. There are two types of syndactyly:
- Simple syndactyly – the fusion of the tissues of the fingers.
- Complex syndactyly – the fusion of the finger bones.
Another example of failure of the hand to separate deformities are seen in the contractures of the hand – the abnormal pulling forward of the fingers of the hand. It is usually caused by problems with the muscles or skin.
- Congenital triggering – occurs when one or more of the fingers is unable to extend, usually seen in the thumb.
Duplication of Fingers
As a baby develops in the womb, the hand first forms in the shape of a paddle and later divides into separate fingers. If the process continues further than it is supposed to, a single finger can divide again, causing the creation of an extra finger. This deformity is referred to as polydactyly.
The most common treatment for polydactyly is removing the extra finger, typically done between 1 to 2 years of age. The method used to remove an extra finger depends on the location and size of the finger:
- Removing an extra little finger that is connected to the hand by a small skin bridge is treated by clipping right where it joins the hand, where it will then shrivel and fall off over a period of about two weeks.
- If the extra finger is fully developed, surgery is required to remove the finger, typically done between 1 to 2 years of age. Sometimes more than one surgery is needed.
Most patients treated for polydactyly recover full hand function and improved appearance of their hand. It is important to treat these hand deformities to not miss developmental milestones, such as grasping for objects.
Undergrowth of Fingers
The undergrowth of the fingers, also known as symbrachydactyly, is when a baby is born with short fingers, which may be webbed, or they are missing fingers. Usually, this happens only on one hand and the other hand looks normal.
Most babies born with symbrachydactyly have a complete thumb but can sometimes be short or missing. Babies with symbrachydactyly may have one or more of these symptoms:
- Short fingers in which some bones are smaller than normal or are missing.
- Fingers that are joined or webbed.
- Skin or tissue where their fingers should be.
- Short hand bones.
- Short forearm.
Most children with symbrachydactyly can still do all the things that children with normal hands so because they have enough function or gain enough function with treatment. However, some children need occupational therapy or surgery to improve the use of their hand. Your healthcare provider will work to determine the best fit for your child.
Overgrowth of Fingers
The overgrowth of fingers is also down as macrodactyly, which causes an abnormally large finger. In some cases, the hand and forearm may also be involved. If your child has macrodactyly, one or more of their fingers will be much larger than the others.
- Static macrodactyly, the most common case, means the enlarged fingers or toes grow at the same rate as the rest of your child’s hand or foot.
- Progressive macrodactyly means the affected fingers or toes grow faster than the rest of the hand or foot.
Your healthcare provider will likely notice the signs of macrodactyly soon after your child is born. However, if your child has the progressive kind, it may not be detected right away. In mild cases, treatment may simply involve watching the hand or foot carefully over time.
In more severe cases, your healthcare provider may recommend surgery, which may include:
- Soft tissue debunking – aims to correct the width of the affected digits by removing the thickened layers of skin and fat and replacing with healthy skin. Usually performed in several stages and three months apart.
- Shortening procedures – aims to correct length and involves surgical removal of the bone in the affected digit.
- Ray resection – involves surgical removal of the entire affected digit.
Congenital Constriction Band Syndrome
Congenital constriction band syndrome occurs when a tissue band forms around a finger or limb, causing problems that can affect blood flow and normal growth. This condition may be associated with other congenital problems, such as clubfoot or cleft lip.
With this condition, there are four degrees of severity, including:
- Simple constrictions
- Constrictions that cause deformities beyond the constriction.
- Constrictions that are associated with the fusion of parts of the finger.
- Constrictions so severe that amputation is required.
Your provider will examine the finger to determine the severity of the constriction and recommend treatment. Treatments may include:
- Limb manipulation and stretching
- Splinting the affected digit or limb.
- Tendon transfer
- Physical therapy