Congenital Hand Deformities
What are congenital hand deformities?
Congenital anomalies are 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 fingers, 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
What are the different classifications of congenital hand deformities?
The classifications for hand deformities can vary. This classification has been accepted
by the American Society for Surgery of the Hand. There are currently 7 groups of deformities
of the hand:
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:
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.
Duplications 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:
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.
Other generalized problems with the skeletal system. These are a rare and complex group of problems.
Treatment for congenital hand deformities
Specific treatment for congenital hand deformities will be determined by your child's doctor
Your child's age, overall health, and medical history
Extent of the condition
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
Skin grafts. These involve replacing or attaching skin to a part of the hand that
is missing skin or has been removed during a procedure.
Prosthetics. These may be used when surgery is not an option, or in addition to surgical