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Pediatrics - Congenital Hand Differences


 

Introduction

Congenital hand differences are abnormalities present when a child is born. They occur before birth when an embryo is developing the upper extremity. Congenital hand differences are caused by genetic, environmental, and unknown reasons. A variety of hand conditions may occur. 

A hand surgeon and hand therapist should evaluate all babies born with a hand difference. Some conditions do not need treatment. For others, treatment during the first few years of life allows children to best adapt to their hands. Treatments may include splinting, hand therapy, or surgery. 

Anatomy

A child’s upper limb (arm) develops before he or she is born. An embryo develops an arm bud at four weeks. The tip of the arm bud sends genetic signals to cells to direct limb formation. The upper limb is formed when an embryo is between four to eight weeks old in the womb. The arm develops first at the shoulder and progresses to the fingers. The development of a limb is a complex process involving millions of steps guided by genetics, your child’s inherited blueprint for growth.

Your child’s upper extremity is composed of many bones that provide structure for his or her wrist and fingers. The bones are connected with strong ligament tissues. Tendons are strong fibers that attach muscles to bones and allow movement. Your child’s hand also contains nerves, blood vessels, and fat. The skin that covers your child’s hand protects it from the environment.

Causes

Congenital hand differences are abnormalities present when a child is born. Congenital hand differences occur when an embryo is developing the upper limb. Some conditions may develop due to genetic problems, and they may pass from generation to generation. Other congenital hand differences develop because of environmental factors or for no known reason.

Symptoms

There are several different types of congenital hand differences. Variances can range from major to minor. Some congenital hand differences are associated with other medical or genetic problems. Congenital hand differences are categorized by type including failure of formation, failure of separation, duplication, undergrowth or overgrowth, and constriction band syndrome.

Failure of formation describes upper arms, forearms, wrists, hands, or fingers that do not form completely or at all. Failure of separation includes finger webbing. Finger webbing can involve only the skin or can include the finger bones, extra bones, or fingernails. The two bones that make up the forearm, the ulna and radius, can also be joined together.

Duplication is another type of congenital hand difference. It most commonly involves an extra thumb or little finger, although duplication of any portion of the hand can occur. Overgrowth or undergrowth causes a section of the hand or arm to be too large or too small. This can affect joint structure and function. Constriction band syndrome causes tight bands of tissue to form around the arm, forearm, wrist or fingers. The constrictions can range from mild to severe. Severe constrictions can result in the loss of a portion of the hand.

Diagnosis

A hand specialist should evaluate all babies born with a hand difference. The doctor can diagnose a congenital hand difference by reviewing your child’s medical history and conducting an examination. X-rays will be taken to identify the location and position of affected bones. If necessary, your doctor may refer your child to a geneticist or specialist for diagnosis and treatment of associated medical conditions

Treatment

Treatment for congenital hand differences depends on the type and extent of the condition. Some children may not require any treatment. Splinting and hand therapy may be used to improve hand structure and function. Hand therapists can recommend assistive devices to make everyday activities such as handwriting, grooming tasks, and feeding easier.

Surgery

Surgery can help severe hand differences. Surgeons are able to separate webbed fingers and remove extra fingers. The hand and fingers can be surgically reconstructed to improve function and appearance. There are many methods that may be used and your hand surgeon will discuss the most appropriate options for your child with you. As this type of surgery is specialized even within the realm of hand surgery, your child may be referred to a hand specialist with expertise in congenital hand differences.

Recovery

Recovery from hand surgery may include splinting and hand therapy. Surgery that is performed in the first few years of life provides children with the greatest opportunity to adapt to their reconstructed hand. Hand therapy and possibly additional hand surgery may be necessary as a child grows and develops.

Prevention

There is no way to prevent congenital hand differences that occur during pregnancy. It is important for babies with the condition to receive prompt diagnosis from a hand specialist and receive early treatment, if necessary.

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