Congenital Hand Differences

Congenital Hand Conditions  Congenital Hand Differences

Cerebral Palsy Spastic Hemiparesis Congenital Hand Differences

Congenital hand anomalies refer to a rather rare group of conditions of the hand where a child is born with abnormal hands. “Congenital” refers to any condition that the child is born with, as opposed to being acquired later in life. A common example of a congenital skeletal limb anomaly would be clubfeet (1/1000 births). Congenital hand anomalies are much more common, comprising 10% of all congenital birth defects. The spectrum can vary from an extra digit to the total absence of a part of the upper limb. 

These hand disorders can present as an isolated anomaly, like syndactyly (fused or webbed fingers) or in association with a systemic syndrome like Poland syndrome (webbed and short fingers with the absent sternocostal head of the pectoralis major muscle). In certain malformations that affect the thumb side of the forearm and the hand (radial longitudinal deficiencies), there may be an association with multiple other abnormalities called the VACTERL complex.

We do not understand the cause of all these congenital hand anomalies, but we do have a better understanding of the development of the limb bud in utero. At around eight weeks, the limb bud develops very quickly, and it is typically during this period that abnormalities arise.

Most of the deformities that we see these days are not secondary to any medication or pregnancy-related problems but tend to happen sporadically. There is a genetic component in some of the congenital differences, especially the ones that affect the thumb side of the wrist, and these are typically investigated during the birth period.

Irrespective of the extent of the anomaly, we understand that parents have to deal with significant emotional issues and challenging decisions.

How are congenital hand anomalies approached and treated?

Congenital hand anomalies treatment depends entirely on the hand deformity your child has. The main goal and benefit of treatment is to improve your child's ability to function with the abnormality. Another goal is to improve the appearance of your child's hand and help support and boost your child's self-esteem.

Congenital hand anomalies treatment may include:

  • Using a splint or cast
  • Stretching
  • Physical therapy to increase strength and functionality
  • Prosthetics, if there are missing parts or bones
  • Surgery

Most of the continental hand differences are not urgent, and if surgery is needed, we plan this only around one year of age or when a baby is around 10kg. This helps to reduce the anaesthetic risk for the intervention as the sizing is proportionally slightly larger. Once children are born with the deformity, it is advisable to establish an early diagnosis and to counsel the parents accordingly on what the deformity involves, what the option of treatment is, and when the best time is for surgery to be done.

It is very important to also realize that these children, even with exceptional deformities, often become very functional with their hands in a different way. We, therefore, only operate if needed and where we can improve function. The approach is always to achieve some form of hand function in the form of a pinch so that an object can be grasped between the thumb digit and one of the other digits.

In some of the other congenital deformities that involve multiple joints, we very specifically consider performing a few stages of surgery over many years. Some surgeries often only happen when the child is in their adolescent phase and when they decide whether or not to have this attended to.

Please feel free to come and see us if your child suffers from a congenital hand deformity. I would be delighted to evaluate, guide and walk the path accordingly.

It's important to consult with our qualified healthcare professionals to ensure the appropriate diagnosis and treatment plan for your specific situation.

Syndactyly and extra digits before surgery

Radial Club after surgery