Congenital Hand Anomalies

Clinical examination approaches

Dr. Hendra Gunawan SpOT

Introduction

• Incidence : 1 in 600 live births

• Only a fraction are defects severe enough operative treatment

• Cause : – Heritable genetic mutations

– Intrauterine damage : • Drugs

• Infection

• Ionizing radiation

• UNKNOWN

Introduction

• Clinical examination in Orthopedics :

– Hx : • Symptoms (deformity/dysfunction)

– Physical examination • Look

• Feel

• Move

– Other investigation : • Imaging

• Laboratory

General considerations

• Abnormalities of upper extremity part of larger syndrome/isolated condition

• Radial dysplasia associated with VACTERL; – Vertebral anomalies

– Anal atresia

– Cardiovascular anomalies

– Tracheo-Oesophageal Fistula

– Renal anomalies

– Limb defect

Classification

1. Failure of formation

2. Failure of differentiation

3. Duplication

4. Undergrowth

5. Overgrowth

6. Congenital band syndrome

7. Generalized skeletal anomalies

Most common cases?

Syndactyly

www.eatonhand.com

Syndactyly

• Look :

– deformity of fingers

• Feel :

– Web of fingers

• Move :

– Adjacent fingers

Polydactyly

• Extra digits

• Pre-axial, post axial,

central

• Painless

• Unable move

www.childrenshospital.org

Congenital trigger thumb

"Notta's node"

www.childrenshospital.org

Congenital trigger thumb

• Look :

– Minimal deformity

• Feel :

– Notta’s node

• Move :

– triggering

Clinodactyly

• Bent sideways

• Abnormal shaped

middle phalang

www.e-radiography.net

www.newborns.stanford.edu

Camptodactyly

• “Bent finger”

flexion deformity

• Abnormal muscle

insertion

www.congenitalhand.wustl.edu

Constriction rings

• Localized

strangulation

• Swollen, and cyanotic

• Painfull

• Auto amputation

threatening

www.childrenhospital.org

Radial dysplasia/Radial club

hand

Salam A.M.S.(Ortho), MRCS ( Edin) Fellow in Limb lengthening and reconstruction ( USA), Coimbatore Tamil Nadu, India

Salam A.M.S.(Ortho), MRCS ( Edin) Fellow in Limb lengthening and reconstruction ( USA), Coimbatore Tamil Nadu, India

Treatment

• Conservative

– Stretching

– Splinting

• Operative considerations

– Function

– Progression of deformity

– Appearance

– Pain