Congenital & Acquired Hand Deformities

✋ Congenital & Acquired Hand Deformities

Hand deformities—whether congenital (present at birth) or acquired (developed later in life)—can significantly impact function, appearance, and quality of life. Treatment often involves a combination of reconstructive surgery, therapy, and sometimes prosthetics.

🧬 Congenital Hand Deformities

These result from abnormal development in the womb, often due to genetic mutations, syndromes, or unknown causes.

Common Types:

1. Syndactyly

Fusion of two or more fingers.

Can be simple (skin only) or complex (bones and tendons).

Treatment: Surgical separation with skin grafting.

2. Polydactyly

Extra digits (common in thumbs and little fingers).

Can be preaxial (thumb side), postaxial (little finger side), or central.

Treatment: Excision and reconstruction, often in infancy.

3. Radial Club Hand (Radial Deficiency)

Underdevelopment or absence of the radius bone → wrist bends inward.

Often associated with heart or kidney abnormalities.

Treatment: Stretching, splinting, centralization surgery, tendon transfers.

4. Thumb Hypoplasia/Aplasia

Underdeveloped or missing thumb.

Graded I–V based on severity.

Treatment: Tendon transfers, thumb reconstruction, or pollicization (index finger converted into a thumb).

5. Camptodactyly

Non-traumatic flexion deformity, typically of the little finger.

Treatment: Stretching, splinting, or surgical release if severe.

6. Cleft Hand (Ectrodactyly)

“Split hand” or lobster-claw deformity.

Central digit(s) missing, causing a cleft.

Treatment: Reconstruction to improve grip and appearance.

🛠️ Acquired Hand Deformities

These develop after birth due to trauma, disease, or repetitive stress.

Common Causes:

1. Trauma

Fractures, tendon/nerve injuries, burns.

Treatment: Surgical repair, tendon transfers, bone grafts, microsurgery.

2. Arthritis

Rheumatoid arthritis and osteoarthritis can lead to deformities like:

Swan-neck deformity

Boutonnière deformity

Ulnar drift

Treatment: Medication, splinting, joint reconstruction or fusion.

3. Dupuytren’s Contracture

Thickening of fascia in the palm → fingers (esp. ring & little) curl toward palm.

Treatment: Collagenase injections, needle aponeurotomy, or surgical fasciectomy.

4. Nerve Injuries

Ulnar nerve → Claw hand

Median nerve → Ape thumb

Radial nerve → Wrist drop

Treatment: Nerve repair, tendon transfers, bracing.

5. Cerebral Palsy / Stroke

Spastic deformities due to neurological disorders.

Treatment: Splinting, botulinum toxin, muscle/tendon balancing, surgical release.

🧠 Multidisciplinary Management

Hand surgeons (plastic, orthopedic, or microsurgeons)

Occupational/physical therapists

Pediatricians and geneticists (for congenital cases)

Rheumatologists or neurologists (for systemic or acquired causes)

🎯 Goals of Treatment

Restore function (grip, dexterity, sensation)

Improve appearance and psychosocial confidence

Prevent further deformity or contracture

Support independence and daily living activities