Congenital Hand/Arm Differences

Overview:

Occasionally, babies are born with structural differences in their upper extremities. Extra fingers (polydactyly), fingers fused to each other (syndactyly), and foreshortening of one or both the forearm bones are just a few of the congenital upper extremity variants that are evaluated in our office. Also, our surgeons assess joint contractures from conditions such as cerebral palsy. The causes of such abnormalities are beyond the scope of this article, and should be evaluated by the patient’s pediatrician to determine if the brain or other body systems may be involved.

Symptoms:

Note: The following symptoms are not meant to diagnose a condition. If you notice these or other symptoms, the patient should be evaluated by a qualified healthcare provider.

  • Symptoms are noted at or shortly after birth, and are not correlated with a known injury.
  • Extra fingers or thumb.
  • Absent fingers or thumb.
  • Hand deformity.
  • Short forearm.
  • Stiffness or contracture in hand, wrist, or elbow.
  • With hand contractures, skin changes or infections may occur if the fingers are significantly contracted into the palm.

Treatment:

  • History and Physical Exam: The doctor or midlevel provider will obtain a history of the problem and perform an appropriate physical exam to find the area of concern.
  • Imaging: To evaluate the bones for deformity, imaging begins with x-rays. If more information is needed, the doctor may order a CT scan.
  • Non-surgical Treatment: Depending on the condition, a period of watchful waiting may be the appropriate therapy, monitoring with office visits and x-rays. Splinting and Occupational Therapy may also be appropriate, again depending on the diagnosis.
  • Surgery: The goal of surgical treatment is to restore as much function to the affected area as possible. Surgical treatment is decided on a case by case basis, and the specific procedure depends on the type of deformity. Depending on the condition, timing of surgery is important. Some conditions are best treated before the baby grows too much.

Pre-operative Care:

  • If you suspect your baby has a congenital difference in his/her upper extremity, you should inform your pediatrician and ask if a referral to a qualified hand surgeon is an option.
  • Be sure the hand surgeon is familiar with the possible causes of the congenital deformity.
  • If a decision for surgery is made after seeing one of our Orthopaedic Hand Surgeons, your child may require pre-operative medical clearance by our Anesthesia department or your pediatrician.

Post-operative Care:

  • Recovery time is variable depending on the patient’s medical history and the surgery performed. Generally, the patient is immobilized in a cast or splint for several weeks to months, with restrictions on use of the arm.
  • After surgery, the child will be placed in a post-operative dressing which he/she must wear until the first post-operative visit with one of our surgeons. You must keep the dressing CLEAN and DRY to avoid risk of infection and other wound healing complications.
  • We often use absorbable sutures which do not require removal. Depending on the surgery, a splint or cast may be applied. If the cast becomes wet or soiled, you should come into the office for a new cast.
  • To evaluate healing at the follow-up appointments, the doctor may order imaging such as x-rays or a CT scan.
  • Patients may be sent to an Occupational Therapist, with the goal of regaining functional use of the operative hand. Remember, a significant part of recovery depends on the desire to participate in therapy.