What are Hand and Finger Anomalies?
Some children are born with deformities in the hand or finger. These anomalies are known as congenital hand deformities. If left untreated, these deformities will severely affect the child’s ability to interact with the environment using their hands.
The degree of the deformity will vary for each child. Some suffer from uneven or unequal fingers, while others don’t have any bones in their fingers. The absence of bone falls into the more severe category of hand and finger anomalies.
Parents must consult a reconstructive hand specialist, like BM Cosmetics, as soon as possible. This helps avert the consequences that hand and finger anomalies may impose on the child and helps them lead a normal, satisfying life.
The hand and finger anomalies commonly seen in children are:
- Syndactyly
- Polydactyly
- Thumb hypoplasia
- Congenital trigger thumb
Syndactyly
This is a condition seen in children where two or more fingers are attached together. The condition occurs when the baby is in the womb. As a result, the baby is born with webbed fingers. The most commonly reported cases of syndactyly involve the middle and ring fingers being attached together.
Syndactyly is categorised into three types based on its severity. They are:
- Simple Syndactyly: In this type of syndactyly, the fingers are only fused by the skin and soft tissue. This is the most common type of syndactyly.
- Complex Syndactyly: This type of syndactyly is rarer and more complicated than simple syndactyly. Children suffering from this condition have their bones joined as well, along with the skin and soft tissues.
Complicated Syndactyly: In children suffering from complicated syndactyly, the skin and soft tissues are joined together, and there is an abnormal growth of extra bones, tendons, and ligaments.
Causes of Syndactyly
The hands of a baby in the womb are usually in the shape of a paddle. In the sixth or eighth week of pregnancy, the paddle starts developing into fingers. A disturbance in the baby’s genes interferes with this splitting, causing certain parts of the paddle to stay joined.
Syndactyly is often an inherited condition. Roughly 10 to 40% of children suffering from syndactyly have had one or both parents with the condition. Syndactyly can occur in a baby’s legs as well.
Treatment Options
Surgery is the most common and preferred type of treatment for syndactyly. The reconstructive hand specialists at BM Cosmetics will analyse the severity of the condition using an X-ray and find the right treatment. Once that is done, surgery will be performed on the baby’s hands. The surgery is often performed on the baby when they are 1 or 2 years old.
The surgery involves splitting the merged skin evenly. Some babies may need a skin graft or a skin substitute to cover the separated fingers. The elbow or wrist crease is often the preferred spot for skin grating.
Usually, only one side of the web space is separated at a time. This is done to avoid complications. If the baby has several fingers webbed together, then they’ll require multiple surgeries.
Some of the milder forms of syndactyly can be cured without surgery. This is usually for syndactyly in the toes. It is recommended to consult an expert hand and finger specialist, like BM Cosmetics, to find out whether your baby needs surgery.
Post Surgery Care
The operated fingers will have to be under a cast or a bandage for at least 2 to 3 weeks. This is done to ensure that the hand stays still and the healing skin is protected. After the cast is removed, the baby will have to wear a splint for around 6 weeks to keep the fingers apart.
Polydactyly
Polydactyly is a birth condition where a baby has more than five fingers per hand or five toes per foot. The additional fingers or toes are small and abnormally developed. Polydactyly is one of the more common types of hand and finger anomalies found in children. Not just fingers, babies can have an extra thumb as well.
Polydactyly is of three types. They are:
- Preaxial Polydactyly: The child has one extra thumb or a big toe.
- Central Polydactyly: The child has an extra finger or toe in the middle. In the hand, the extra finger is usually found between the index, middle, or ring fingers. The extra toe appears between other toes that aren’t the big or the pinkie toe.
- Postaxial Polydactyly: A birth condition where a baby has an extra pinkie finger or a toe.
Causes of Polydactyly
Like syndactyly, polydactyly is hereditary as well. Polydactyly that is passed down is often known as familial polydactyly. A change in the baby’s genes when in the womb is also a reason for polydactyly.
The genes involved in polydactyly are:
- GLI3
- GLI1
- ZNF141
- MIPOL1
- PITX1
- IQCE
There are also instances where polydactyly was not passed down from the baby’s parents. The following parents’ behaviour/condition was found to be the reason for polydactyly in a few cases.
- Women with diabetes
- Mothers who suffered from upper respiratory tract infections in the first 3 months of pregnancy
- Mothers with a history of epilepsy
Parents’ behaviour aside, children with the following conditions are also at risk of polydactyly.
- Children with low birth weight
- Children who aren’t firstborn
- Children exposed to thalidomide
Treatment Options
Treatment for polydactyly involves surgically removing the extra finger or toe. The surgery is performed when the child is 1 or 2 years old, so that they can handle the effects of anaesthesia or surgery without affecting their development. One of the following treatments is considered, depending on the location of the extra finger or toe.
- Surgical Ligature: This is the preferred method when the child has an extra finger. A specialist will tie a tight string or band on the base of the extra finger to cut off the blood supply. The extra finger falls off on its own after a few weeks. This procedure is followed only if the extra finger doesn’t have any bones or connective tissues.
- In-Office Excision: In this method, a specialist will use a local anaesthetic around the extra finger. Then, a cautery device is used to remove the additional finger or toe. The device is also used to seal off the skin around the removed finger. Like surgical ligature, in-office excision is an option only if bones are yet to develop in the extra finger or toe.
- Polydactyly Surgery: This is a surgical method to remove the extra finger or toe. In this outpatient procedure, the extra finger or toe is surgically removed, and the incision is sealed using sutures. A special glue is used over the sutures, which will dissolve after a specific period of time.
Post Surgery Care
The post surgery care varies based on the type of polydactyly.
- Simple Polydactyly: The child should avoid getting the incision wet for 2 weeks after the surgery. The glue and stitches used on the incision come off within 2 to 4 weeks after the surgery.
- Complex Polydactyly: The child will need a pin during the recovery period to hold the bones in place. Additionally, the child will also have to wear a cast to protect the surgery site. The child may have to make multiple doctor visits before removing the pin and cast.
Thumb Hypoplasia
Thumb hypoplasia is a birth defect where a child’s thumb is underdeveloped or smaller than usual. Thumb hypoplasia is also known as hypoplastic thumb. This condition is rare and occurs in about 1 in 100,000 infants. It affects both male and female babies. About 60% of babies suffer from thumb hypoplasia in both thumbs.
In extreme cases, a baby will miss an entire thumb. This condition is known as thumb aplasia.
Thumb hypoplasia is classified into the following types:
- Type 1: The thumb appears smaller than usual but has stable bones and normal muscles.
- Type 2: The thumb appears smaller with similar bones and muscles. An unstable thumb joint is also seen. As a result, the thumb may wobble and has limited movement.
- Type 3A: The condition of the thumb is similar to Type 2, with the only exception being the absence of muscles.
- Type 3B: The thumb is smaller with an abnormal bone structure.
- Type 4: Also known as a floating thumb, there is an absence of bones in Type 4 thumb hypoplasia. The thumb is attached to the hand only by means of skin and soft tissue.
- Type 5: The baby is born without a thumb.
Causes of Thumb Hypoplasia
The general cause of thumb hypoplasia is still unknown. The condition is believed to appear along with a set of conditions and syndromes like
- VATER Syndrome: A condition that affects several parts of the body. It gets its name from the parts affected by it. The acronym stands for
- V – Vertebrae
- A – Anus
- T – Trachea
- E – Esophagus
- R – Renal (kidneys and urinary tract)
- TAR Syndrome: A condition caused by a lack of radius bone in the forearm and a low platelet count.
- Holt-Oram Syndrome: Also known as the hand-heart syndrome. It is characterised by illnesses in the hands and arms, along with cardiac defects.
- Fanconi’s Anaemia: A rare blood disorder that affects multiple parts of the body.
Treatment Options
The thumb is responsible for about 40% of the hand’s functions. Failure to treat thumb hypoplasia can have irreparable effects on the child.
Surgery is often the recommended method to treat thumb hypoplasia. But other methods are also considered, depending on the severity of the condition.
- Non-Surgical Therapy: This is usually the preferred treatment for Type 1 thumb hypoplasia. The specialist will suggest physical therapy to improve thumb function.
- Reconstructive Surgery: This is a recommended procedure for children with Type 2 and Type 3 thumb hypoplasia. The surgery is performed on children aged 6 and 18 months. The procedure involves reconstructing the ligaments of the thumb and transferring a tendon from one part of the hand to another. The surgery will also include a procedure to disconnect the webbed space between the thumb and index finger.
- Pollicization: This is the recommended method for Type 3, Type 4, and Type 5 thumb hypoplasia. In this process, another finger is transferred to the thumb’s position. This new finger will act as the child’s thumb. The index finger is usually the replacement thumb used in pollicization. Any child older than 1 can opt for pollicization.
Post Surgery Care
The post surgery phase is important for children who have undergone any of the surgeries mentioned above. You will have to visit an expert hand surgeon in Chennai, like BM Cosmetics, 2 weeks after the surgery. The examination must be repeated twice, 6 weeks and 3 months after the procedure.
Additionally, the child will also need hand therapy after surgery. The duration of the therapy depends on the following factors:
- The type of surgery performed
- The level of normal hand function your child’s hand has
It is also recommended to visit the surgeon once in a while to make sure your child’s hand is going through normal development.
Congenital Trigger Thumb
The base of the palm side of the thumb has a tunnel that a flexor tendon uses to pass through. Sometimes the tendon may get thick and end up stuck in the tunnel. In some cases, this thick tendon may pass through the tunnel with a click or a pop, making the end of the finger appear bent. This condition is commonly seen in infants.
Causes of Congenital Trigger Thumb
The actual cause of congenital trigger thumb is still a mystery. There are claims that genetics may be a factor and that it may randomly occur in children. Overuse of the thumb, trauma, or injury are found not to be reasons for congenital trigger thumb.
Treatment Options
Surgery isn’t always the only method to treat congenital trigger thumb. There is evidence that states that the majority of the children (nearly 80%) suffering from the condition will eventually grow out of it.
Surgery is recommended for the more severe cases. During surgery, the child will be given general anaesthesia. Then, an incision is made to open up the sheath and allow the tendon to move without obstruction. The child can leave the hospital the same day.
Post Surgery Care
After surgery, the hand is bandaged, sometimes with a splint or a cast. Soreness is expected around the surgery site. This soreness is expected to last for at least 2 weeks. The recovery period for congenital trigger thumb is fairly fast. Though the thickness around the tendon may last for years, the child will be able to move the thumb without restrictions.
Hand and finger anomalies will disrupt a child’s life. It’s best to spot the symptoms early and rectify them as soon as possible. Call +919952099620 and get in touch with one of the reconstruction hand specialists at BM Cosmetics, the best plastic surgery hospital in Chennai.
