After your obstetrician conducts an APGAR test on your newborn—the quick assessment of whether the baby needs immediate medical attention—you’ll be likely to count all her fingers and toes. This traditional ritual is irresistible for most parents as they look for indicators that the new family member is “perfect.”
If your child is born with a hand abnormality, it’s understandably distressing. Even though a malformed hand usually doesn’t indicate a serious health issue, an obvious imperfection like fused fingers can be a real blow. What are the various congenital hand abnormalities and what can be done about them?
Children’s Hospital Boston, the primary pediatric teaching hospital associated with Harvard Medical School, is one of the largest hospitals for children in the United States. Characterizing its Hand and Upper Extremity Program as “one of the most experienced in the country for the evaluation and care of complex congenital differences…” the Children’s Hospital team treats a variety of abnormalities.
The most common hand abnormalities are, thankfully, usually easiest to treat. Polydactyly is a condition in which the patient has an extra finger (or toe). Children’s Hospital identifies polydactyly as the most common hand defect, occurring in about one in 1,000 births and it is often passed down through family generations.
Many children require just a one-day surgery to remove the extra digit. In cases where there’s additional involvement of bones, ligaments and tendons, more extensive surgery may be needed. Occasionally, a patient will need a second procedure later in life to improve the hand as he grows.
Another fairly common condition, occurring once in about 2,500 births, is syndactyly. This is what most people call “webbed fingers.” The condition occurs as the fetus’s hand, which starts out as a paddle shaped bud, fails to separate the fingers completely as they split from the bud during hand development. According to Children’s Hospital, fingers can be conjoined completely or partly, and may be simple (skin and tissue involvement) or complex (bone involvement).
Children’s Hospital usually performs surgery to separate fingers when a child is 12 to 18 months old. Skin is divided in a zigzag pattern between the two fingers, with skin grafts used to complete coverage. You’ll need to follow post-surgical instructions carefully to avoid recurring syndactyly (“web creep”) and ensure the best possible function for the separated fingers.
Constriction ring syndrome occurs once in about 10,000 to 15,000 births. Its other name, amniotic sac syndrome, helps paint a visual of the condition: bands of fibrous tissue in the lining of the uterus entangling themselves around the developing baby. Most often, a stray band of tissue wraps around the fetus’s hand and fingers, constricting proper growth as a rubber band would. Resulting deformities vary a great deal from infant to infant. Some have simple indentations in their fingers, others have severe swelling and bulbous, misshapen digits.
Treatment is customized to each patient and depends on how severe the constriction rings are. The surgeons at Children’s Hospital prefer to wait several months for the baby and his hand to grow a bit. But if circulation is greatly restricted, surgery may be scheduled right away to give your child the best chance for improved function and a better appearance. Even though many hands and fingers cannot be made to look completely normal, surgeons can usually help your child achieve excellent function.
In symbrachydactyly, another congenital hand disorder, fingers are abnormally short. Many infants have short fingers, sometimes webbed, with a relatively normal thumb. Sometimes the thumb and little finger are the only digits actually present. In the most difficult cases, little stumps or nubs are the only evidence of fingers. The condition occurs when one or more fingers fail to “grow” from the developing hand in the womb—no one knows exactly why. Symbrachydactyly affects approximately one out of every 32,000 newborns.
If your child is born with symbrachydactyly, your surgeon’s goal will be to give her the best possible function for the hand (usually only one hand is affected). Less severe cases may require surgery to separate webbing, or no treatment at all. In some cases, the surgeon may recommend adding bones from elsewhere (sometimes the toes) to try to lengthen fingers. Sometimes a toe or toes may be transplanted to allow your child to grip objects.
A rare congenital abnormality of the hand is thumb hypoplasia, a small or abnormally developed thumb. The mechanics behind the condition vary from simple, when the thumb’s structures are all present in smaller size than normal, to dramatic, when the thumb “floats” with no bony support at all. Occasionally the thumb is missing altogether; this condition is called aplasia.
At first glance, thumb hypoplasia may appear to be less dramatic than other hand abnormalities, such as symbrachydactyly. But according to the experts at Children’s Hospital, the thumb accounts for about half the functionality of our hands, and children born with a defective thumb need to be carefully evaluated. Treatment options depend on the severity of the case. Physical therapy may be all that’s needed for a slight case. Other children may require a reconstructive procedure involving skin, tendons and ligaments. When a child has no thumb or a completely dysfunctional thumb, your surgeon may recommend moving a finger to the thumb position. Although this may seem drastic at first, it may be way to give your child the best possible function in the long run.
Hand abnormalities can be startling and upsetting for new parents. The good news is that most congenital defects of the hand can be improved a great deal with expert medical attention. Look for a program that specializes in pediatric hand surgery and your child can look forward to a bright future.