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.
2.
3.
4.
5.
6.
7.

Failure of formation
Failure of differentiation
Duplication
Undergrowth
Overgrowth
Congenital band syndrome
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 :
Nottas node

Move :
triggering

Clinodactyly
Bent sideways
Abnormal shaped
middle phalang

www.newborns.stanford.edu

www.e-radiography.net

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