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Limb, hand and toe disorders

Limb, hand and toe disorders

Congenital hand deformities

A congenital condition is one that a child is born with. Congenital hand deformities occur in several different ways and have different causes. Some deformities can be inherited and others are caused by developmental abnormalities while the baby is still in the womb. The congenital hand deformities treated at Shriners Hospitals for Children — Spokane include:

  • Extra fingers or polydactyly: This may occur on one or both hands. The extra finger is usually a small piece of soft tissue that can be removed. Sometimes the finger will contain bones, but not joints. Very rarely the extra finger will be a complete, fully functioning digit. Polydactyly can occur by itself or be inherited, but may be a feature related to another underlying medical condition or syndrome.
  • Webbed fingers or syndactyly: This is a common condition in which a child’s fingers or toes do not fully separate during development. The spaces between the connected fingers and toes may be webbed or they may be fully attached and sharing tendons, nerves, blood vessels and bone. Syndactyly can be subdivided into several different types depending on which fingers are connected and how many. Syndactyly can be inherited or can occur independently, even if the condition does not run in the family. Most cases are isolated and occur in a child who is completely healthy otherwise.
  • Missing fingers or symbrachydactyly: Children born with symbracydactyly have small or missing fingers or a missing hand. They may also have webbed fingers or a short hand or forearm. Symbrachydactyly is the most common type of hand or arm deficiency, but the exact cause is unknown. It does not seem to run in families. The condition is usually only present on one side and there may be muscle abnormalities on that side as well.
  • Abnormal thumbs or trigger thumb: Trigger thumb occurs when there is a bump on the tendon that moves the joint near the tip of the thumb, causing the thumb to jump or “trigger” when it is used. In some cases, the thumb may be locked in a bent position. Trigger thumb is caused by a tendon that is too thick and so is unable to move normally, causing the thumb to lock.

Amniotic band syndrome: Constricting bands of digits, arms and toes

Amniotic band syndrome (ABS) occurs when the fetus is entangled with strands of amniotic bands that are fibrous and string-like. These strands in the womb restrict blood flow, affecting the baby’s growth and development, and can cause deformities to the arms, face, fingers, legs and toes.

In some cases, a fibrous band can be so tightly wrapped around a baby’s limb that it may need to be amputated. Some newborns can have a cleft palate if the bands are across their face or clubfoot if the bands wrap themselves around their feet.

At Shriners Hospitals for Children — Spokane, we offer treatment for ABS that is based upon the severity of the deformities. In some cases, the child’s deformity may not be severe and no treatment may be needed. Children with some physical defects or limb deficiencies may receive physical and occupational therapy to support their growth and development.

Treatment options

  • Prosthetics: In cases where amniotic band syndrome has affected a limb, the child may be able to receive a prosthesis. These devices can begin to be used when children are very young, typically when they are developmentally ready to begin standing and walking (usually between 12 and 18 months of age). Occasionally, surgery will be needed to optimize the site where the prosthesis will be attached.
  • Surgery: Children whose amniotic band syndrome has affected their face or limb may require reconstructive surgery.

Other conditions treated