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Congenital Hand Differences

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Introduction

Congenital hand differences are abnormalities present at birth.  They occur before birth when an embryo is developing the upper extremity.  Congenital hand differences are caused by genetic, environmental, and unknown reasons.  A variety of hand conditions may occur. 

A hand surgeon and hand therapist should evaluate all babies born with a hand difference.  Some conditions do not need treatment.  For others, treatment during the first few years of life allows children to best adapt to their hands.  Treatments may include splinting, hand therapy, or surgery. 

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Anatomy

Your upper limb (arm) develops before you are born.  An embryo develops an arm bud at four weeks.  The tip of the arm bud sends genetic signals to cells to direct limb formation.  The upper limb is formed when an embryo is between four to eight weeks old in the womb.  The arm develops first at the shoulder and progresses to the fingers.  The development of a limb is a complex process involving millions of steps guided by genetics, your inherited blueprint for growth.
 
Your upper extremity is composed of many bones that provide structure for your wrist and fingers.  The bones are connected with strong ligament tissues.  Tendons are strong fibers that attach your muscles to your bones and allow movement.  Your hand also contains nerves, blood vessels, and fat.  The skin that covers your hand protects it from the environment.
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Causes

Congenital hand differences are abnormalities present at birth.  Congenital hand differences occur when an embryo is developing the upper limb.  Some conditions may develop due to genetic problems and passed from generation to generation.  Other congenital hand differences develop because of environmental factors or for no known reason.

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Symptoms

There are several different types of congenital hand differences.  Variances can range from major to minor.  Some congenital hand differences are associated with other medical or genetic problems.  Congenital hand differences are categorized by type including failure of formation, failure of separation, duplication, undergrowth or overgrowth, and constriction band syndrome.
 
Failure of formation describes upper arms, forearms, wrists, hands, or fingers that do not form completely or at all.  Failure of separation includes finger webbing.  Finger webbing can involve only the skin or can include the finger bones, extra bones, or fingernails.  The two bones that make up the forearm, the ulna and radius can also be joined together.
 
Duplication is another type of congenital hand difference.  It most commonly involves an extra thumb or little finger, although duplication of any portion of the hand can occur.  Overgrowth or undergrowth causes a section of the hand or arm to be too large or too small.  This can affect joint structure and function.  Constriction band syndrome causes tight bands of tissue to form around the arm, forearm, wrist or fingers.  The constrictions can range from mild to severe.  Severe constrictions can result in the loss of a portion of the hand.
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Diagnosis

A hand specialist should evaluate all babies born with a hand difference.  The doctor can diagnose a congenital hand difference by reviewing your child’s medical history and conducting an examination.  X-rays will identify the location and position of affected bones.  If necessary, your doctor may refer you to a geneticist or specialist for diagnosis and treatment of associated medical conditions.
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Treatment

Treatment for congenital hand differences depends on the type and extent of the condition.  Some people may not require any treatment.  Splinting and hand therapy may be used to improve hand structure and function.  Hand therapists can recommend assistive devices to make everyday activities such as handwriting, grooming tasks, and feeding easier.
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Surgery

Surgery can help severe hand differences.  Surgeons are able to separate webbed fingers and remove extra fingers.  The hand and fingers can be surgically reconstructed to improve function and appearance.  There are many methods that may be used and your hand surgeon will discuss the most appropriate options for your child with you.  As this type of surgery is specialized even within the realm of hand surgery, you may be referred to a hand specialist with expertise in congenital hand differences.
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Recovery

Recovery from hand surgery may include splinting and hand therapy.  Surgery performed in the first few years of life provides children with the greatest opportunity to adapt to their reconstructed hand.  Hand therapy and possibly additional hand surgery may be necessary as a child grows and develops.
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Prevention

There is no way to prevent congenital hand differences that occur during pregnancy.  It is important for babies with the condition to receive prompt diagnosis from a hand specialist and receive early treatment, if necessary.
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This information is intended for educational and informational purposes only. It should not be used in place of an individual consultation or examination or replace the advice of your health care professional and should not be relied upon to determine diagnosis or course of treatment.

The iHealthSpot patient education library was written collaboratively by the iHealthSpot editorial team which includes Senior Medical Authors Dr. Mary Car-Blanchard, OTD/OTR/L and Valerie K. Clark, and the following editorial advisors: Steve Meadows, MD, Ernie F. Soto, DDS, Ronald J. Glatzer, MD, Jonathan Rosenberg, MD, Christopher M. Nolte, MD, David Applebaum, MD, Jonathan M. Tarrash, MD, and Paula Soto, RN/BSN. This content complies with the HONcode standard for trustworthy health information. The library commenced development on September 1, 2005 with the latest update/addition on February 16, 2022. For information on iHealthSpot’s other services including medical website design, visit www.iHealthSpot.com.

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Dr. Reznick did major surgery on my right hand (carpal tunnel and 3 trigger fingers). Prior to the surgery, I could not hold a pen or write my name legibly. I was in constant pain. After the surgery, while the stitches were still in and the brace still in place, I had more flexibility in my fingers than I had before the surgery. I am six weeks out from the surgery and I continue to progress. I have more functionality and strength in my hand than I have had in the last year. I can't even see the scars on my hand. Dr. Reznick not only did a spectacular job of restoring the use of my hand, but she is a very likable person. Her staff is friendly and professional. I cannot say enough good things about this experience!

Nancy L.

via md.com

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Les D.

via healthgrades.com

Amazing visit. I can't remember the last time I spent quality time with a doctor. She explained everything to me on why I was having trigger finger issues. I have been dealing with this for some time. She nailed it on the first visit ‘cause she talks to you and listens! If you need a hand doctor you will be happy she is the one.

Anonymous

via healthgrades.com

Dr. Reznick is one of the most professional, sensitive and caring physicians I have visited. She is a teacher--patient and informative, and she made sure I understood just exactly what was necessary for my particular problems. She took care of both my left and right carpal tunnel surgeries, and I couldn't have asked for a better recovery. Everything went just as planned. She is my ‘go to’ hand doctor!

Anonymous

healthgrades.com

When I was having problems with my wrist, she guided me through every step, and always made sure I was comfortable with what she was doing. Very straightforward and trustworthy. I never doubted what she was doing and she always wants to try every technique before doing surgery to try to make you better.

Shannon C.

healthgrades.com

I recently rode 900 miles on a vibrating Harley-Davidson and did not have a single tingle in either of my hands. You do great work. Thanks for helping me.

Ed G.

Just wanted to let you know again how much I appreciated your care, expertise and skill in conducting the surgery on my hand. A job well done. Thank you.

Randall A.

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Kevin M.

Dr. Lisa Reznick has performed carpal tunnel surgery on both hands and has removed my basal joint from my right hand. All of my surgeries have been successful, and I now have complete use of both hands and my right thumb, which I credit to a great surgeon, good therapy, and a genuine concern for patients.

Robert

My hand is in perfect working order because of your expertise. I appreciate your genuine concern for my healing. Through the myriad of maladies my husband experienced, I became acquainted with many doctors. None even approached your level of patient care.

Trudy R.

Dr. Reznick performed surgery on my hand for ‘trigger finger’ and did a wonderful job. I’ll definitely user her again if the need ever presents itself again.

Don L.

Dr. Reznick is very to the point and no nonsense. She tells you what options there are in your treatment and advises you accordingly. I had hand surgery four years ago and it was a complete success. I actually went back to work one week early. I have recommended Dr. Reznick to many friends and associates. Frankly, I won’t go to anyone else when it comes to muscles or bones. I have complete faith in her.

J. Schully

via vitals.com

Dr. Reznick did major surgery on my right hand (carpal tunnel and 3 trigger fingers). Prior to the surgery, I could not hold a pen or write my name legibly. I was in constant pain. [Now] I have more functionality and strength in my hand than I have had in the last year. I can't even see the scars on my hand. Dr. Reznick not only did a spectacular job of restoring the use of my hand, but she is a very likable person. Her staff is friendly and professional. I cannot say enough good things about this experience!

~ Nancy L. via md.com

Lisa R. Reznick MD, PA

Board Certified Orthopedic and Hand Surgeon

4100 Fairway Court, Suite 120
Carrollton, TX 75010
Phone: (972) 395-9000
Fax: (972) 395-9002

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In Carrollton, TX, board-certified orthopedic surgeon Dr. Lisa Reznick offers conservative treatment options for all types of general orthopedic issues, while specializing in surgeries of the hand, wrist, and elbow.