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Both genetic factors and chance can result in variation of hand wrist and /or arm structure at birth. Some presentations can be relatively common, such as the prescence of an extra digit (polydactyly), or webbing between the fingers (syndactyly). Sometimes a finger can be deviated sideways, or be slightly bent. (clinodactyly and camptodactyly) Others can be more unusual. There are also some genetic syndromes that can also affect the hand.
Referral to a specialised hand surgeon is the first step. Some surgeons specialise specifically in paediatric hand surgery. They will be able to give advice on the options for treatment. The type of anomaly will indicate the need for surgery and appropriate age for this to happen. The surgeon may also refer to a specialised hand therapist, who will be either a physiotherapist or an occupational therapist to advise on conservative methods of management.
Your hand therapist will advise you on types of splints that can be fabricated for your child to assist in correction of movement and range of the joints as development occurs. They will also assess the development of hand function and provide guidance in therapy and for the home and school to help your child learn to use the hand. Your hand therapist will often use play and functional activity as therapy and support you to provide an environment at home that will best support your child to learn the skills of independence.
Conditions such as camptodacytly and clinodacytly, described earlier, tend to be treated successfully conservatively. Your hand therapist will fabricate a hand splint, often for night wear, that will be designed to gently stretch and mobilise the affected joints.
Advice from the surgeon and therapist will assist you to make the best decision for your child and the future.
Hand surgery can be sometimes indicated depending on the type of anomaly your child has. Surgery will aim to restore biomechanics and maximise the functional ability of the hand. The assessment process with a paediatric hand surgeon will give you the information needed to decide whether this is the best option.
Post operative management will vary depending on the operation performed. The hand therapist will support this process in conjunction with the treating consultant and may employ the use of protective splints, scar care, swelling reduction, and strategies such as therapy through play to facilitate functional re education and motor relearning.
