Congenital Hand Differences

Referral Pathway for Congenital Hand Differences

Congenital hand differences (CHD) occur in approximately 1 in 600 births. While many CHDs are relatively minor, their unexpected nature can cause a degree of anxiety for parents -particularly when not detected antenatally.

Polydactyly (Extra Digits)

• Mild cases with small, non-functional swellings can be monitored. 
• Simple accessory digits attached to the little finger by a rudimentary stalk are excised under local anaesthetic in children below the age of 3 months. 
• Fully formed or functional extra digits may require further investigation prior to being surgically removed or reconstructed. 

Syndactyly (Fusion of Digits – fingers or toes)

• Mild, incomplete cases may not need surgery.
• Finger syndactyly that is complete and/or complex (e.g., involving bone or joint fusion) may require surgical separation to improve function.
• Of note, surgery to release simple toe syndactyly is very rarely indicated. 

Trigger Thumb

• In babies, this condition often resolves spontaneously. 
• Most children, once referred will be monitored in our service and undergo physiotherapy in the first instance 
• If non-operative measures are not sufficient and there is a concern regarding functional impairment, then surgical release can be considered    

Radial Dysplasia and/ or Thumb Hypoplasia

• Radial dysplasia involves underdevelopment or absence of the radius bone, leading to deviation of the wrist and hand. Thumb hypoplasia is underdevelopment of the thumb, often leading to reduced grip strength and hand function.
• Any conditions resulting in hypoplasia on the radial side of the hand (either radius or thumb) can be associated with syndromes including Fanconi’s anaemia, Holt-Oram, VACTERL or TAR. Usually, these cases are detected at birth but any suspected cases detected later in childhood will need a separate paediatric assessment in addition to  exclude any associated conditions 
• Mild cases may require observation and physiotherapy. 
• Severe cases may need surgical intervention.  

Amniotic Band Syndrome

• Amniotic Band Syndrome occurs during foetal development leading to anomalies such as constricted fingers or amputated digits. Constricting circumferential scars can sometimes be seen on the digit.  
• Initial management includes monitoring for functional impairment or vascular compromise. 
• Surgery may be needed to release constricting bands or reconstruct affected areas. 

Clinodactyly (curved finger)

• Clinodactyly refers to a finger, usually the little finger that is radially deviated, often due to a bony irregularity. 
• Mild cases are often monitored and most cases are managed non-operatively.
• Generally, it does not benefit from physiotherapy as stretches and splinting will not change the bony irregularity. 
• If the deviation impairs function, surgery may be considered.

Camptodactyly

• Camptodactyly involves flexion of the fingers at the proximal interphalangeal joint, most commonly affecting the little finger.  
• Mild cases may not require immediate intervention  – physiotherapy and splinting may be sufficient  
• Surgery is considered for severe cases after a period of non-operative management if hand function is compromised. 

Paediatric Ganglia of the Hand

• Ganglia are benign fluid-filled cysts that form near joints or tendons, often appearing on the back of the hand or wrist. 
• Other pathology should be considered if there is a history of large size, rapid growth or severe pain
• Most ganglia will resolve spontaneously. Aspiration is occasionally considered. Surgery is rarely indicated.

MA & LW 18/6/26