{"id":3816,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/congenitalhanddeformity\/"},"modified":"2026-06-18T16:48:10","modified_gmt":"2026-06-18T15:48:10","slug":"congenitalhanddifferences","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/plasticsurgery\/handsurgery\/congenitalhanddifferences\/","title":{"rendered":"Congenital Hand Differences"},"content":{"rendered":"\n<p class=\"has-alert-red-color has-text-color wp-block-paragraph\"><mark style=\"background-color:#ffffff\" class=\"has-inline-color has-standard-black-color\"><strong>Referral Pathway for Congenital Hand Differences<\/strong><\/mark><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">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.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Polydactyly (Extra Digits)<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mild cases with small, non-functional&nbsp;swellings&nbsp;can be&nbsp;monitored.&nbsp;<\/li>\n\n\n\n<li>Simple accessory digits attached to the little finger by a rudimentary stalk are excised under local&nbsp;anaesthetic&nbsp;in&nbsp;children&nbsp;below&nbsp;the age of 3 months.&nbsp;<\/li>\n\n\n\n<li>Fully formed or functional extra digits may&nbsp;require further investigation prior to&nbsp;being&nbsp;surgically&nbsp;removed or reconstructed.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Syndactyly (Fusion of Digits \u2013 fingers or toes)<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Mild, incomplete cases may not need surgery.<\/li>\n\n\n\n<li>Finger syndactyly that is complete&nbsp;and\/or complex (e.g., involving bone or joint fusion)&nbsp;may&nbsp;require surgical separation to improve function.<\/li>\n\n\n\n<li>Of note, surgery to release simple toe syndactyly is very rarely indicated.<strong>&nbsp;<\/strong><\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Trigger Thumb<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>In&nbsp;babies, this condition often resolves spontaneously.&nbsp;<\/li>\n\n\n\n<li>Most children,&nbsp;once referred will be&nbsp;monitored&nbsp;in our service and undergo physiotherapy in the first instance&nbsp;<\/li>\n\n\n\n<li>If non-operative measures are not sufficient and there is a concern&nbsp;regarding&nbsp;functional&nbsp;impairment,&nbsp;then surgical release can be considered&nbsp;&nbsp;&nbsp;&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Radial Dysplasia and\/ or Thumb Hypoplasia<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Radial dysplasia involves underdevelopment or absence of the radius bone, leading to&nbsp;deviation&nbsp;of the wrist and hand.&nbsp;Thumb hypoplasia is&nbsp;underdevelopment&nbsp;of the thumb, often leading to reduced grip strength and hand function.<\/li>\n\n\n\n<li>Any conditions resulting in hypoplasia on the radial side of the hand (either radius or thumb) can be associated with syndromes including Fanconi\u2019s&nbsp;anaemia, Holt-Oram, VACTERL or TAR.&nbsp;Usually,&nbsp;these cases are detected at&nbsp;birth&nbsp;but any suspected cases detected later in childhood will need a&nbsp;separate paediatric&nbsp;assessment in addition to &nbsp;exclude any associated&nbsp;conditions&nbsp;<\/li>\n\n\n\n<li>Mild cases may require observation and physiotherapy.&nbsp;<\/li>\n\n\n\n<li>Severe cases&nbsp;may&nbsp;need surgical intervention.&nbsp;&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Amniotic Band Syndrome<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Amniotic Band Syndrome occurs during&nbsp;foetal&nbsp;development&nbsp;leading to anomalies such as constricted fingers or amputated digits. Constricting circumferential scars can sometimes be seen on the digit.&nbsp;&nbsp;<\/li>\n\n\n\n<li>Initial management includes monitoring for functional impairment&nbsp;or vascular compromise.&nbsp;<\/li>\n\n\n\n<li>Surgery may be needed to release&nbsp;constricting&nbsp;bands or reconstruct affected areas.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Clinodactyly (curved finger)<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Clinodactyly refers to a finger, usually the little finger&nbsp;that is radially deviated, often due to a bony irregularity.&nbsp;<\/li>\n\n\n\n<li>Mild cases are often&nbsp;monitored and most&nbsp;cases are managed non-operatively.<\/li>\n\n\n\n<li>Generally,&nbsp;it does not&nbsp;benefit&nbsp;from physiotherapy as stretches and splinting will not change the bony irregularity.&nbsp;<\/li>\n\n\n\n<li>If the&nbsp;deviation&nbsp;impairs function, surgery may be&nbsp;considered.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Camptodactyly<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Camptodactyly&nbsp;involves flexion&nbsp;of the fingers&nbsp;at&nbsp;the&nbsp;proximal interphalangeal joint, most commonly affecting the little finger.&nbsp;&nbsp;<\/li>\n\n\n\n<li>Mild cases may not require immediate intervention&nbsp; &#8211; physiotherapy and splinting may be sufficient &nbsp;<\/li>\n\n\n\n<li>Surgery is considered for severe cases&nbsp;after a period of non-operative management if hand function is&nbsp;compromised.&nbsp;<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><u>Paediatric Ganglia of the Hand<\/u><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Ganglia are benign fluid-filled cysts that form near joints or tendons, often appearing on the back of the hand or wrist.&nbsp;<\/li>\n\n\n\n<li>Other pathology should be considered if there is a history of large size, rapid growth or severe pain<\/li>\n\n\n\n<li>Most ganglia will resolve spontaneously. Aspiration is occasionally considered. Surgery is rarely indicated.<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>MA &amp; LW 18\/6\/26<\/strong><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\"><mark><mark style=\"background-color:#C4DCFD\" class=\"has-inline-color has-standard-black-color\"><strong>Please include \u201cFAO Miss Pauline McGee\/ Miss Lucie Wright\u201d when referring patients to ensure review in the congenital hand clinic<\/strong><\/mark><\/mark><\/h4>\n\n\n\n<h4 class=\"wp-block-heading\">Who can refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Any doctor reviewing a patient with a congenital hand condition<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who to refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Any patient with any of following conditions* (see information section):<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Polydactyly (Extra Digits)<\/li>\n\n\n\n<li>Syndactyly (Fusion of Digits \u2013 fingers or toes)<\/li>\n\n\n\n<li>Camptodactyly<\/li>\n\n\n\n<li>Clinodactyly (curved finger)<\/li>\n\n\n\n<li>Radial Dysplasia and\/ or Thumb Hypoplasia<\/li>\n\n\n\n<li>Trigger Thumb<\/li>\n\n\n\n<li>Amniotic Band Syndrome<\/li>\n\n\n\n<li>Paediatric Ganglia of the Hand<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">*<em>If referring patients with conditions not detailed above then please give as much information as possible about the hand difference and how it is impacting them<\/em><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Who Not to Refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Any paediatric trauma should be referred to their local hand surgery team<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to Refer<\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">Via SCI-Gateway: SJH \\ Plastic Surgery \u2013 Hands Service \\ Hand Clinic<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong><u>Contact Details<\/u><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">For urgent assessment of post-axial polydactyly in newborns please email both:&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Miss Pauline McGee (Consultant Plastic and Hand Surgeon):&nbsp; <a href=\"mailto:Pauline.McGee@nhs.scot\">Pauline.McGee@nhs.scot<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Miss Lucie Wright (Consultant Plastic and Hand Surgeon): <a href=\"mailto:Lucie.Wright@nhs.scot\">Lucie.Wright@nhs.scot<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong><u>What to Tell Parents: Next Steps<\/u><\/strong><\/h4>\n\n\n\n<p class=\"wp-block-paragraph\">It may be helpful to give families a brief overview of what to expect:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Their child will be managed by a <strong>multidisciplinary team<\/strong> (surgeon, therapist, psychosocial practitioner)<\/li>\n\n\n\n<li><strong>Surgery<\/strong> may or may not be needed<\/li>\n\n\n\n<li>Most surgery (if needed) is done after <strong>1 year of age<\/strong><\/li>\n<\/ul>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>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) Syndactyly (Fusion of Digits &ndash; fingers or toes) Trigger Thumb Radial Dysplasia and\/<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3988,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"_searchwp_excluded":"","footnotes":""},"categories":[551],"class_list":["post-3816","page","type-page","status-publish","hentry","category-congenitalhanddeformity"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/plasticsurgery\/handsurgery\/congenitalhanddeformity\/\" rel=\"tag\">Congenital Hand Deformity<\/a>","rttpg_excerpt":"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) Syndactyly (Fusion of Digits &ndash; fingers or toes) Trigger Thumb Radial Dysplasia and\/","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3816","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=3816"}],"version-history":[{"count":14,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3816\/revisions"}],"predecessor-version":[{"id":28422,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3816\/revisions\/28422"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3988"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=3816"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=3816"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}