Congenital hand differences

Every parent wishes to have a perfect baby. But sometimes (once in about 20 of 10,000 births) when a baby is born, the parents discover that the baby has a hand that looks different. Naturally this can cause significant distress.

What causes these problems?

The causes can be divided into environmental or genetic. The hand in a foetus develops between the ages of 4 to 6 weeks. An external cause, such as an infection in the mother can cause the hand to develop abnormally. On the other hand there can be problems in the genes that cause the hand to develop abnormally.

What are the environmental causes?

It can be due to infections such as rubella, herpes simplex or toxoplasmosis or it can be an external force such as compression bands in the uterus. Some medications taken by the mother such as some chemotherapy drugs can cause such defects. That is why it is important for the mother to be vaccinated prior to planning a pregnancy, and also only to take medications approved by the obstetrician.

What about genetic causes?

These are usually due to an isolated change in one of the genes that deals with hand formation. More rarely there can be a genetic problem that runs in families. Even more rare, is to have a syndrome which is a cluster of anomalies in various body parts.

Was it the fault of one of the parents? Could it be caused by an eclipse?

No. Eclipses don’t cause health problems. Except for infections in the mother none of these are preventable.

My baby had normal prenatal Ultrasounds? Why didn’t the doctor see anything?

These defects are usually too subtle to be detected on prenatal Ultrasounds.

What are the types of hand differences?

They can be disorders of duplication (extra fingers), absence (missing fingers/ parts), formation (congenital amputations), and separation (fingers stuck together). The commonest are extra fingers (polydactyly), and fused fingers (syndactyly)

Can anything be done?

Most babies benefit from surgery, and near normal appearance and function can be achieved. In very complicated cases, achieving a normal appearance can be impossible, but function can be improved. Some babies require physiotherapy, or splinting.

Can it cause other problems in my child?

Some children will also have a problem in another limb or organ. Even though children born with a congenital problem are usually comfortable with their body, and manage to do all activities, they can be the target of teasing by other children. Good family support can help the child immensely.

Is my baby too small for surgery?

The optimal age for surgery depends on the condition. It is important to have a through discussion with the Hand surgeon once the child is born to plan the surgery at the optimum time. Non-emergency surgery with general anaesthesia can be done at the age of 3 months, while local anaesthesia procedures such as removing small floppy fingers can be done when the child is a few days old. If one waits too long the child will already have adapted to their condition and may not get optimum function after surgery.