Definition and Overview
Pediatric hand problems are congenital conditions that affect any part of the hand and arm, such as the bones, muscles, tendons, ligaments, and joints. These problems come in many different types with varying severity, ranging from deformities, injuries, and tumors. Some may not be serious and correct themselves as the child grows while some may hinder a child from using his hands properly.
Cause of Condition
Most pediatric hand problems are congenital, which means the child is born with it. These conditions are believed to be caused by genetic problems but in the majority of cases, the specific cause is unknown.
The process involved in the formation of the hands is very complex and entails several steps beginning with a paddle-shaped hand that eventually splits into different fingers. Any irregularity during the crucial stages of embryonic development may cause abnormalities in the separation of the fingers, causing malformations. These malformations may occur anytime between the sixth and seventh weeks of gestation, the estimated period during which the hands begin to form.
Some hand problems, however, may also be acquired or may develop over time as the child grows due to an underlying health condition. For example, deformities of the hand may be caused by the destruction of certain structures in the hand, either due to trauma or to a different health condition, such as osteomyelitis.
Below are the different types of hand problems and their symptoms:
Congenital hand problems
Syndactyly – This is considered as the most common congenital malformation affecting the hands. At present, it has an incidence rate of 1 out of every 2,000 to 3,000 live births. It comes in two main types; a simple type wherein only soft tissues are affected and a more complex type wherein the bones and nails are also affected. This condition is characterized by webbed fingers, in which some or all the fingers are attached together.
Polydactyly – This condition is characterized by having extra fingers at birth. Considered as a congenital anomaly, it is believed to occur during the embryonic development, either due to a hereditary syndrome or a gene defect that causes one finger to split into two separate fingers.
Finger triggering – Also known as congenital trigger, this condition occurs when the muscles and tendons below the first finger are thickened. This condition may require surgical intervention.
Apert hand – Related to the Apert syndrome, this is a congenital disorder that causes a child’s hands to be malformed. The Apert syndrome may also cause the same type of malformation to a child’s skull, face, or feet. Apert hands have four common features: a shorter thumb with a deviated radius, a syndactyly affecting the index finger to the ring finger in complex cases (which means bones and joints are also deformed), a syndactyly affecting the soft tissues of the fourth hand, and a symbrachyphalangism. They may occur in many different types, though, such as a spade hand (type I), a mitten hand (type 2), and a hoof hand (type 3). The hoof hand is the most severe but also the rarest type of Apert hand wherein the fingers, including the thumb, are fused together into one single solid structure, with the bones overlapping.
Acquired or developed conditions
- Radial club hand – Although quite rare, this hand problem causes one or both hands to be deformed due to the lack of the hand’s radius.
- Ganglion cysts – These are cysts that usually grow on the dorsum part of the wrist
- Nail bed injuries – These are injuries affecting the nail bed or fingertips. These are acquired problems and may be caused by trauma to a child’s hand.
Who to See and Types of Treatments Available
Pediatric hand problems are treated by pediatric hand specialists and pediatric surgeons. These medical professionals currently use both surgical and non-surgical techniques to address the problem, although surgical techniques are only used when necessary.
Non-surgical treatment methods include splinting, while surgical treatment may involve an open surgery to make necessary adjustments to the affected soft tissues or a bone grafting procedure, when the bones are affected.
In general, treatment tends to be simpler when only skin and soft tissues are involved, as they are more pliable and easier to remodel. If bones and joints are also affected, remodeling them poses an additional challenge that has to be taken into consideration during the treatment process.
- American Orthopedic Society