Subscribe to RSS
DOI: 10.1055/s-0043-1777096
Common Pediatric Hand Anomalies

Abstract
Upper extremity congenital anomalies in the newborn are second only to congenital heart anomalies. Some of the more commonly encountered upper extremity anomalies are trigger thumb, thumb hypoplasia, polydactyly, syndactyly, and amniotic band syndrome. While some conditions occur in isolation, others are known to commonly occur in association with syndromes. Familiarity with these conditions is important not only to provide adequate evaluation and workup of these patients but also to deliver appropriate surgical intervention and prepare parents with appropriate expectations. In this article, we outline the etiology, classification, surgical management, and outcomes of these five commonly encountered upper extremity congenital anomalies.
Keywords
upper extremity - congenital hand - thumb hypoplasia - syndactyly - trigger thumb - amniotic band syndrome - polydactylyPublication History
Article published online:
28 November 2023
© 2023. Thieme. All rights reserved.
Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA
-
References
- 1 Flatt A. The Care of Congenital Hand Anomalies. 2nd ed.. St. Louis, MO: Quality Medical Pub., Inc.; 1994
- 2 Parker SE, Mai CT, Canfield MA. et al; National Birth Defects Prevention Network. Updated National Birth Prevalence estimates for selected birth defects in the United States, 2004-2006. Birth Defects Res A Clin Mol Teratol 2010; 88 (12) 1008-1016
- 3 Goldfarb CA, Shaw N, Steffen JA, Wall LB. The prevalence of congenital hand and upper extremity anomalies based upon the New York Congenital Malformations Registry. J Pediatr Orthop 2017; 37 (02) 144-148
- 4 Bamshad M, Watkins WS, Dixon ME. et al. Reconstructing the history of human limb development: lessons from birth defects. Pediatr Res 1999; 45 (03) 291-299
- 5 Temtamy SA, McKusick VA. The genetics of hand malformations. Birth Defects Orig Artic Ser 1978; 14 (03) i-xviii , 1–619
- 6 Rodgers WB, Waters PM. Incidence of trigger digits in newborns. J Hand Surg Am 1994; 19 (03) 364-368
- 7 Kikuchi N, Ogino T. Incidence and development of trigger thumb in children. J Hand Surg Am 2006; 31 (04) 541-543
- 8 Slakey JB, Hennrikus WL. Acquired thumb flexion contracture in children: congenital trigger thumb. J Bone Joint Surg Br 1996; 78 (03) 481-483
- 9 Shen K, Han B, Xu Y. Characterization of pediatric extension trigger thumb: an insight into a rare manifestation from a single-center retrospective cohort analysis. J Hand Surg Am 2021; 46 (10) 926.e1-926.e8
- 10 Ger E, Kupcha P, Ger D. The management of trigger thumb in children. J Hand Surg Am 1991; 16 (05) 944-947
- 11 Hueston JT, Wilson WF. The aetiology of trigger finger explained on the basis of intratendinous architecture. Hand 1972; 4 (03) 257-260
- 12 Fahey JJ, Bollinger JA. Trigger-finger in adults and children. J Bone Joint Surg Am 1954; 36-A (06) 1200-1218
- 13 Kuo M, Rayan GM. Complete annular and partial oblique pulley release for pediatric locked trigger thumb. Hand (N Y) 2010; 5 (04) 408-414
- 14 Verma M, Craig CL, DiPietro MA. et al. Serial ultrasound evaluation of pediatric trigger thumb. J Pediatr Orthop 2013; 33 (03) 309-313
- 15 Kim J, Gong HS, Seok HS, Choi YH, Oh S, Baek GH. Quantitative measurements of the cross-sectional configuration of the flexor pollicis longus tendon using ultrasonography in patients with pediatric trigger thumb. J Hand Surg Am 2018; 43 (03) 284.e1-284.e7
- 16 Khoshhal KI, Jarvis JG, Uhthoff HK. Congenital trigger thumb in children: electron microscopy and immunohistochemical analysis of the first annular pulley. J Pediatr Orthop B 2012; 21 (04) 295-299
- 17 Kozin S, Pederson W, Wolfe S, Cohen M, Hotchkiss R. Green's Operative Hand Surgery. Seventh Edition. Philadelphia, PA: Elsevier; 2017
- 18 Dinham JM, Meggitt BF. Trigger thumbs in children. A review of the natural history and indications for treatment in 105 patients. J Bone Joint Surg Br 1974; 56 (01) 153-155
- 19 Baek GH, Kim JH, Chung MS, Kang SB, Lee YH, Gong HS. The natural history of pediatric trigger thumb. J Bone Joint Surg Am 2008; 90 (05) 980-985
- 20 Baek GH, Lee HJ. The natural history of pediatric trigger thumb: a study with a minimum of five years follow-up. Clin Orthop Surg 2011; 3 (02) 157-159
- 21 Hutchinson DT, Rane AA, Montanez A. The natural history of pediatric trigger thumb in the United States. J Hand Surg Am 2021; 46 (05) 424.e1-424.e7
- 22 Dittmer AJ, Grothaus O, Muchow R, Riley S. Pulling the trigger: Recommendations for surgical care of the pediatric trigger thumb. J Pediatr Orthop 2020; 40 (06) 300-303
- 23 Marek DJ, Fitoussi F, Bohn DC, Van Heest AE. Surgical release of the pediatric trigger thumb. J Hand Surg Am 2011; 36 (04) 647-652.e2
- 24 Ray SB, Gibbs CM, Fowler JR. Trigger thumb in pediatric patients: a 20-year update. Hand (N Y) 2022; (e-pub ahead of print)
- 25 Colen DL, Lin IC, Levin LS, Chang B. Radial longitudinal deficiency: recent developments, controversies, and an evidence-based guide to treatment. J Hand Surg Am 2017; 42 (07) 546-563
- 26 Nguyen JL, Ho CA. Congenital disorders of the pediatric thumb. JBJS Rev 2022; 10 (03) 21-147
- 27 Webb ML, Rosen H, Taghinia A. et al. Incidence of Fanconi anemia in children with congenital thumb anomalies referred for diepoxybutane testing. J Hand Surg Am 2011; 36 (06) 1052-1057
- 28 Soldado F, Zlotolow DA, Kozin SH. Thumb hypoplasia. J Hand Surg Am 2013; 38 (07) 1435-1444
- 29 Forman M, Canizares MF, Bohn D. et al; CoULD Study Group. Association of radial longitudinal deficiency and thumb hypoplasia: an update using the CoULD Registry. J Bone Joint Surg Am 2020; 102 (20) 1815-1822
- 30 Manske PR, McCarroll Jr HR. Reconstruction of the congenitally deficient thumb. Hand Clin 1992; 8 (01) 177-196
- 31 Ishida O, Ikuta Y, Sunagawa T, Ochi M. Abductor digiti minimi musculocutaneous island flap as an opposition transfer: a case report. J Hand Surg Am 2003; 28 (01) 130-132
- 32 Kozin SH, Ezaki M. Flexor digitorum superficialis opponensplasty with ulnar collateral ligament reconstruction for thumb deficiency. Tech Hand Up Extrem Surg 2010; 14 (01) 46-50
- 33 Kawabata H, Tamura D, Goldfarb CA. Treatment of blauth type IIIB thumb hypoplasia using a nonvascularized toe phalanx. J Hand Surg Am 2021; 46 (01) 68.e1-68.e7
- 34 Liu B, Chen S, Chow ECS, Li P, Liu K, Yang C. Type IIIB and IV hypoplastic thumb reconstruction with non-vascularized fourth metatarsal. J Hand Surg Eur Vol 2020; 45 (07) 722-728
- 35 Manske PR. Index pollicization for thumb deficiency. Tech Hand Up Extrem Surg 2010; 14 (01) 22-32
- 36 Carter P, Ezaki M. Pollicization: making a thumb—for the surgeon. Texas Scottish Rite Hospital for Children 2006 Accessed August 5, 2023. https://vimeopro.com/tsrh/pollicization-surgeon
- 37 Upton J, Taghinia AH. Abductor digiti minimi myocutaneous flap for opponensplasty in congenital hypoplastic thumbs. Plast Reconstr Surg 2008; 122 (06) 1807-1811
- 38 Vuillermin C, Butler L, Lake A, Ezaki M, Oishi S. Flexor digitorum superficialis opposition transfer for augmenting function in types II and IIIA thumb hypoplasia. J Hand Surg Am 2016; 41 (02) 244-249 , quiz 250
- 39 de Kraker M, Selles RW, Zuidam JM, Molenaar HM, Stam HJ, Hovius SE. Outcome of flexor digitorum superficialis opponensplasty for Type II and IIIA thumb hypoplasia. J Hand Surg Eur Vol 2016; 41 (03) 258-264
- 40 Goldfarb CA, Monroe E, Steffen J, Manske PR. Incidence and treatment of complications, suboptimal outcomes, and functional deficiencies after pollicization. J Hand Surg Am 2009; 34 (07) 1291-1297
- 41 Clark DI, Chell J, Davis TRC. Pollicisation of the index finger. A 27-year follow-up study. J Bone Joint Surg Br 1998; 80 (04) 631-635
- 42 Baek G. The Pediatric Upper Extremity. 1st edition. (Abzug J, Kozin S, Zlotolow D, eds.). New York, NY: Springer; 2015
- 43 Watt AJ, Chung KC. Duplication. Hand Clin 2009; 25 (02) 215-227
- 44 Wassel HD. The results of surgery for polydactyly of the thumb. A review. Clin Orthop Relat Res 1969; 64 (64) 175-193
- 45 Zuidam JM, Selles RW, Ananta M, Runia J, Hovius SER. A classification system of radial polydactyly: inclusion of triphalangeal thumb and triplication. J Hand Surg Am 2008; 33 (03) 373-377
- 46 Miura T. Triphalangeal thumb. Plast Reconstr Surg 1976; 58 (05) 587-594
- 47 Wood VE. Polydactyly and the triphalangeal thumb. J Hand Surg Am 1978; 3 (05) 436-444
- 48 Bauer AS, Netto AP, James MA. Thumb hypoplasia occurring in patients with preaxial polydactyly. J Hand Surg Am 2020; 45 (03) 182-188
- 49 Manske PR. Treatment of duplicated thumb using a ligamentous/periosteal flap. J Hand Surg Am 1989; 14 (04) 728-733
- 50 Tonkin MA, Bulstrode NW. The Bilhaut-Cloquet procedure for Wassel types III, IV and VII thumb duplication. J Hand Surg Eur Vol 2007; 32 (06) 684-693
- 51 Baek GH, Gong HS, Chung MS, Oh JH, Lee YH, Lee SK. Modified Bilhaut-Cloquet procedure for Wassel type-II and III polydactyly of the thumb. J Bone Joint Surg Am 2007; 89 (03) 534-541
- 52 Bell B, Butler L, Mills J, Stutz C, Ezaki M, Oishi S. “On-top plasty” for radial polydactyly reconstruction. J Hand Surg Am 2017; 42 (09) 753.e1-753.e6
- 53 Gholson JJ, Shah AS, Buckwalter IV JA, Buckwalter V JA. Long-term clinical and radiographic follow-up of preaxial polydactyly reconstruction. J Hand Surg Am 2019; 44 (03) 244.e1-244.e6
- 54 Dijkman RR, van Nieuwenhoven CA, Selles RW, Hovius SE. Comparison of functional outcome scores in radial polydactyly. J Bone Joint Surg Am 2014; 96 (06) 463-470
- 55 Bickham RS, Waljee JF, Chung KC, Adkinson JM. Postoperative patient- and parent-reported outcomes for children with congenital hand differences: a systematic review. Plast Reconstr Surg 2017; 139 (06) 1422-1429
- 56 Goldfarb CA, Patterson JM, Maender A, Manske PR. Thumb size and appearance following reconstruction of radial polydactyly. J Hand Surg Am 2008; 33 (08) 1348-1353
- 57 Hong SW, Kim J, Oh S, Lee MH, Baek GH. When is primary metacarpal corrective osteotomy recommended in patients with Flatt type IV radial polydactyly?. Plast Reconstr Surg 2021; 147 (02) 399-408
- 58 Luangjarmekorn P, Virojanawat N, Pongpacharaamphon P, Kitidumrongsook P. Preoperative angulation as a predictor for operations of Wassel type IV polydactyly. J Pediatr Orthop B 2021; 30 (06) 605-610
- 59 Ekblom AG, Laurell T, Arner M. Epidemiology of congenital upper limb anomalies in 562 children born in 1997 to 2007: a total population study from Stockholm, Sweden. J Hand Surg Am 2010; 35 (11) 1742-1754
- 60 Watson BT, Hennrikus WL. Postaxial type-B polydactyly. Prevalence and treatment. J Bone Joint Surg Am 1997; 79 (01) 65-68
- 61 Rayan GM, Frey B. Ulnar polydactyly. Plast Reconstr Surg 2001; 107 (06) 1449-1454 , discussion 1455–1457
- 62 Goebel GJ, Dawson S, Loewenstein SN, Adkinson JM. Long-term outcomes after treatment for type B ulnar polydactyly. J Pediatr Orthop 2022; 42 (05) e466-e469
- 63 Singer G, Thein S, Kraus T, Petnehazy T, Eberl R, Schmidt B. Ulnar polydactyly - an analysis of appearance and postoperative outcome. J Pediatr Surg 2014; 49 (03) 474-476
- 64 Manske M, Goldfarb C. The Pediatric Upper Extremity. 1st edition. (Abzug J, Kozin S, Zlotolow D, eds.). New York, NY: Springer; 2015
- 65 Dao KD, Shin AY, Billings A, Oberg KC, Wood VE. Surgical treatment of congenital syndactyly of the hand. J Am Acad Orthop Surg 2004; 12 (01) 39-48
- 66 Syndactyly KS. J Am Soc Surg Hand 2001; 1 (01) 1-13
- 67 Hutchinson DT, Frenzen SW. Digital syndactyly release. Tech Hand Up Extrem Surg 2010; 14 (01) 33-37
- 68 Vekris MD, Lykissas MG, Soucacos PN, Korompilias AV, Beris AE. Congenital syndactyly: outcome of surgical treatment in 131 webs. Tech Hand Up Extrem Surg 2010; 14 (01) 2-7
- 69 Hsu VM, Smartt Jr JM, Chang B. The modified V-Y dorsal metacarpal flap for repair of syndactyly without skin graft. Plast Reconstr Surg 2010; 125 (01) 225-232
- 70 Sherif MM. V-Y dorsal metacarpal flap: a new technique for the correction of syndactyly without skin graft. Plast Reconstr Surg 1998; 101 (07) 1861-1866
- 71 Miyamoto J, Nagasao T, Miyamoto S. Biomechanical analysis of surgical correction of syndactyly. Plast Reconstr Surg 2010; 125 (03) 963-968
- 72 Wall LB, Velicki K, Roberts S, Goldfarb CA. Outcomes of pediatric syndactyly repair using synthetic dermal substitute. J Hand Surg Am 2020; 45 (08) 773.e1-773.e6
- 73 Edwards KE, Gannon NP, Novotny SA, Van Heest AE, Bohn DC. Complications in the 2-year postoperative period following pediatric syndactyly release [published online ahead of print. J Hand Surg Am 2022;2022(02):
- 74 Lumenta DB, Kitzinger HB, Beck H, Frey M. Long-term outcomes of web creep, scar quality, and function after simple syndactyly surgical treatment. J Hand Surg Am 2010; 35 (08) 1323-1329
- 75 Goldfarb CA, Steffen JA, Stutz CM. Complex syndactyly: aesthetic and objective outcomes. J Hand Surg Am 2012; 37 (10) 2068-2073
- 76 Garza A, Cordero JF, Mulinare J, Garza A. Epidemiology of the early amnion rupture spectrum of defects. Am J Dis Child 1988; 142 (05) 541-544
- 77 Lindenau KF, Evers G. [An unusual case of bilateral and symmetric amniogenic indentations]. Padiatr Grenzgeb 1974; 13 (01) 61-65
- 78 Goldfarb CA, Sathienkijkanchai A, Robin NH. Amniotic constriction band: a multidisciplinary assessment of etiology and clinical presentation. J Bone Joint Surg Am 2009; 91 (Suppl. 04) 68-75
- 79 Foulkes GD, Reinker K. Congenital constriction band syndrome: a seventy-year experience. J Pediatr Orthop 1994; 14 (02) 242-248
- 80 Streeter GL. Focal deficiencies in fetal tissues and their relation to intrauterine amputation. Contrib Embryol 1930;22(126):
- 81 Bamforth JS. Amniotic band sequence: Streeter's hypothesis reexamined. Am J Med Genet 1992; 44 (03) 280-287
- 82 Torpin R. Amniochorionic mesoblastic fibrous strings and amnionic bands. Associated constricting fetal malformations or fetal death. Am J Obstet Gynecol 1965; 91 (01) 65-75
- 83 Van Allen MI. Fetal vascular disruptions: mechanisms and some resulting birth defects. Pediatr Ann 1981; 10 (06) 219-233
- 84 Satake H, Ogino T, Iba K, Watanabe T, Eto J. Metacarpal hypoplasia associated with congenital constriction band syndrome. J Hand Surg Am 2012; 37 (04) 760-763
- 85 Patterson TJS. Congenital ring-constrictions. Br J Plast Surg 1961; 14 (C): 1-31
- 86 Moran SL, Jensen M, Bravo C. Amniotic band syndrome of the upper extremity: diagnosis and management. J Am Acad Orthop Surg 2007; 15 (07) 397-407
- 87 Gogola G. The Pediatric Upper Extremity. 1st edition. (Abzug J, Kozin S, Zlotolow D, eds.). New York, NY: Springer; 2015
- 88 Upton J, Tan C. Correction of constriction rings. J Hand Surg Am 1991; 16 (05) 947-953
- 89 Choulakian MY, Bruce Williams H. Surgical correction of band syndrome in Z-plasty with congenital constriction children: replacing direct closure. Can J Plast Surg 2008; 16 (04) 221-223
- 90 Habenicht R, Hülsemann W, Lohmeyer JA, Mann M. Ten-year experience with one-step correction of constriction rings by complete circular resection and linear circumferential skin closure. J Plast Reconstr Aesthet Surg 2013; 66 (08) 1117-1122
- 91 Mutaf M, Sunay M. A new technique for correction of congenital constriction rings. Ann Plast Surg 2006; 57 (06) 646-652
- 92 Jiang Y, Mao H, Yang X. et al. Single-stage resection of Type II constriction rings in limbs on the basis of histologic and magnetic resonance imaging observations: A retrospective study of 21 consecutive patients. Plast Reconstr Surg 2016; 138 (01) 164-173
- 93 Inglesby DC, Janssen PL, Graziano FD, Gopman JM, Rutland JW, Taub PJ. Amniotic band syndrome: Head-to-toe manifestations and clinical management guidelines. Plast Reconstr Surg 2023; 152 (02) 338e-346e
- 94 Jones NF, Smith AD, Hedrick MH. Congenital constriction band syndrome causing ulnar nerve palsy: early diagnosis and surgical release with long-term follow-up. J Hand Surg Am 2001; 26 (03) 467-473
- 95 Meyer H, Cummins H. Severe maternal trauma in early pregnancy: congenital amputations in the infant at term. Am J Obstet Gynecol 1941; 42 (01) 150-153
- 96 Weeks PM. Radial, median, and ulnar nerve dysfunction associated with a congenital constricting band of the arm. Plast Reconstr Surg 1982; 69 (02) 333-336
- 97 Tada K, Yonenobu K, Swanson AB. Congenital constriction band syndrome. J Pediatr Orthop 1984; 4 (06) 726-730
- 98 Richardson GA, Humphrey MS. Congenital compression of the radial nerve. J Hand Surg Am 1989; 14 (05) 901-903
- 99 Uchida Y, Sugioka Y. Peripheral nerve palsy associated with congenital constriction band syndrome. J Hand Surg [Br] 1991; 16 (01) 109-112