Hand Problems

One baby in every 500 birth has hand or upper extremity birth problems. The most frequent birth hand problems are syndactilia (adherent fingers) and polydactilia (existence of more than normal number of fingers).

An important ratio of these problems may be treated under surgical methods providing normal or very close to normal view and functions.

The hand and arm starts to grow and take shape with the second month in pregnancy. However sometimes pauses or failures may happen due to mechanical (diseases faced in pregnancy, used medication etc.), genetic (blood marriages increase the risks) or multi-factorial causes. The upper extremity problems may be observed alone or may be together with other problems in other parts of the body. Such a situation causes psychological problems for the family just after the birth and by 4-5 years old for the child (the starting age of socialization). Also, since the children employ a substantial adaptation capability, the child will start to use its hand at its degenerated ability. This means in case the operation is performed late, the child will have difficulties in adapting itself to the new functions and shape. All the operations have an age limitation and indeed an age to provide the maximum benefits.

Syndactilia (Adherent finger): Syndactilia is the case where two-three fingers can not perform the required separation and seem as conjoint in the same skin cover. It is seen once in each 2000 births. This adherent view may be in the starting point of the fingers, at the finger tips and at other points. These fingers may have common single veins. It is most frequent for the 2nd and 3rd fingers. The bones also shall be checked with radiography.

The lengths of two adjacent fingers may by no means be same in human hand. Thus, operation is a must for to prevent the stop of the lengthening and development of the fingers. If syndactilia exists between the thumb and 2nd finger the operation shall be performed when the baby is 4-6 months; if it exists in other fingers than it shall be performed when the baby is about 1 year.

In case three fingers are adhered, first a finger shall be separated and then a second operation is performed for the separation of the leaving two. The inguinal skin patch is used for to fill the skin missing between the fingers during the operation. The hand stays in plaster separator for three weeks.

Polydactilia (More than normal number of fingers): It is the case when more than 5 fingers exist in one hand. This is the most frequent hand anomaly. It has many types. The fingers may seem like divided to two or there may be an extra finger. Extra finger may be in shape of a mole budding from a finger or may have its own bone within. The operation should be performed between 6 months to 2 years. The hand shall be fixed with wire for 3 weeks in case a problem related to soft tissue exists. For the bone problems the hand shall be in plaster separator for 6 weeks.

Amniotic band syndrome: It may be seen in fingers, arms or legs. The arm or finger seems like wrapped and strangled with a thin rope. There is an oedema towards the finger tip. If circulation problems exist in the finger tip part from such band, urgent operation is required. In other situations the operation shall be performed within a couple of weeks by the birth. Otherwise the finger development and nourishment may be adversely effected. Cleft hand:The middle part of the hand seems like cleft due to the insufficient development of that part. The hand is like a V letter. The third finger may be absent. The other fingers may also be underdeveloped. It is seen once at every 90,000 birth. If syndactilia exists then it should be corrected first. Afterwards the operations to bring the fingers towards each other, and to close the cleft, shall be performed.

Club hand: Two bones are present in the forearm. These are named as radius and ulna. In case these bones not develop sufficiently or do not exist, the forearm or hand will tend to lean towards respective direction. Absentia of the same line fingers, muscles, nerves or anomaly of the same may be seen together with such leaning. It is seen once at every 30.000 to 100.000 births. Generally it is seen together with other anomalies of the body such as cardiovascular diseases, blood diseases, digestion system failures or kidney problems.

In the first place, manipulations and applications to correct the position of the arm are performed after the birth. The hand is taken to the middle axis when the child reaches to third year, provided its health situation is all right for the operation. Spastic arm-hand The brains of the spastic children send wrong signals and spasms with spontaneous moves happen in the hands and arms. The child then experiences great difficulties in holding any object or performing its own needs. It may not continue its daily life.

The toxin applications are very successful for these children. In the first place, if over constricted muscle groups do not permit any motion, toxin application may be performed. Then the child has eases in dressing, combing, holding the objects and etc. motions.

If the child cannot bend its finger then tendon transfer may be performed to its palm; and to its back if can not raise its hand. By this way such motions are made probable.