Finger malpositions are relatively rare. They are either inherited or occur as spontaneous mutations, which are then also passed on to offspring. In addition, finger abnormalities can result from accidents. Externally, they are usually not very conspicuous, such as camptodactyly, unless severe malpositions are involved.
What is camptodactyly?
If the camptodactyly is only slightly pronounced – if the joint can be stretched passively – most specialists recommend conservative therapy with splints and stretching exercises (physiotherapy). See AbbreviationFinder for abbreviations related to Camptodactyly.
Camptodactyly is excessive bending of the middle joint of a finger. The misalignment was first described in 1846. In finger contractures, only the soft tissue structures are shortened. Bony parts of the joint are only affected in some syndromic camptodactylies. The middle joint of the finger is more or less bent upwards and cannot be actively stretched.
However, greater diffraction is possible without restrictions. The other phalanxes are angled toward the palm because of the over-flexion. Camptodactyly thus resembles the clinical picture of malleus finger. It usually occurs sporadically and occurs on both sides and symmetrically on only one finger. The little finger is usually excessively curved. Occasionally, camptodactyly occurs in the ring finger and – even more rarely – in the middle finger.
The malformation is extremely rare (probability 1:100,000). Since it is not associated with pain, those affected often feel hardly restricted. It is only when the finger bends at an even greater angle that the misalignment is perceived as disturbing. In most cases, it only manifests itself between the ages of 10 and 14.
Causes
The exact causes of camptodactyly are still unknown. The sporadic form is the result of an accident, a burn (caused by scarring) or is considered a new mutation. New mutations are always inherited in an autosomal dominant manner. Doctors have recently suspected that there are also cases of autosomal recessive inheritance. The genetically caused finger anomaly is inherited in an autosomal dominant manner. In patients with congenital camptodactyly, the deformity occurs on both sides and affects the same fingers (symmetrical deformity).
In some cases, it is associated with other malformations such as polydactyly (many fingers) and hammer toe. Camptodactyly is also a common feature of a genetic malformation syndrome. This is the case, for example, with trisomy 21 (Down syndrome), Zellweger syndrome, Juberg-Marsidi syndrome and Marfan syndrome.
Symptoms, Signs & Ailments
Camptodactyly occurs in an early and a late form. The first signs of the early form appear within the first 12 months of the child’s life: It shows a bilateral and asymmetrical camptodactyly. In the late form, which becomes manifest from the age of 10 and progresses slowly, the degree of flexion of the affected finger increases continuously until the patient is around 30 years old.
In some patients affected by finger contractures, knuckle-pads can be observed over the dorsal portions of the joints (“knuckle-pads2”). In addition, nodular changes under the skin of the volar side of the affected joint can be detected. The usual transversal skin folds are also often missing there. In patients with autosomal dominant inherited camptodactyly, there is also an increased excretion of taurine via the urinary tract.
Since the rare finger anomaly is painless and only in a few cases is it associated with a functional restriction, the patient does not feel handicapped by it. The trip to the orthopedist usually only occurs when the person concerned has a visually conspicuous finger contracture or the pronounced malformation is very difficult for him.
Diagnosis & course of disease
The specialist doctor can use imaging methods (X- ray) to assess whether the malformation is milder or more severe. The X-ray shows how much the head of the middle phalanx is tilted on the flexor side. Since camptodactyly is a complex malformation, he usually only recommends surgery if the mobility of the finger is significantly restricted. Over the course of life, uncorrected camptodactyly can lead to an increase in flexion angle.
Complications
Camptodactyly usually leads to various misalignments of the fingers. These malpositions can significantly restrict the patient’s everyday life and reduce the quality of life. As a result, it may no longer be possible to grasp and lift objects. Camptodactyly can also cause severe pain.
The development of the sick child can also be limited by this disease. This disability often leads to depression and other mental disorders, especially in children, when they are bullied or teased because of it. However, camptodactyly does not always lead to limitations or disabilities.
If the patient does not complain of any symptoms, no treatment needs to be carried out. Life expectancy is usually not restricted or reduced by camptodactyly. Camptodactyly can be corrected with the help of therapy or by surgery.
There are no particular complications or discomfort. After the procedure, the affected person can use their entire hand normally again. If there is no treatment, there will be no positive course of the disease.
When should you go to the doctor?
Parents who notice deformities in their children’s fingers should consult a doctor. Camptodactyly usually appears within the first ten to twelve months of the child’s life. If treatment is started during this period, there is a good chance of a symptom-free life. You should also see a doctor if you have any unusual symptoms, for example if the child cannot grasp properly or complains of hand pain. If a malformation can be recognized externally, the pediatrician should be consulted immediately.
The child then requires conservative treatment via splinting and physiotherapy. Close monitoring by the doctor is necessary during treatment. If the measures have no effect, you should talk to your doctor about an operation at an early stage. Even after surgery, camptodactyly needs to be checked regularly. Parents should contact their pediatrician or general practitioner or a sports medicine doctor directly if they suspect a deformity.
Therapy & Diagnosis
If the camptodactyly is only slightly pronounced – if the joint can be stretched passively – most specialists recommend conservative therapy with splints and stretching exercises (physiotherapy). The individually manufactured splint gently stretches and stretches the affected finger joint. Treatment is continued until there is a significant improvement in the condition.
If the therapy is unsuccessful, an operation is usually performed. However, since very few surgical interventions show the desired result – the finger can only be moved freely again in exceptional cases – an operation is usually not recommended. As a rule of thumb, surgery is only recommended if the stretch deficit is greater than 30 degrees. The operation is a moderately difficult procedure that is performed under general anesthesia. It takes 45 to 90 minutes without anesthesia.
The hand surgeon breaks the affected joint and rewires it. If necessary, the deformity of the tendons or ligaments is corrected. The patient will be hospitalized for approximately two days. Another operation takes place about ten days later, during which the wire is removed. However, this is only a minor intervention. The wound heals with barely visible scarring because the surgical area is very small.
Outlook & Forecast
Regular stretching and straightening of the affected finger joint is usually sufficient to achieve both short and long-term improvement. The more intensively these exercises are carried out, the lower the risk that an operative measure has to be taken.
If, despite all efforts, there is no improvement, an operation may be necessary. Here, the affected person can ensure faster and less complication-free healing through good pre- and post-operative care. This includes abstaining from stimulants such as tobacco and alcohol, as well as consulting the doctor in relation to over-the-counter medicines that have been taken. Even if they are apparently harmless homeopathic remedies, these could lead to serious interactions with anesthetics and endanger the success of the treatment. Postoperatively, the wound must first be spared and carefully cared for before, after consultation with the doctor, lighter exercises to improve mobility can be resumed.
If other illnesses or the patient’s constitution prevent an operation, treatment with splints or prostheses to immobilize the patient in a stretched position may also be advisable, which is also supported with targeted stretching and stretching exercises. Ultimately, it depends not only on the cause and extent of the finger misalignment, but also on the doctor’s prognosis as to which measures the patient can contribute to the improvement.
Prevention
Prevention is not possible with camptodactyly because it is genetic or occurs as a result of an accident.
Aftercare
As a rule, the follow-up measures for camptodactyly depend heavily on the exact severity and cause of the disease, so that no general prediction can be made. However, since this disease is a hereditary disease, it cannot be completely cured. If you wish to have children, genetic testing and counseling can be useful to prevent camptodactyly from reoccurring in the offspring.
Self-healing does not occur with this disease, so that early diagnosis of the disease is paramount. The symptoms of the disease are usually alleviated by the measures of physiotherapy or physiotherapy. In many cases, some of the exercises can be done at home, speeding up treatment.
A surgical procedure can also be carried out, after which the person concerned should definitely rest and protect their body. Physical or stressful activities should be avoided in order not to unnecessarily burden the body. Further follow-up measures are often not necessary for camptodactyly. The disease also does not lead to a reduced life expectancy for the patient.
You can do that yourself
In the case of camptodactyly, conservative treatment using a splint and stretching exercises is usually possible. The doctor will primarily suggest that the patient regularly straighten and stretch the affected finger joint. This is usually sufficient to achieve a long-term improvement in the condition.
If the finger malposition does not improve, an operation is necessary, the success of which can be supported by the patient with good pre- and post-operative care. The usual measures apply in preparation for the procedure, i.e. abstaining from stimulants and checking regularly taken drugs in order to avoid interactions with the anesthetics used. After the procedure, the affected finger must first be rested. In the first few days, the wound should be carefully cared for so that no wound healing disorders or other complications occur.
If no surgical intervention is possible, for example because the patient suffers from a chronic bone disease, the camptodactyly must be treated using a suitable aid. Here, for example, prostheses come into question that expand the range of motion of the finger. Exactly which measure makes sense depends on the cause and severity of the deformity, but also on the doctor’s prognosis.
