Finger deformities occur relatively rarely. They are either inherited or occur as spontaneous mutations, which are then also passed on to the offspring. In addition, finger abnormalities can be the result of accidents. They are usually not very noticeable externally, such as camptodactyly, unless they are severe cases of deformity.
What is camptodactyly?
Camptodactyly is the excessive flexion of the middle joint of a finger. The deformity was first described in 1846. In finger contracture, only the soft tissue structures are shortened. Bony joint parts are affected only in some syndromal camptodactyls. The middle joint of the finger is more or less bent upward and cannot be actively extended. However, a stronger flexion is possible without restrictions. The other phalanges of the finger are bent toward the palm because of overbending. Thus, camptodactyly resembles the clinical picture of the hammer finger. It usually occurs sporadically and is bilateral and symmetrical on only one finger at a time. In most cases, the little finger is excessively curved. Occasionally, camptodactyly also 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 hardly feel restricted. Only when the finger bends at an even greater angle is the malposition perceived as disturbing. In most cases, it does not manifest itself until 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 autosomal-dominantly. Recently, physicians suspect that among them there are also cases of autosomal recessive inheritance. Genetically caused finger anomaly is inherited autosomal-dominantly. In patients with congenital camptodactyly, the malformation occurs on both sides and affects the same fingers in each case (symmetrical malposition). In some cases, it is associated with other malformations such as polydactyly (many-fingeredness) and hammertoes. Camptodactyly also frequently occurs as a feature of a genetic malformation syndrome. This is the case, for example, in trisomy 21 (Down syndrome), Zellweger syndrome, Juberg-Marsidi syndrome, and Marfan syndrome.
Symptoms, signs, and symptoms
Camptodactyly occurs in an early and a late form of expression. The first signs of the early form appear within the first 12 months of the child’s life: It shows bilateral and asymmetric 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 about the age of 30 of the patient. In some patients affected by finger contracture, joint pads can be seen over the dorsal portions of the joints (“knuckle-pads2). In addition, nodular changes can be seen under the skin of the volar side of the affected joint. The usual transverse skin folds are also frequently absent there. In patients with autosomal-dominant inherited camptodactyly, an increased excretion of taurine via the urinary tract is also observed. Since the rare finger anomaly is painless and only in a few cases is associated with a functional limitation, the patient does not feel handicapped by it. The visit to the orthopedist usually occurs only when the affected person has a visually conspicuous finger contracture or the severely pronounced deformity makes him very disabled.
Diagnosis and course of the disease
The specialist can use imaging techniques (X-ray) to assess whether the deformity is mild or rather severe. The x-ray shows how much the head of the finger middle phalanx is tilted on the flexion side. Since camptodactyly is a complex malformation, he usually advises surgical intervention only if the mobility of the finger is significantly limited. Over the course of a lifetime, uncorrected camptodactyly can lead to an increase in the angle of flexion.
Complications
Camptodactyly usually results in various deformities of the fingers.These malpositions can significantly restrict the patient’s everyday life and reduce the quality of life. It may no longer be possible to grasp and lift objects. Camptodactyly can also cause severe pain. The development of the affected child may also be restricted by this disease. Due to this disability, it is not uncommon for children to experience depression and other psychological upsets when they are bullied or teased because of it. However, camptodactyly does not necessarily lead to limitations or disabilities in every case. If the patient does not complain of symptoms, there is no need for treatment. Life expectancy is not usually limited or reduced by camptodactyly. Camptodactyly can be corrected with the help of therapies or by surgical intervention. There are no particular complications or discomforts. After the operation, the affected person can use his entire hand normally again. If there is no treatment, there is no positive progression of the disease.
When should you go to the doctor?
Parents who notice malformations of the fingers in their children should consult a doctor. Camptodactyly usually becomes apparent within the first ten to twelve months of a child’s life. If treatment is started during this period, there is a good chance of a symptom-free life. A visit to the doctor should also be made in the event of unusual symptoms, for example if the child cannot grasp sensibly or complains of pain in the hand. If a malformation can be detected externally, the pediatrician should be consulted immediately. The child then requires conservative treatment via splinting and physiotherapy. Close monitoring by the physician is necessary during treatment. If the measures do not show any effect, surgery should be discussed with the doctor at an early stage. Even after surgery, camptodactyly must be examined regularly. Parents should contact their pediatrician or family doctor or a sports medicine specialist directly if they have a specific suspicion of a deformity.
Therapy and diagnosis
In cases of only mildly pronounced camptodactyly – when the joint can be passively stretched – most specialists advise conservative therapy with splinting and stretching exercises (physiotherapy). The custom-made splint gently stretches and extends the affected finger joint. Treatment is continued until there is a marked improvement in the condition. If the therapy is unsuccessful, surgery is usually performed. However, since very few surgical interventions show the desired result – the finger is only freely movable again in exceptional cases – surgery is usually not recommended. As a rule of thumb, surgery is only recommended if the extension deficit is greater than 30 degrees. The operation is a moderately severe procedure that is performed under general anesthesia. It lasts 45 to 90 minutes without anesthesia. The hand surgeon breaks the affected joint and wires it. If necessary, the deformity of the tendons or ligaments is corrected. The patient is hospitalized for about two days. About ten days later, another operation is performed, during which the wire is removed. However, this is only a minor operation. The wound heals with barely visible scarring because the surgical area is very small.
Outlook and prognosis
In most cases, regular stretching and extension of the affected finger joint is sufficient to achieve both short- and long-term improvement. The more intensively these exercises are performed, the lower the risk that surgical intervention will be required. If there is no improvement despite all efforts, surgery may possibly become necessary. In this case, the affected person can ensure a faster and complication-free recovery through good pre- and post-operative care. This includes abstaining from stimulants such as tobacco and alcohol, as well as consulting with the doctor about over-the-counter medications. These could, even if they are seemingly harmless homeopathics, lead to serious interactions with anesthetics and jeopardize the success of the treatment.Postoperatively, the wound must first be spared and carefully cared for before lighter exercises for better mobility can be started again after consultation with the doctor. If further illnesses or the patient’s constitution prevent surgery, treatment with splints or prostheses for immobilization in an extended position may also be advisable, which is also supported with targeted stretching and extension exercises. Ultimately, it depends not only on the cause and extent of the finger malposition, but also the doctor’s prognosis, which measures the patient himself can contribute to improvement.
Prevention
Prevention is not possible for camptodactyly because it is genetic or occurs as a result of an accident.
Aftercare
As a rule, the measures of aftercare in camptodactyly strongly depend on the exact manifestation and also the cause of the disease, so that no general prediction can be made in this regard. However, since this disease is hereditary, it cannot be completely cured. If the patient wishes to have children, genetic testing and counseling may be useful to prevent the recurrence of camptodactyly in the descendants. Self-cure does not occur with this disease, so the early diagnosis of the disease is in the foreground. The symptoms of the disease are usually alleviated by the measures of physiotherapy or physiotherapy. In many cases, some of the exercises can be performed in the patient’s own home, thus accelerating the treatment. Likewise, surgery can also be performed, after which the affected person should in any case rest and take care of his or her body. Physical or stressful activities should be avoided in order not to put unnecessary strain on the body. Further aftercare measures are often not necessary in case of camptodactyly. There is also no reduced life expectancy of the patient due to the disease.
What you can do yourself
In most cases of camptodactyly, conservative treatment using splinting and stretching exercises is possible. First and foremost, the doctor will suggest regular stretching and stretching of the affected finger joint to the patient. This is usually sufficient to achieve long-term improvement of the condition. If the finger deformity does not improve, surgery is required, the success of which the patient can support through good pre- and post-operative care. The usual measures apply in preparation for the operation, i.e. abstaining from stimulants and checking regularly taken medicines to avoid interactions with the anesthetics used. After the operation, the affected finger must initially 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 surgery is not possible, for example because the patient suffers from a chronic bone disease, camptodactyly must be treated with a suitable aid. For example, prostheses that increase the range of motion of the finger can be used. The exact measure that makes sense depends on the cause and severity of the deformity, but also on the doctor’s prognosis.
