What is Cleft Hand?
A cleft hand, also known as ectrodactyly or “split hand,” is a condition where the middle bones and tissues of the hand (index, middle, and ring fingers) are missing or underdeveloped. This usually results in a “V-shaped” gap or division in the hand, and the level of abnormality can vary. Usually, the finger bones (phalanges) are missing, but the bones in the palm of the hand (metacarpals) are present. This condition normally affects both hands.
There are two main types of cleft hands: “typical” and “atypical.” The “typical” type is usually caused by inheritance, affects both hands, and often takes form as a “V-shaped” gap. It may also happen together with deformities in the foot, known as “cleft foot.” On the other hand, “atypical” cleft hands affect the index, middle, and ring fingers, which may be missing, fused together, or underdeveloped. These hands often have more of a “U-shaped” gap than the “V-shape” found in typical cleft hands.
It’s worth noting that atypical cleft hands usually occur due to random genetic changes, rather than inheritance. As a result, they’re typically not associated with any syndromes or other deformities.
What Causes Cleft Hand?
Normal cleft hand deformities are usually caused by a certain trait that a person inherits. This trait affects the development of the central parts of the hand, which are different from the thumb and pinky finger. As a result, this change interferes with the growth of the middle fingers in both the hands and often the feet.
On the other hand, atypical cleft hands are caused by a random change or mutation that a person doesn’t inherit. These are also not linked with any syndromal conditions.
Risk Factors and Frequency for Cleft Hand
Typical cleft hands, a type of hand deformity, occur in about 1 out of every 90,000 births and 1 out of every 120,000 individuals in the population. Atypical cleft hands, another variant of the deformity, are less common and can be seen in 1 out of every 150,000 births and 1 out of every 200,000 people in the population. It’s also noted that cleft hands affect both hands (referred to as bilateral) in 56% of the patients, while it affects only one hand (referred to as unilateral) in 44% of the cases.
- Typical cleft hands occur in 1 out of every 90,000 births and 1 out of every 120,000 individuals in the population.
- Atypical cleft hands are seen in 1 out of every 150,000 births and 1 out of every 200,000 people in the population.
- Bilateral cleft hands, where both hands are affected, are seen in 56% of patients.
- Unilateral cleft hands, where only one hand is affected, are seen in 44% of cases.
Signs and Symptoms of Cleft Hand
Cleft hands are a type of birth defect, and these major deformities can be seen right when a baby is born. It’s crucial to fully understand the exact shape of the deformity to provide the right treatment. If the family has a history of similar hand deformities, this can suggest a typical cleft hand deformity. However, if there’s no family history, it could be due to a random genetic change.
Doctors should closely examine the blood vessels in the hand to make sure the hand is getting enough blood. This is because some types of cleft hands are linked with Poland syndrome, which is caused by underdevelopment of the blood vessels. Also, checking the area of the chest on the same side as the affected hand can help determine the best treatment approach. If the chest muscles are absent or underdeveloped, this could be another sign of poor blood flow in the artery under the collarbone, and it might be necessary to do surgery in stages because of the weak blood vessels.
Testing for Cleft Hand
X-ray images play an important role in diagnosing and planning the treatment of deformities of the hand, often referred to as “cleft hand”. Before any surgery is carried out, doctors need to examine these images to understand the patient’s specific deformity. Important things for doctors to look for include whether or not there are any missing bones in the middle of the hand, if fingers are unnaturally short or fused together, and especially whether the blood supply to the hand is normal.
If the person’s cleft hand condition is due to weak blood supply, a condition known as Poland syndrome, then a series of planned surgeries will be needed to correct their hand.
Treatment Options for Cleft Hand
Surgery for a cleft foot is typically straightforward, but surgery for a cleft hand can be more complex. The surgical approach used will depend largely on the patient’s unique hand structure. One common issue is a small gap between the thumb and index finger which can greatly impact hand functionality. The thumb might not be able to move as freely or provide the necessary support without this space.
Because of this, many surgeries aim to create a larger space between the thumb and index finger. This is often achieved by making an incision that starts at the cleft and runs around the index finger into the space. Frequently, a piece of tissue from the edge of the cleft is used to deepen this space. This creates a larger, more functional gap between the index finger and the thumb, improving overall hand use.
Every surgery is tailored to the individual patient’s condition. Procedures may involve adjusting soft tissues, transferring tissues, or surgically reshaping the bones in the hand to improve alignment and function.
What else can Cleft Hand be?
Poland syndrome is a condition caused by underdevelopment of the subclavian artery, which affects the formation of the arm during growth. This condition results in one side of the chest appearing smaller, with fingers that are unusually short, fused together, or missing. When a hand with these peculiar traits is seen, doctors should consider the possibility of Poland syndrome and check for lackness of chest muscle. If the fingers, in such a scenario, need to be separated surgically, it should be done one finger at a time to prevent any blood circulation issues. This is because the underlying cause of the condition is a shortage of blood supply during development.
What to expect with Cleft Hand
A cleft hand – where the hand has a gap or split, often gives the person a lot of usage, even though it looks unusual and malformed. This condition can usually be greatly improved by surgery in terms of appearance, without impacting how well the hand works. Sometimes, if the function of the hand is impacted, such as when the first space between the thumb and index finger is too small (hypoplastic), surgery can help both its usage and how it looks.
In a study, researchers looked at 23 patients who had surgery for a cleft hand. They found that nearly all – 22 out of 23 – were happy with how their hand looked after surgery, and 21 out of 23 were pleased or very pleased with how well their hand functioned. After surgery, the most common issue patients experienced was stiffness in their fingers.
Possible Complications When Diagnosed with Cleft Hand
People with a hand deformity known as a cleft hand, usually caused by a problem with their blood vessels, face a high risk of skin loss and poor blood flow to the surgical area after surgery. This is especially the case if the surgery isn’t properly planned. In addition, despite improvements in surgery results, stiffness of the fingers is still the most common issue people complain about after the surgery.
Preventing Cleft Hand
If your child has a cleft hand deformity, it’s advisable to consult a specialist in children’s bone health (a pediatric orthopedic specialist). They can identify the best method of treatment. Surgery can help improve the hand’s appearance and in certain scenarios, its functionality too. However, correcting a cleft hand can be challenging and it’s vital to design a unique treatment plan tailored to each child’s needs. The good news is, children with a cleft hand deformity often lead regular lives with minimal or no restrictions, especially when they receive appropriate care.
