Tuesday, March 27, 2012

Camptodactyly



Camptodactyly is the position of flexion of the proximal interphalangeal (PIP) joint. Translated from Greek, camptodactyly means “bent finger.”  It may be first noted in the newborn, as a congenital camptodactyly, or it may present or progress in adolescence.   There are a number of anatomical structures that have been described as “causing” camptodactyly including abnormal muscle and tendon insertions.  Additionally, camptodactyly may results from weak muscle extension power at the PIP joint or may be a part of a larger syndrome such as arthrogryposis.

There are no easy answers for camptodactyly but treatment starts with therapy.  Extension splinting at night (a static or resting splint) and more aggressive splinting during the day (dynamic or static progressive splinting) may be helpful.   Surgery does not provide an easy answer and the results may be disappointing to both surgeon and patient.  The position of the joint can usually be improved but almost never can it be made normal.  Surgery can also help with therapy by taking a joint that had been difficult to splint and making splinting possible.  Surgery usually consists of releasing any abnormal structures that may be limiting PIP joint extension, possibly release the tight joint itself, and possibly moving tendons to increase the strength of extension of the PIP joint.    One of the risks of surgery that worries the surgeon is the loss of ability to fully bend the finger.

Camptodactyly of small finger PIP joint.  Adolescent type.
Patient is attempting to straighten small finger. 

24 comments:

  1. treatment is difficult either conservative or operative.but if extension loss is less than 60% conservative is better because of poor result and stiffness associated with operative management.

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    1. Thanks for the comment. I agree that treatment for camptodactyly is a challenge. Mild deformity can often be treated with success using splints alone. Moderate or severe deformity are indeed difficult with nonsurgical care or surgery.

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  2. This sounds exactly what my baby daughter was born with. What's the first step that I should take to begin her treatment?

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  3. The first step is to find a congenital hand specialist to confirm the diagnosis and initiate treatment. Stretching is likely to be recommended and sometimes splinting. Early initiation of these treatments has a good chance of being helpful.

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  4. This looks exactly like what my son has also. On 6 fingers. 3 fingers each hand. (the index finger and thumb of both hands are not affected) I saw 1 hand specialists, pediatric hand surgeon and a hand surgeon (when we lived in Kansas) from the time he was born to 18 months. None of them knew what it was and said to wait untill he's a bit older, none suggested splinting even though my son's left hand seems more affected and the fingers are really bent. A fourth specialist said that this looks like it could be camptodactyly, said surgery doesn't help much and may even injure his nerves, then he referred me back to the peadiatric hand surgeon.
    We have since then moved to East Africa and have not seen any more specialists. My son is now 3. I stretch his hands gently when he's asleep. Is there something else I should be doing? Is splinting still an option?

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    1. Both my left and right little fingers are bent. However, at age 4 1/2, I started playing the piano and my right little finger improve dramatically (it is maybe now only bent 10%). Since I only started playing with my left hand later, my left little finger only improve to 50%.
      This to say that a splint might still be an option for your son at age 3.
      Good luck!

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  5. I appreciate your comments and this can be a confusing diagnosis. In principle, I agree with stretching and typically recommend stretching 3-4 times/ day for a few minutes each session. Obviously not to the point of pain. Splinting might be an option but difficult to confirm without clinic visit and x-rays. Good luck.

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  6. This is what I have on my right hand, my small finger looks just like the picture above. I am 21 and was diagnosed with this abnormality when I was around the age of 16. On my left hand I have another abnormality in my small finger. My small finger does not bend at the middle joint but instead stays straight, when my hand is laid flat it looks normal, but when I make a fist my finger stays mostly straight except for the top joint near the tip of my finger and the joint near the base of my finger. When I saw the doctor he didn't have much to say about the left hand small finger other than it was a frozen joint. Is there a more technical term for this or is it similar or at all related to Camptodactyly?

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    1. The left small finger is likely something called symphalangism, although this is just my educated guess. Symphalangism is the failure of the joint to develop normally. There are other possibilities for sure to explain your difficulty including a simple lack development of a joint.

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  7. have a nice day ,I am a physiotherapy student in Poland ,may I know what is your best solution ,to solve captodactyly ,how ever the result would be deppend on the time that how early we diagnose such syndrome ,splinting ,electrical machines or even casting could be well to avoid deveolp or even cure !?

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    1. Thank you. I believe in splinting and even serial casting for most patients with camptodactyly. I do agree that younger patients may respond better. However, these treatments do not cure the problem, only (hopefully) make it better.

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  8. I have this condition in my right hand and it's never been a problem although the other middle joints have always been a bit larger in my right hand. In the last few years I've started experiencing some arthritis like symptoms. I have rock climbed on and off for 20+ years and do many other activities but there's an increasing recovery period from pain and stiffness in that hand. I'm 49 so some of this the symptoms might just be age related or is this a pretty standard progression?

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  9. Thank you for posting. Your symptoms could be arthritis as some types of camptodactyly seem more prone to develop joint problems such as arthritis. The joint mechanics are also abnormal in camptodactyly, increasing the risk of difficulties. Bottom line is that if the finger is bothering you enough, a hand surgeon consultation with x-rays makes sense.

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  10. I think I might have this, but I've never received any kind of therapy for it. It's very slight and isn't nearly as noticeable as the photo above. It's also never hindered me in any way, except that sometimes when I need to have my hands flat against a surface for an extended period of time (when I am washing my car, for example) my pinkie finger starts to hurt because of the strain. I first noticed it in kindergarten when my teacher tried to press my hand flat against a paper so she could trace it for me and my pinkie wouldn't lay flat. She kept trying to force it down (it hurt) and that was when I wondered if there was something wrong. Are there different types of camptodactyly that are less severe than others? It never even occurred to me that this is something that people would get therapy for, because it's never been a problem. I was just curious to find out why my finger couldn't straighten out all the way. I know of other members of my family who have it too, but I'm not sure how severely they may have it.

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    1. Jane, thanks for your comment. You are absolutely correct in that the severity varies for camptodactyly. Obviously, I can't be certain of your diagnosis but seems quite possible that you have a mild camptodactyly. The fact that it hasn't worsened is great and means it likely will not get worse later (assuming you are fully grown- adolescent growth spurts can be associated with worsening). In patients with a mild deformity that doesn't interfere with activities, I rarely recommend even therapy.

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  11. Hello Charles,

    I read this information and I agree completely with you.
    I have camptodactyly in my both hands ( pinky fingers).

    It has been worrying me. So I had a plastic surgery to my right pinky when i was 21. I feel like the doctor has not made the operation good.. Now I am not able to bend my pinky finger. It is slightly better than before in looks but I am not able to bend completely ..It is worse.. I need help of 4th finger to touch the palm. What is the reason? Can I get do further treatments to make it normal? I am experiencing difficulties to bend it.. It also pains.. sometimes the pain extends to whole right hand!,, I need help. i hope i can still make it completely alright or atleast make it to bend!

    Thanks in advance!

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  12. Sorry to hear about your difficulty, unfortunately, it is not uncommon to hear. Camptodactyly surgery can sometimes cause more problems than the camptodactyly itself. That is why most surgeons who treat this believe that therapy to include splinting is the best treatment. If therapy is not successful, then surgery is considered.

    I always worry that patients I treat could lose the ability to bend the finger fully. Sometimes the finger becomes stiff and straight but it sounds like your situation is different- you can bend the finger (passive motion) but it just won't completely bend on its own (active motion). Therapy may be able to help as adhesions around the flexor tendons are the most likely cause. Good luck!

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  13. I have this same condition in my little finger of the left hand same as the above picture i first noticed it when i was young but it never hurt until now, im 35 now and a month ago the knuckle started swelling and with a burning/painful sensation then the little finger on the right hand (always been straight) has started to swell and bend and extremely painful, now both fingers are burning/hurting which caused me to stop working while im waiting to see the surgeon which will be many months away ....i have a splint for the right finger and have been stretching it (right is way to far gone for a splint) is there anything else i can do to help ease the pain and stop it bending like the left finger

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    1. Sorry to hear about your fingers. Your experience with the left small finger is most typical- painless but bent (flexed) position. I do not think the right small finger is the same problem and not sure why both are hurting. Possibly arthritis or a trauma. Agree that you need to be evaluated. Good luck.

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  14. I have lived with this for 56 years now. Both hands, right worse then left. Surgery was attempted at Mayo Clinic when I was in 5th grade, '67 or '68. It failed and I went back in 1980 and had another surgery on the same finger, as I had wanted them to take it off as it was constantly cold and I could not straighten it beyond 90 degrees. They would not do that, but managed to give me more extension and the return of some sensation, lost that also after original surgery. My right hand all fingers are probably about 90 degrees at full extension. My left hand is much better with ring and little finger close to being straight on full extension. Middle and index probably about 45 degrees on extension. I have worked as a medic for almost 20 years now. Played softball, mostly as a pitcher for almost 30 years. Yes there are times I wish I had straight fingers, could play the guitar etc.Times I asked why? But I managed. My eldest boy has the same, except he got his Mothers long fingers and when they, Mayo, wanted to do surgery when he reached 10 lbs, I said HELL NO!!
    So that's my deal.

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  15. I have Camptodactyly and recently went to a consultation with my doctor, he said it is 60 degrees bent. its never been this bad but when i was child it was completely straight. My dad also has it but not as worse and so does my mums nan.
    I've been told surgery is the only way to fix it i was wondering will it ever be completely straight after my surgery?

    Thank You

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    1. Hod Jam,
      Thank you for the question. I am not sure how old you are but there are 2 age peaks for camptodactyly- one peak is the first few years of life and the other is during the teenage years. Your camptodactyly may be the adolescent type- this type is associated with rapid growth during these years. Sometimes splinting can make a difference and is probably worth a try. However, a 60- degree contracture is high and splinting may be tough. Surgery is the other option, especially if your bent finger is limiting your function. If you chose to undergo surgery, it will likely improve your finger position but is unlikely to make the finger completely straight.

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  16. My daughter is about to turn one. We have recently noticed she has a unilateral camptodactyly on her rt little finger. We are slightly worried as she as has a large single cafe au lait spot on her chest and a umbilical hernia. She seems to be otherwise developing normally and has met all her developmental milestones. Could this combination be a sign of a syndrome, or is the camptodactyly likely to be an isolated issue?

    Can I also ask about a regime for passive stretching? How many times a day, and for how long each time?

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    1. Thank you for the question. I am unaware of any specific connection between camptodactyly and cafe au lait spots but there could be an unusual genetic condition. For me, the key is that all else seems well including milestones, etc. Presumably, therefore, camptodactyly will be an isolated musculoskeletal condition.

      There are numerous passive stretching protocols and your doctor will certainly have a preference. To my patients, I recommend stretching for a few minutes with each diaper change. As your daughter gets a little older, a nighttime splint might be helpful.

      Good luck.

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