Wednesday, June 5, 2013

Camptodactyly, Unusual Cause

Camptodactyly is a flexion deformity of the finger, typically the small finger, and is typically caused by an imbalance between the flexors and extensors of the PIP joint.  There have been a number of specific causes identified including abnormal muscle insertion, a tight flexor digitorum superficialis tendon, and weak extensor tendons.  Most patients with camptodactyly have good function because flexion of the finger(s) is maintained (i.e., they can make a good fist).  Sometimes, however, the lack of finger straightening can be a problem during function, especially if the position of flexion is severe (and if severe, the flexed finger can interfere with holding objects in the palm).  Camptodactyly is difficult to "fix" and therapy is often considered the best option.  Surgery is reserved for patients that fail therapy and have real functional limitations.

Congenital conditions, including camptodactyly, are uncommon.  Despite the rarity of conditions such as camptodactyly, there are accepted patterns, causes, and treatments as noted above.  However, there can be an exceptionally unusual cause of any congenital condition which requires a different treatment approach and will change expected outcomes.  For example, bony outgrowths can cause a camptodactyly appearance.

Dysplasia epiphysealis hemimelica (DEH) is more commonly called Trevor disease.  It is a rare, developmental disorder which affects the growth plates of the body's long bones (technically the epiphysis of the bone).  It most commonly affects the knee or ankle but is exceedingly rare even there.  Recently, I was able to treat a 6 month old patient who seemed to have Trevor disease of the hand causing an appearance of camptodactyly.   Osteochondroma (bony tumor which is benign) may be the most common cause of blocked joint extension.  In the case below in a 6 month old child, surgical excision immediately allowed improved motion.





Young patient with camptodactyly caused by a bony growth.

Another view of camptodactyly caused by bony outgrowth.

The finger cannot be extended in this case of camptodactyly.

These x-rays of camptodactyly demonstrate an unusual appearance of the PIP joint of the ring finger, caused by the bony outgrowth.

A side view of camptodactyly finger.  Note the deformity of the PIP joint.  The bony growth is clearly visible and is blocking the ability of the finger to straighten.  







3 comments:

  1. I was born with straight fingers and by six months old my left ring finger had became completely bent. Up until thirteen years old I could straighten it by pushing it up but it would pop back down. I have been unable to straighten it through my adult years. My mother had a slightly bent pinkie finger but not sideways into other finger but down like mine, just not in entirety, if that makes sense. Would my deformity be called camptodactyly also?

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    1. Janie,
      Thank you for writing. It is difficult for me to really know what your finger condition may be- but I do believe it sounds most like camptodactyly. Sometimes stretching can help and rarely, as noted, surgery is beneficial.

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