Saturday, August 17, 2013

Mild Camptodactyly

Camptodactyly comes in different types based on age and severity.  I have written several times about camptodactyly including http://congenitalhand.wustl.edu/2012/03/camptodactyly.html

While there are different ways to consider camptodactyly, there are three basic types: infantile, adolescent, and camptodactyly associated with a syndrome (i.e., athrogryposis, etc.).  For most patients, camptodactyly affects the small fingers on both sides but may be different on each side.  Syndromic kids may have any finger affected.  When, for example, the long finger is affected, it tends to be more of a problem compared to the small finger and get in the way of grasp.  Upton and others have done a nice job breaking down these 3 types with the results of treatment.  http://www.ncbi.nlm.nih.gov/pubmed/7814601

I certainly see all three types of camptodactyly patients and each has its challenges.  Pain is rare but with a worsening deformity (i.e., worsening position of flexion), functional issues increase.  This includes difficulties with playing musical instruments, typing on the computer, sports, among others. Different patients are bothered at different levels of contracture.  We, as surgeons and doctors, try to define the point at which camptodactyly becomes a problem but the reality is that we can assign numbers like 30 degrees or 45 degrees or others but, again, it is really about the patient.

The good news about camptodactyly is that many patients will respond to therapy including stretching and splinting.  This depends, again, on the patient, but also on the degree of camptodactyly because once it is too severe, splinting and therapy become less effective.  Therapy and splinting may be a challenge in really young patients but is easier in adolescents (who really want their finger to get better).  Stretching during the day, specialized dynamic splints during the waking hours, and static splints at night all have a role.  Progress is typical.

Here is a recent patient with what I would consider mild camptodactyly.  He was excited to try therapy and I expect that he will improve.  I plan to post soon on the surgical options.

Bilateral small finger camptodactyly.  Note that the bottom hand, the right hand, is worse and was more of a problem.

Left small finger x-ray of camptodactyly.  Attempted full straightening.  The joint is well formed.

The more severely affected side in camptodactyly.  The joint is not quite normally formed but is generally satisfactory.





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