Camptodactyly is the bent (flexed) position of a finger. I have previously blogged about camptodactyly HERE, but wanted to share my updated surgical strategy.
Surgery is considered for camptodactyly when therapy is not expected to be effective or if therapy has failed to lead to improvement. It is absolutely my preference to always begin camptodactyly treatment with therapy. That includes passive stretching as well as splinting. Splints may include resting splints to stretch the finger (s) at night as well as splints that are spring loaded to wear for shorter periods of time ( LMB link). For some patients, the initial deformity- that is the severity of the flexion position- is too much to allow effective splinting. And, for others, splints simply do not make enough of a difference in straightening the finger(s). In these cases, surgery is considered. The primary goal of surgery for camptodactyly is to release the tight structures on the palm side of fingers- these structures are different for each patient but typically include skin, tendons, muscles, and possibly the joint (PIP joint). Only rarely is it necessary to strengthen the tendons which straighten the finger.
A treatment algorithm has evolved based on the treatment of many children with camptodactyly. While a variety of different anatomical structures have been related to camptodactyly, in our experience, four surgical steps are key to a satisfactory correction.
1) Address the lack of skin on the palm side of the joint. There is almost always a lack of skin which means that once the other issues are corrected, there will be a skin deficit. I do not believe skin grafts are the best treatment option and instead favor a rotation flap. The use of skin from the side of the finger to rotate over the palm side of the joint has been very effective for our patients. See pictures below.
2) The tight flexor digitorum superficialis (FDS) tendon is a part of the bent posture of the finger. The other finger flexor, the FDP is expected to be present and, therefore, we typically release the FDS tendon. This removes one major contributor the finger flexion position.
3) The PIP joint itself is tight in the flexed position in patients with a more severe camptodactyly. While a formal joint release (or volar plate release) is sometimes required, we have had success with joint manipulation as a means to straighten the joint. This requires less surgical dissection and allows a faster procedure and, I believe, a faster recovery.
4) I try to avoid pinning the joint. We have used kirshner wires to pin the joint temporarily in a straight position. I have found benefit to avoiding the pins and simply casting/ splinting the joint for 2 weeks after surgery.
Here are a few pictures, before and after surgery, of a recent patient with all 4 fingers affected. By definition, this patient has a distal arthrogryposis.
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| 4 finger camptodactyly |
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| 4 finger camptodactyly with a lack of skin on the palmar side. |
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| After surgery for camptodactyly, the skin flaps are visible and the fingers straighten. |
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| After surgery for camptodactyly, the skin flaps are visible and the fingers straighten. |
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| After surgery for camptodactyly, the skin flaps are visible and the fingers straighten. |
My Bio at Washington University
congenitalhand@wudosis.wustl.edu
This one is good. keep up the good work!.. Dr. HE Schlauchmagen Op Türkei
What about camptodactyly in adults. Can stretches work for someone who has gone untreated for so long? My husband has it (I assume. I’m not a doctor and he hasn’t seen one since he was around 2) in all 20 digits. The pain goes from annoying to sometimes unbearable though (especially in his toes since he walks on top of them). I’ve tried massaging the muscles/tendons and stretching them before, but it never seemed to help…just hurt.
Hello Heather,
Thank you for the question. Camptodactyly in adults is not typical. And camptodactyly is not painful in most cases (there can be tightness with stretching). I would see a physician to have this evaluated.
I'm trying to find a surgeon for my camptodactyly. I'm in east TX. Any suggestions?
I know there are great surgeons in the larger cities, most notably in Dallas. I do not know of others who may be closer to you.
My daughter has been diagnosed with adolescent onset Camptodactyly.
I am in Mississippi and will need to look out of state for treatment. What questions should I ask to determine the level of treatment experience the surgeon/physician has? This is so rare and I really want experienced care.
Thank you.
Deanna- thank you for the question. The simplest question is ‘how many patients with camptodactyly do you treat each year?’ While this is not always an easy question for surgeons to answer, you should get some sense. And, of course, you want to discuss nonoperative choices as well as surgery. And, more tricky, surgeons don’t all approach this the same way. Good luck and I am happy to email offline- congenitalhand@wustl.edu
One of my pinky fingers has been bent for about 8 or so years at the PIP joint. I went to hand surgeon and he x-rayed and said it looked like a broken finger that did not heal correctly – nothing he could do at the time. He also said it looked like i had a little Dupreten’s contracture. The finger has stayed in the same position all these years and it won’t straighten out. Do you know of any surgeries for this problem? To me, from looking at pictures on internet of camptodactyly fingers that is what mine looks like. The doctor did not mention that to me when I saw him. Thanks for any updates on this condition and can it be treated.
Elizabeth, thank you for the question. While I can’t provide a clear answer for your finger, this does provide an opportunity to offer my thoughts on PIP joint contractures (ie, the joint stuck in a bent position). 1. Camptodactyly (can present from birth to adolescence) 2. Post traumatic (can be related to joint injury, fracture, tendon injury, etc) 3. Dupuytrens (especially in older adults)- usually a palpable ‘cord’ causing the bent position. I hope this helps.
Hello. I have the identically same hands as what you have shown in the pictures above. I wasn’t able to have surgery as I was born and grew up in a third world country and we couldn’t afford it. Now I’m living in the US, 40 years old. I grew up with a camptodactyly. My only major concern is of we’re having a child. I know my child could be a carrier and thinking of there’s a way to avoid it.
Angeli- thank you for the question. In brief, camptodactyly can be idiopathic (i.e., happening for unclear reasons without a certain genetic relationship) or can be more clearly genetic in nature. The good news is that if your child is affected, and this may not be clear at birth, stretching, therapy, and occasionally surgery may be helpful.
For your hands, as long as you remain functional and without pain, observation makes sense. However, if you develop pain or if your function is compromised, surgery could be considered.