Camptodactyly is a condition that may present in infancy or in adolescence. The PIP joint (see below) does not straighten for a variety of different reasons. It can be very different from patient to patient. It can involve one finger or multiple fingers. It can be a nuisance or can fundamentally interfere with function.
My views on camptodactyly have changed over the years. When I began in practice, most felt that intervention (ie, surgery) was unpredictable in that results were not always great. So surgery was often not offered. It was difficult to address in surgery the large number of listed causes- from abnormal muscles to short tendon, etc, etc.
Today, we have a ‘standard’ approach that seems to be helpful in the majority of patients. First, and most importantly, we use therapy to stretch the finger(s). This is important for a few reasons. First, therapy can truly make a difference and may be all that is necessary for improvement. And second, therapy is important because families need to commit to therapy because if surgery is ultimately the answer, therapy after is very important to the outcome. We cannot expect the patient to work on therapy alone, no matter how old the child may be. Whether the child is 3 or 13, this must be a family event to stretch the fingers at least 3-4 times each day for a few minutes. Splints can also be very helpful to gain and maintain motion. And, with a growing child, some degree of therapy is often needed until the child is finished growing.
Surgery, in our hands, has become straightforward. We have 3 possible steps in each surgery. First because there is typically insufficient skin, we rotate skin from the side of the finger to the palmar surface of the finger. This is almost always enough skin to correct the skin shortage. Skin grafts are not typically a good option (for a variety of reasons). Second, we release one tendon in the finger, the FDS. This tendon is often tight and prevents the PIP joint from straightening. The finger functions really, really well even without the FDS. And finally, if the PIP joint itself is tight, we perform a joint release to increase PIP joint straightening. I would not suggest that our approach is perfect. Its biggest challenge is the other finger tendon that bends the finger (i.e., finger flexor), the FDP. Its anatomy is complicated and if it remains tight after the other parts of the procedure have been completed, it can limited PIP joint straightening.
These pictures demonstrate one type of camptodactyly. That is, in this young patient, the index finger PIP joint rests in a position of flexion. That is clear on the picture on the far right and in the middle. The middle picture shows the child reaching for an object and unable to straighten the finger. BUT, the far right picture shows that the finger can straighten. So, in this child, we would work on therapy to keep the finger flexible while we hope that the extensor tendons (which straighten the finger) get stronger. Ultimately, if that does not happen, then surgery, as noted above, can be helpful.
