Impairment of hand function can lead to severe disability and is a common presentation.

Causes

Congenital

Failure of formation

  • Absent digit

  • Finger and thumb hypoplasia

  • Radial club hand

  • Macrodactyly

Failure of separation

  • Syndactyly (fusion of digits)

  • Camptodactyly

Duplication

  • Polydactlyl

Primary muscle contractures

  • Arthrogryposis multiplex congenita

Acquired

  • Dupuytren’s contracture

  • Rheumatoid arthritis ( Fig. 32 )

    Figure 32, Rheumatoid hand deformity .

  • Osteoarthritis

  • Trauma

  • Burns

  • Volkmann’s ischaemic contracture

  • Brachial plexus lesions

  • Peripheral nerve lesions

  • Spinal cord lesions

    • Poliomyelitis

    • Syringomyelia

  • Multiple chondromas (Ollier’s disease)

History

Congenital

These presentations will be recognisable at birth. Arthrogryposis multiplex congenita is due to non-differentiation of mesenchymal tissues, often together with a neurogenic element, the combination producing gross contractures.

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