Camptodactyly

Introduction

Camptodactyly is a congenital condition characterized by the permanent flexion of one or more fingers, most commonly the little finger. It results from abnormalities in tendons, ligaments, or muscles and may vary in severity. The condition can be hereditary or occur sporadically. Treatment options include stretching, splinting, and, in severe cases, surgery.

Camptodactyly is a condition in which the middle joint of a finger bends abnormally. Although it can occur in other fingers, it is most frequently found in the little finger.

Camptodactyly: what is it?

If your child has camptodactyly, it indicates that their finger is bent and cannot be fully straightened. At a joint known as the proximal interphalangeal (PIP) joint, the finger normally bends in the middle.

Some children can straighten their fingers (passive motion) with help from a physical therapist. Even with assistance, the joint could be too tight to straighten for others. About 1% of children have some degree of camptodactyly. Girls are more affected than boys.

Types

Type I: Infantile camptodactyly

• Equally impacts boys and girls.
• Adapts well to splinting and stretching

Type II: Adolescent camptodactyly

• More often affects girls than boys.
• Surgery might be necessary.

Type III: Syndromic camptodactyly

• Impacts many fingers
• Linked to several syndromes
• Severe and frequently present from birth

Symptoms

Your child might not exhibit any symptoms if they have moderate camptodactyly. Although their finger—likely the small one—will be somewhat bent, it won’t interfere with how they use their hand. Your child’s hand function may be slightly affected if their case is more severe.

The primary symptom of camptodactyly is a slightly flexed posture of the middle joint, which prevents the finger from fully straightening. It is most common in the little finger, but it can also affect other fingers. Over time, the condition may get worse, and it frequently gets worse during increases in growth. In most cases, camptodactyly does not cause pain or significantly impair hand function.

Your child has camptodactyly if their finger is bent and unable to straighten entirely.
It could begin in adolescence or be present from birth, and it could get worse as the child gets older.

Your child won’t have any symptoms if the condition is mild. The little curvature of the finger, most likely the little one, will not have any effect on hand function. Your child’s hand function may be slightly affected if their case is more severe.

• At least one finger is bent all the time.
• The proximal interphalangeal (PIP) joint is where the finger bends in the center.
• In extreme situations, even with assistance, the joint is too tight to straighten.

Causes

Your child’s finger may have abnormal structures that lead to camptodactyly. These could consist of: The majority of the time, the cause of this is unknown. However, some kids with camptodactyly have a family history of similar issues with their fingers.

• Tight skin
• Contracted tendons and ligaments
• Abnormal muscles
• Irregularly shaped bones
• Abnormal muscles in the hand.
• Differences in bone shape
• Camptodactyly might be caused by problems with the skin, tendons, ligaments, muscles or bones of the finger.
• Camptodactyly could be a hereditary disorder (inherited in families).

Additionally, camptodactyly may be a symptom of a more widespread illness or sickness that impacts numerous body parts.

Risk factor

Risk factors for camptodactyly include abnormal structures in the fingers, genetic conditions, and syndromes.

• Abnormal structures
• Tight skin
• Contracted tendons and ligaments
• Abnormal muscles
• Irregularly shaped bones
• Abnormal lumbrical insertion
• Abnormal flexor digitorum superficialis insertion
• Abnormal extensor tendon anatomy

Genetic conditions

• Camptodactyly can be inherited as an autosomal dominant trait.
• Mutations in the connexin-43 gene (GJA1) may cause misassembly of channels or alter channel conduction properties.

Diagnosis

The first step in identifying camptodactyly at Children’s Hospital of Philadelphia (CHOP) is usually a physical examination of your child’s hand and fingers. To confirm the diagnosis, doctors may occasionally suggest an X-ray. X-rays assist physicians in determining the hand’s underlying structure by creating images of the bones.

Along with X-rays and a physical examination, your child might also have:

• Tests of range of motion to see if the illness is impairing agility and flexibility
• Tests for nerve evaluation to see whether any nerves have been harmed or compressed
• A precise diagnosis aids us in choosing the best treatment plan for your child.

Treatment

Since mild camptodactyly rarely results in pain or functional issues, surgery is typically not advised. The doctor will likely advise your child to wear a splint and undertake physical therapy if their disease is moderate.

If your child’s finger curve is more severe, and it is becoming worse, surgery might be necessary. Your child’s finger may still have some bend, even though surgery can help it work better. Following surgery, splinting and physical therapy are required to avoid joint stiffness.

The majority of camptodactyly patients don’t need surgery. Nonoperative treatment will be advised if your child has minor camptodactyly, which is defined as less than a 30-degree bend in their finger that does not impair hand function.

Physical therapy treatment

Goals

• Correction of palmar tissue shortening and reduction of fixed flexion contracture at the PIPJ
• Prevention of contracture development or recurrence
• Maintenance of flexion range

Treatment options that don’t involve surgery include:

Massage

Before stretching the finger(s), massage your muscles and tissues to loosen them. Although older kids might be able to do this on their own, a parent or other adult should help.
Please check below for advice on how to massage the affected fingers.

• Apply a moisturizer or massage oil to the affected fingers and hands. (Ensure your child is not allergic to any substances in the cream or oil used.)
• Apply strong pressure to the region. (Massage should not cause discomfort or damage to the skin.)
• Use the other hand’s fingers to support the back of the injured finger.
• With your thumb, rub the front as well as sides of the affected finger.

Splinting

Physical therapy splinting is quite effective, and the best outcomes come from early intervention. The first treatment location, with follow-up sessions possibly taking place at a local hospital. The degree of bending and the amount of pressure required to straighten the finger will determine the course of treatment.

Throughout the treatment, the splints will be observed and modified. Splints are usually only needed to be worn while you sleep, but occasionally you may need to wear them for eight to twenty hours per day.

• Splinting: With the help of an physical therapist, the initial line of treatment consists of a program of finger stretching and splinting.
• Stretches for the affected finger or fingers to increase range of motion
• To keep the bent finger straight, use a splint.
• Dynamic finger orthosis (capener orthosis) indicated for adolescents with contractures of 45 degrees or less, who are very proactive during the day and unlikely to comply with stretching and active extension strengthening regimens, gain the most from this orthosis.

A camptodactyly splint is a device that supports and straightens a bent finger. It’s frequently composed of mouldable plastic.

When do you use a splint?

• A doctor may prescribe occupational therapy and a splint for mild camptodactyly.
• To treat camptodactyly in children, a therapist may propose a splint to keep the affected finger straight.
• A camptodactyly splint is a device that supports and straightens a bent pinky finger. It is used to treat mild cases of camptodactyly, which causes a finger to bend.

How it functions.

• The hand-based splint lengthens the palmar skin and extends the PIPJ.
• It is attached with tape or Velcro at the distal end of the proximal phalanx.
• The splint should be comfortable and not involve unaffected fingers, thumbs, or wrists.

Therapeutic play

• Taking hold of blocks and bigger objects, like balls
• Playdoh/putty games
• Musical instruments: piano, hand drums
• Weight bearing exercises and Activity

Surgical treatment

Your child’s doctor might suggest surgery if your child’s finger curvature increases quickly or if it gets to the point where it affects hand function. Surgery is dependent on the finger’s deformity. After surgery, bending the finger may become difficult, and success rates are frequently low. For children, no one surgical technique is advised.

If your child’s camptodactyly is severe, worsening over time, or impairing their hand function, surgery may be recommended. Surgery is most beneficial when performed while your child is still young and the bones have not fully developed.

Children with hand issues benefit from several surgeries performed by board-certified orthopedic and plastic surgeons at CHOP.

Two commonly used procedures are:

• Dividing the tendon that causes the muscle to shorten.
• Transferring a tendon and/or muscle to restore balance in the hand.
• In rare situations, if a child’s camptodactyly is caused by abnormal bones or bone structure, surgeons may need to undertake surgery to repair, remove, or fuse a bone to improve hand function.

During this procedure, the joint’s range of motion may be lost. Following surgery, your child’s finger, hand, or arm may be immobilized in a cast, splint, or sling while it heals.

Complication

• Stiffness: Residual stiffness in the finger after surgery
• Hand function: More severe cases can affect hand function
• Difficulty holding objects: People with severe camptodactyly may have trouble holding objects
• Progression of deformities: In non-operative cases, the condition may progress
• Other features of camptodactyly: Tight skin, contracted tendons and ligaments, Abnormal muscles, and irregularly shaped bones.

FAQs

Reference

• Camptodactyly | Boston Children’s Hospital. (n.d.). https://www.childrenshospital.org/conditions/camptodactyly
• Camptodactyly – Alder Hey Children’s Hospital Trust. (2024, March 19). Alder Hey Children’s Hospital Trust. https://www.alderhey.nhs.uk/conditions/patient-information-leaflets/camptodactyly/
• Camptodactyly in Children | Children’s Hospital Colorado. (n.d.). https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/camptodactyly
• Glick, Y., & Weerakkody, Y. (2011). Camptodactyly. Radiopaedia.org. https://doi.org/10.53347/rid-13487
• Wikipedia contributors. (2024, November 18). Camptodactyly. Wikipedia. https://en.wikipedia.org/wiki/Camptodactyly
• Kate. (2022, June 28). Camptodactyly – GC Hand Therapy. GC Hand Therapy. https://gchandtherapy.com/camptodactyly/
• St George’s University Hospitals NHS Foundation Trust, H. T. D. (2023). Hand therapy treatment for children with camptodactyly. https://www.uhs.nhs.uk/Media/UHS-website-2019/Patientinformation/Childhealth/Hand-therapy-treatment-for-children-with-camptodactyly-3474-PIL.pdf
• Philadelphia, C. H. O. (n.d.). Camptodactyly. Children’s Hospital of Philadelphia. https://www.chop.edu/conditions-diseases/camptodactyly
• Occupational Therapy Department. (2014). Congenital hand anomalies: camptodactyly. In The Royal Children’s Hospital. https://www.rch.org.au/uploadedFiles/Main/Content/hand-therapy/congenital_hand_anomalies-camptodactyly.pdf