Congenital clasped thumb

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Congenital clasped thumb
Other namesinfant’s persistent thumb-clutched hand, [1] flexion-adduction deformity of the thumb, [2] pollex varus, [3] thumb in the hand deformity. [4]
Congenital clasped thumb right.jpg
Congenital clasped thumb

Congenital clasped thumb describes an anomaly which is characterized by a fixed thumb into the palm at the metacarpophalangeal joint in one or both hands. [5] The incidence and genetic background are unknown. A study of Weckesser et al. showed that boys are twice as often affected with congenital clasped thumb compared to girls. The anomaly is in most cases bilateral (present in both hands). [5] A congenital clasped thumb can be an isolated anomaly, but can also be attributed to several syndromes.

Contents

Causes

The thumb contains five groups of muscle and/or tendons:[ citation needed ]

  1. Extensor tendons (to stretch the thumb)
  2. Flexor muscles/tendons (to bend the thumb)
  3. Abductor muscles/tendons (to move the thumb outwards)
  4. Adductor muscle (to move the thumb inwards)
  5. Opposing muscles (to move the thumb opposite the small finger)

In order for the thumb to maintain a normal position, a strict balance between these groups is required. Weak or absent extensors and/or abductors (the extensor pollicis brevis tendon, the extensor pollicis longus tendon or, rarely, the abductor pollicis longus tendon), can cause a disbalance, leading to an abnormal position of the thumb: congenital clasped thumb. There is also the possibility that two tendons are affected simultaneously.[ citation needed ]

The following tendon deviations can induce congenital clasped thumb:

Furthermore, a tight thumb web space (the area between thumb and index finger) can contribute to congenital clasped thumb. The thumb cannot be properly abducted (moved outwards), if the web space is too tight.[ citation needed ]

To summarize, the causes of congenital clasped thumbs may vary between patients and can sometimes be a combination of the preceding components. Treatment should be tailored to all occurring components in order to achieve good results.[ citation needed ]

Diagnosis

Diagnosing the congenital clasped thumb is difficult in the first three to four months of life, as it is normal when the thumb is clutched into the palm in these first months. [6] Diagnoses that cause the same flexion or adduction abnormalities of the thumb are:

Syndrome associated flexion-adduction of the thumb:

Classification

There are a few different classifications conceived to categorize the spectrum of variety of congenital clasped thumb. In literature, X classifications have been described for clasped thumb. The two most relevant of the existing classifications, to our opinion, are the classifications of McCarrol [12] and Tjuyuguchi et al. [13]

The most global format is the classification of McCarrol, which divides the congenital clasped thumbs into two groups. Group I includes the supple clasped thumb, when the thumb is only passively correctable. While complex clasped thumbs, thumbs which cannot be moved neither passively or actively, belong to group II.[ citation needed ]

Tjuyuguchi et al. designed a classification existing of three groups:[ citation needed ]

Treatment

Treatment of congenital clasped thumb includes two types of therapy: conservative and surgical.

Conservative treatment

Treatment of all categories of congenital clasped thumbs should start with either serial plaster casting or wearing a static or dynamic splint for a period of six months, [5] while massaging the hand. Extension by splinting shows reduction of the flexion contracture. To gain optimal results, it is important to start this treatment before the age of six months. The result of this therapy is better in less severe deformities. [14] In most uncomplicated cases, a satisfactory result can be gained when splint therapy starts before the age of six months. [15] Splinting should be tried for at least three months and possibly for as long as six months or longer. If the result of splint therapy stagnates, surgery treatment is indicated. [16]

Surgical treatment

Surgical treatment should be considered in patients who have not been treated at younger age or when conservative therapy fails. Surgery is recommended during the age of three to five years.[ citation needed ]

Techniques

Other procedures

Related Research Articles

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<span class="mw-page-title-main">Thumb</span> First digit of the hand

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<span class="mw-page-title-main">Wrist</span> Part of the arm between the lower arm and the hand

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<span class="mw-page-title-main">De Quervain syndrome</span> Medical condition

De Quervain syndrome occurs when two tendons that control movement of the thumb become constricted by their tendon sheath in the wrist. This results in pain and tenderness on the thumb side of the wrist. Radial abduction of the thumb is painful. On some occasions, there is uneven movement or triggering of the thumb with radial abduction. Symptoms can come on gradually or be noted suddenly.

<span class="mw-page-title-main">Wrist drop</span> Medical condition

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<span class="mw-page-title-main">Arthrogryposis</span> Medical condition

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<span class="mw-page-title-main">Carpometacarpal joint</span> Joint between the wrist and hand

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<span class="mw-page-title-main">Dorsal interossei of the hand</span> Muscles between the metacarpals

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<span class="mw-page-title-main">Camptodactyly</span> Medical condition

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<span class="mw-page-title-main">Swan neck deformity</span> Medical condition

Swan neck deformity is a deformed position of the finger, in which the joint closest to the fingertip is permanently bent toward the palm while the nearest joint to the palm is bent away from it. It is commonly caused by injury, hypermobility or inflammatory conditions like rheumatoid arthritis or sometimes familial.

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<span class="mw-page-title-main">Median nerve palsy</span> Medical condition

Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.

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<span class="mw-page-title-main">Radial dysplasia</span> Medical condition

Radial dysplasia, also known as radial club hand or radial longitudinal deficiency, is a congenital difference occurring in a longitudinal direction resulting in radial deviation of the wrist and shortening of the forearm. It can occur in different ways, from a minor anomaly to complete absence of the radius, radial side of the carpal bones and thumb. Hypoplasia of the distal humerus may be present as well and can lead to stiffness of the elbow. Radial deviation of the wrist is caused by lack of support to the carpus, radial deviation may be reinforced if forearm muscles are functioning poorly or have abnormal insertions. Although radial longitudinal deficiency is often bilateral, the extent of involvement is most often asymmetric.

<span class="mw-page-title-main">Muscles of the thumb</span>

The muscles of the thumb are nine skeletal muscles located in the hand and forearm. The muscles allow for flexion, extension, adduction, abduction and opposition of the thumb. The muscles acting on the thumb can be divided into two groups: The extrinsic hand muscles, with their muscle bellies located in the forearm, and the intrinsic hand muscles, with their muscles bellies located in the hand proper.

References

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  13. Tsuyuguchi et al. Congenital clasped thumb: a review of forty-three cases. J Hand Surg Am. 1985 Sep; 10(5):613-8.
  14. S-C Lin et al. A simple splinting method for correction of supple congenital clasped thumbs in infants. The Journal of Hand Surgery, British & European Volume, Volume 25, Issue 5, October 1999.
  15. Hisam abdel Ghani et al. Characteristics of patients with congenital clasped thumb: a prospective study of 40 patients with the result of treatment. J Child Orthop. 2007 November; 1(%): 313-322.
  16. Medina et al. Flexion deformities of the thumb: clasped thumb and trigger thumb. Chirurgie de la main, Dec 2008;27 Suppl 1:S35-9.
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