Congenital hand anomalies

Congenital upper limb anomalies affect 0.1–0.2% of all newborns. They are often isolated phenomena but can be associated with other congenital anomalies and may be the only external manifestation of a syndrome. Knowledge of the treatment options is imperative to ensure appropriate referral and counselling.The aim of surgery for a congenital hand anomaly is to improve both function and appearance. Apart from the face, the hand is the only other part of the body on regular display.Independent living is largely dependent on good bimanual hand function. For example a large proportion of activities of daily living such as washing, dressing, and feeding consist of bimanual tasks. It is only when we temporarily lose the function of one hand that the significance of this becomes apparent. However, children with congenital hand anomalies adapt very well to limitations of hand function and can often find “trick” manoeuvres to achieve essential tasks.As there is a wide variation in the types and severities of hand anomalies these cases are largely managed in specialized clinics. It is in this setting that the child and family will have access to long-term multidisciplinary care which includes input from geneticists, psychologists, therapists and children’s hand surgeons. For some children with more complex anomalies, psychological support can be as valuable as surgery to aid integration with and acceptance by their peers.