Dr. Benson got a call from a family that had fallen in love with a little Chinese face. At that time they were aware that she had been left at the orphanage with her hands and feet covered to conceal her differences. The photos and report forwarded to her prospective parents noted bilateral cleft hands and feet. Although their hearts yearned to say yes immediately to her adoption, they took the time to investigate whether or not she would have other medical issues.
What is a cleft hand?
Cleft hand, in the past, has also been known as split hand or lobster claw hand. It is a congenital disorder in which the central portion of the hand does not develop in a typical fashion. The cleft hand appears as a V-shaped cleft situated in the center of the hand. Occasionally other fingers might be syndactilyzed (held together) with one or more digits absent. In most types, the thumb, ring finger and little finger are the less affected parts of the hand.
When the cleft is in the shape of a U it was previously referred to as “atypical cleft hand”. This classification is no longer used as the atypical cleft hand is now more appropriately called symbrachydactyly, which is not a subtype of cleft hand.
Is a cleft hand common?
Cleft hand can be present as an isolated difference, but the exact incidence is unknown. More commonly it tends to run in families involving both hands and feet, indicating that there is a genetic component. There are syndromes associated with cleft hands but these are very rare.
What causes a cleft hand?
The etiology of cleft hand is thought to be a result of a defect in the developing limb. Particularly in bilateral cases the cause is genetic with a pattern of autosomal dominant inheritance. The gene information that miscodes for this difference is not yet well-defined.
How is a cleft hand diagnosed?
An exam by a pediatric hand surgeon may be all that is required although frequently x-rays are obtained to clarify the bone involvement.
How is a cleft hand treated?
For many patients the function of the hand is so excellent that no treatment is required.
Surgical approaches may address adjacent syndactylies that benefit from web-space reconstructions. The goal of surgery is to maximize the breadth and power of the hand while restoring a more typical appearance to the hand. Occasionally, the V-shaped cleft is narrowed to a more traditional contour. When the thumb is contracted or syndactylized to the index finger, bone structures may be shifted to maximize thumb range of motion and opposition. The timing of surgery depends on the limitations seen at birth. In general thumb contractures are approached at about a year of age. Surgery for other differences is less urgent.
What is the long-term outlook for my child?
The growth and development of the hand is consistent with the child’s growth. The child’s ability to write, participate in sports and play most musical instruments is negligibly affected. Most patients with cleft hand report normal life skills.
Approximately seven months later, a beaming family came to my office with little Emily for evaluation of her cleft hands and feet. Within 2 months she had already gained quite an English vocabulary. Because of syndactylies holding her ring and small fingers together we began planning for web-space reconstructions. Her parents were pleased to report that in every way she seemed a normal, interactive child who was their very own.