Hand Deformities

Hand deformities can occur at the bones or joints, it can be due to imbalance of muscles or nerve dysfunction or it’s a result of congenital defects.

Hand deformities can be a mirror of many systemic disease.

See Also: Hand Anatomy

Systemic Causes of Hand Deformities

Size and shape of hand Deformities

Large, blunt fingers (spade hand):

• Acromegaly
• Hurler disease (gargoylism)

Gross irregularity of shape and size:

1. Paget disease of bone
2. Maffucci syndrome
3. Neurofibromatosis

Spider fingers, slender palm (arachnodactyly)

1. Hypopituitarism
2. Eunuchism
3. Ehlers–Danlos syndrome, pseudoxanthoma elasticum
4. Tuberculosis
5. Asthenic habitus
6. Osteogenesis imperfecta

Sausage-shaped phalanges

1. Rickets (beading of joints)
2. Granulomatous dactylitis (tuberculosis, syphilis)

Spindliform joints (fingers)

1. Early rheumatoid arthritis
2. Systemic lupus erythematosus
3. Psoriasis
4. Rubella
5. Boeck sarcoidosis
6. Osteoarthritis

Cone-shaped fingers

1. Pituitary obesity
2. Frohlich dystrophy

Unilateral enlargement of hand

1. Arteriovenous aneurysm
2. Maffucci syndrome

Square, dry hands

1. Cretinism
2. Myxedema

Single, widened, flattened distal phalanx

1. Sarcoidosis

Shortened fourth and fifth metacarpals (bradymetacarpalism)

Shortened, incurved fifth finger (symptom of DuBois)

1. Mongolism
2. Behavioral problem
3. Gargoylism (broad, short, thick-skinned hand)

Malposition and abduction, fifth finger

1. Turner syndrome (gonadal dysgenesis, webbed neck, etc.)

Syndactylism

1. Congenital malformations of the heart, great vessels
2. Multiple congenital deformities
3. Laurence-Moon-Biedl syndrome
4. In normal individuals as an inherited trait

Clubbed fingers

1. Subacute bacterial endocarditis
2. Pulmonary causes
   1. Tuberculosis
   2. Pulmonary arteriovenous fistula
   3. Pulmonic abscess
   4. Pulmonic cysts
   5. Bullous emphysema
   6. Pulmonary hypertrophic osteoarthropathy
   7. Bronchogenic carcinoma
3. Alveolocapillary block
   1. Interstitial pulmonary fibrosis
   2. Sarcoidosis
   3. Beryllium poisoning
   4. Sclerodermatous lung
   5. Asbestosis
   6. Miliary tuberculosis
   7. Alveolar cell carcinoma
4. Cardiovascular causes
   1. Patent ductus arteriosus
   2. Tetralogy of Fallot
   3. Taussig-Bing complex
   4. Pulmonic stenosis
   5. Ventricular septal defect
5. Diarrheal states
   1. Ulcerative colitis
   2. Tuberculous enteritis
   3. Sprue
   4. Amebic dysentery
   5. Bacillary dysentery
   6. Parasitic infestation (gastrointestinal tract)
6. Hepatic cirrhosis
7. Myxedema
8. Polycythemia
9. Chronic urinary tract infections (upper and lower): Chronic nephritis
10. Hyperparathyroidism (telescopy of distal phalanx)
11. Pachydermoperiostosis (syndrome of Touraine, Solente, and Gole).

Joint disturbances

1. Arthritides:
   1. Osteoarthritis
   2. Rheumatoid arthritis
   3. Systemic lupus erythematosus
   4. Gout
   5. Psoriasis
   6. Sarcoidosis
   7. Endocrinopathy (acromegaly)
   8. Rheumatic fever
   9. Reiter syndrome
   10. Dermatomyositis.
2. Anaphylactic reaction-serum sickness
3. Scleroderma

Edema of the hand

1. Cardiac disease (congestive heart failure)
2. Hepatic disease
3. Renal disease
   1. Nephritis
   2. Nephrosis
4. Hemiplegic hand
5. Syringomyelia
6. Superior vena caval syndrome
7. Superior thoracic outlet tumor
8. Mediastinal tumor or inflammation
9. Pulmonary apex tumor
10. Aneurysm
11. Generalized anasarca, hypoproteinemia
12. Postoperative lymphedema (radical breast amputation)
13. Ischemic paralysis (cold, blue, swollen, numb)
14. Lymphatic obstruction: Lymphomatous masses in axilla
15. Axillary mass: Metastatic tumor, abscess, leukemia, Hodgkin disease
16. Aneurysm of ascending or transverse aorta or of axillary artery
17. Pressure on innominate or subclavian vessels
18. Raynaud disease
19. Myositis
20. Cervical rib
21. Trichiniasis
22. Scalenus anticus syndrome.

Neuromuscular effects

Atrophy

1. Painless:
   1. Amyotrophic lateral sclerosis
   2. Charcot–Marie–Tooth peroneal atrophy
   3. Syringomyelia (loss of heat, cold, and pain sensation)
   4. Neural leprosy
2. Painful: Peripheral nerve disease
3. Radial nerve (wrist drop):
   1. Lead poisoning, alcoholism, polyneuritis, trauma
   2. Diphtheria, polyarteritis, neurosyphilis, anterior poliomyelitis
4. Ulnar nerve (benediction palsy): Polyneuritis, trauma
5. Median nerve (claw hand): Carpal tunnel syndrome
6. Rheumatoid arthritis
7. Tenosynovitis at wrist
8. Amyloidosis
9. Gout
10. Plasmacytoma
11. Anaphylactic reaction
12. Menopause syndrome
13. Myxedema

Extrinsic pressure on the nerve (cervical, axillary, supraclavicular, or brachial)

1. Pancoast tumor (pulmonary apex)
2. Aneurysms of subclavian arteries, axillary vessels, or thoracic aorta
3. Costoclavicular syndrome
4. Superior thoracic outlet syndrome
5. Cervical rib
6. Degenerative arthritis of cervical spine
7. Herniation of cervical intervertebral disk

Shoulder–hand syndrome

1. Myocardial infarction
2. Pancoast tumor
3. Brain tumor
4. Intrathoracic neoplasms
5. Discogenic disease
6. Cervical spondylosis
7. Febrile panniculitis
8. Senility
9. Vascular occlusion
10. Hemiplegia
11. Osteoarthritis
12. Herpes zoster

Ischemic contractures (sensory loss in fingers)

1. Tight plaster cast applications

Polyarteritis nodosa

Polyneuritis

1. Carcinoma of lung
2. Hodgkin disease
3. Pregnancy
4. Gastric carcinoma
5. Reticuloses
6. Diabetes mellitus
7. Chemical neuritis: Antimony, benzene, bismuth, carbon tetrachloride, heavy metals, alcohol, arsenic lead, gold, emetine
8. Ischemic neuropathy
9. Vitamin B deficiency
10. Atheromata
11. Arteriosclerosis
12. Embolic

Carpodigital (carpopedal spasm) tetany

1. Hypoparathyroidism
2. Hyperventilation
3. Uremia
4. Nephritis
5. Nephrosis
6. Rickets
7. Sprue
8. Malabsorption syndrome
9. Pregnancy
10. Lactation
11. Osteomalacia
12. Protracted vomiting
13. Pyloric obstruction
14. Alkali poisoning
15. Chemical toxicity: Morphine, lead, alcohol

Tremor

1. Parkinsonism
2. Familial disorder
3. Hypoglycemia
4. Hyperthyroidism
5. Wilson disease (hepatolenticular degeneration)
6. Anxiety
7. Ataxia
8. Athetosis
9. Alcoholism, narcotic addiction
10. Multiple sclerosis
11. Chorea (Sydenham, Huntington)

Local Causes of Hand Deformities

Hand Deformity	Possible Cause
MCP joint flexion	Rupture of the extensor tendon just proximal to the MCP joint
Hyperextension of the MCP joint	Paralysis of the interossei
Deepening of the anterior (palmar) gutter and an inability to fully stretch out the palm	Tightness of the anterior (palmar) aponeurosis
Wasting of the hypothenar eminence and a clawed hand with flexion of the fourth and fifth digits (hand of benediction)	Ulnar nerve palsy
Wrist drop with increased flexion of the wrist, flexion of the MCP joint, and extension of the DIP joints	Radial nerve lesion
Isolated thenar atrophy	Arthritis of the carpometacarpal joint Median nerve lesion C8 or T1 nerve root lesion
Ape hand deformity with a wasting of the thenar eminence and an inability to oppose or flex the thumb or abduct it in its own plane.	Median nerve palsy
Z-deformity of the wrist	Pattern of deformity in the rheumatoid hand
Atrophy of the hand intrinsics	Pancoast tumor
Claw hand deformity	Loss of ulnar nerve motor innervation to the hand, with resultant paralysis of the interosseous muscles, and muscle atrophy of the hypothenar eminence; this deformity is more severe in lesions distal to innervation of the FDP muscle, as this muscle adds to the flexion force upon the IP joints
PIP hyperextension and slight flexion of the DIP	Rupture or paralysis of the flexor digitorum superficialis (FDS)
A fixed flexion deformity of the MCP and PIP joints, especially in the ring or little finger	Dupuytren contracture
A hook-like contracture of the flexor muscles, which is worse with wrist extension as compared to flexion	Volkmann ischemic contracture

References

• Berry TJ: The Hand as aMirror of Systemic Disease. Philadelphia: FA Davis Co, 1963;Juddge RD, Zuidema GD, Fitzgerald FT: General appearance. In:Judge RD, Zuidema GD, Fitzgerald FT, eds. Clinical Diagnosis, 4th ed. Boston, Little, Brown and Company, 1982:29–47.
• Eberhardt K, Johnson PM, Rydgren L. The occurrence and significance of hand deformities in early rheumatoid arthritis. Br J Rheumatol. 1991 Jun;30(3):211-3. doi: 10.1093/rheumatology/30.3.211. PMID: 2049583.
• Dutton’s Orthopaedic Examination, Evaluation, And Intervention 3rd Edition.