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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:
- Paget disease of bone
- Maffucci syndrome
- Neurofibromatosis
Spider fingers, slender palm (arachnodactyly)
- Hypopituitarism
- Eunuchism
- Ehlers–Danlos syndrome, pseudoxanthoma elasticum
- Tuberculosis
- Asthenic habitus
- Osteogenesis imperfecta

Sausage-shaped phalanges
- Rickets (beading of joints)
- Granulomatous dactylitis (tuberculosis, syphilis)

Spindliform joints (fingers)
- Early rheumatoid arthritis
- Systemic lupus erythematosus
- Psoriasis
- Rubella
- Boeck sarcoidosis
- Osteoarthritis
Cone-shaped fingers
- Pituitary obesity
- Frohlich dystrophy

Unilateral enlargement of hand
- Arteriovenous aneurysm
- Maffucci syndrome
Square, dry hands
- Cretinism
- Myxedema
Single, widened, flattened distal phalanx
- Sarcoidosis
Shortened fourth and fifth metacarpals (bradymetacarpalism)
Shortened, incurved fifth finger (symptom of DuBois)
- Mongolism
- Behavioral problem
- Gargoylism (broad, short, thick-skinned hand)
Malposition and abduction, fifth finger
- Turner syndrome (gonadal dysgenesis, webbed neck, etc.)
Syndactylism
- Congenital malformations of the heart, great vessels
- Multiple congenital deformities
- Laurence-Moon-Biedl syndrome
- In normal individuals as an inherited trait

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

Joint disturbances
- Arthritides:
- Osteoarthritis
- Rheumatoid arthritis
- Systemic lupus erythematosus
- Gout
- Psoriasis
- Sarcoidosis
- Endocrinopathy (acromegaly)
- Rheumatic fever
- Reiter syndrome
- Dermatomyositis.
- Anaphylactic reaction-serum sickness
- Scleroderma
Edema of the hand
- Cardiac disease (congestive heart failure)
- Hepatic disease
- Renal disease
1. Nephritis
2. Nephrosis - Hemiplegic hand
- Syringomyelia
- Superior vena caval syndrome
- Superior thoracic outlet tumor
- Mediastinal tumor or inflammation
- Pulmonary apex tumor
- Aneurysm
- Generalized anasarca, hypoproteinemia
- Postoperative lymphedema (radical breast amputation)
- Ischemic paralysis (cold, blue, swollen, numb)
- Lymphatic obstruction: Lymphomatous masses in axilla
- Axillary mass: Metastatic tumor, abscess, leukemia, Hodgkin disease
- Aneurysm of ascending or transverse aorta or of axillary artery
- Pressure on innominate or subclavian vessels
- Raynaud disease
- Myositis
- Cervical rib
- Trichiniasis
- Scalenus anticus syndrome.

Neuromuscular effects
Atrophy
- Painless:
- Amyotrophic lateral sclerosis
- Charcot–Marie–Tooth peroneal atrophy
- Syringomyelia (loss of heat, cold, and pain sensation)
- Neural leprosy
- Painful: Peripheral nerve disease
- Radial nerve (wrist drop):
- Lead poisoning, alcoholism, polyneuritis, trauma
- Diphtheria, polyarteritis, neurosyphilis, anterior poliomyelitis
- Ulnar nerve (benediction palsy): Polyneuritis, trauma
- Median nerve (claw hand): Carpal tunnel syndrome
- Rheumatoid arthritis
- Tenosynovitis at wrist
- Amyloidosis
- Gout
- Plasmacytoma
- Anaphylactic reaction
- Menopause syndrome
- Myxedema
Extrinsic pressure on the nerve (cervical, axillary, supraclavicular, or brachial)
- Pancoast tumor (pulmonary apex)
- Aneurysms of subclavian arteries, axillary vessels, or thoracic aorta
- Costoclavicular syndrome
- Superior thoracic outlet syndrome
- Cervical rib
- Degenerative arthritis of cervical spine
- Herniation of cervical intervertebral disk
Shoulder–hand syndrome
- Myocardial infarction
- Pancoast tumor
- Brain tumor
- Intrathoracic neoplasms
- Discogenic disease
- Cervical spondylosis
- Febrile panniculitis
- Senility
- Vascular occlusion
- Hemiplegia
- Osteoarthritis
- Herpes zoster
Ischemic contractures (sensory loss in fingers)
- Tight plaster cast applications
Polyarteritis nodosa
Polyneuritis
- Carcinoma of lung
- Hodgkin disease
- Pregnancy
- Gastric carcinoma
- Reticuloses
- Diabetes mellitus
- Chemical neuritis: Antimony, benzene, bismuth, carbon tetrachloride, heavy metals, alcohol, arsenic lead, gold, emetine
- Ischemic neuropathy
- Vitamin B deficiency
- Atheromata
- Arteriosclerosis
- Embolic
Carpodigital (carpopedal spasm) tetany
- Hypoparathyroidism
- Hyperventilation
- Uremia
- Nephritis
- Nephrosis
- Rickets
- Sprue
- Malabsorption syndrome
- Pregnancy
- Lactation
- Osteomalacia
- Protracted vomiting
- Pyloric obstruction
- Alkali poisoning
- Chemical toxicity: Morphine, lead, alcohol

Tremor
- Parkinsonism
- Familial disorder
- Hypoglycemia
- Hyperthyroidism
- Wilson disease (hepatolenticular degeneration)
- Anxiety
- Ataxia
- Athetosis
- Alcoholism, narcotic addiction
- Multiple sclerosis
- 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.
Last Reviewed
February 22, 2022
February 22, 2022
Contributed by
OrthoFixar
OrthoFixar
Orthofixar does not endorse any treatments, procedures, products, or physicians referenced herein. This information is provided as an educational service and is not intended to serve as medical advice.
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