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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:

  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
arachnodactyly
Arachnodactyly

Sausage-shaped phalanges

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

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
cone shaped finger
Cone shaped finger

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
Syndactylism
Syndactylism

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).
Clubbed fingers
Clubbed fingers

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.
hand edema
Hand Edema

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
carpopedal spasm
Carpopedal spasm

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 DeformityPossible Cause
MCP joint flexionRupture 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 palmTightness 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 jointsRadial 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 intrinsicsPancoast tumor
Claw hand deformityLoss 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 fingerDupuytren contracture
A hook-like contracture of the flexor muscles, which is worse with wrist extension as compared to flexionVolkmann ischemic contracture
Hand and Finger Deformities and Their Possible Causes

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.

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