Testing & Diagnosis for Cleft Hand in Children

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Contact the Hand and Orthopedic Upper Extremity Program

  • 617-355-6021
  • International: +1-617-355-5209
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At Boston Children's Hospital, we understand that the first step to treating your child is obtaining an accurate, timely and thorough diagnosis.

Cleft hand develops between the 28th and 56th day of fetal development—when the bones of the hand are forming. The condition can sometimes be detected on a routine prenatal ultrasound. After the baby is born, the deformity is visible.

Details of the diagnosis are usually confirmed through a physical exam and x-rays. Your child’s doctor will closely evaluate every anatomic structure of your child’s hand, determining what is present or absent, normal or abnormal. The doctor will take particular care to assess the specifics of the soft tissue of your child’s hands, including ligaments, blood vessels, nerves and muscles.

x-ray of cleft handIf your child is diagnosed with a cleft hand, her doctor will check for other associated deformities or syndromes, including:

•    cleft lip and palate
•    ectrodactyly (split hand-split foot malformation)
•    foot abnormalities
•    encephalocele (protrusion of brain membrane)
•    conditions affecting the heart and digestive systems
•    (rarely)deafness

Types of cleft hand

In diagnosing the condition, your child’s doctor will likely classify it as one of five types, based on an assessment of the first web space (the space between the thumb and index ray)—from Type I (least severe) to Type V (most severe).

Type Description


I Normal first web space  
IIA Mildly narrowed first web space  
IIB Severely narrowed first web space  
III Syndactylized thumb and index rays and first web space
IV Merged first web space and cleft, index ray suppressed
V Absent web, thumb suppressed, ulnar rays present  
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