Symbrachydactyly | Diagnosis & Treatment

How is symbrachydactyly diagnosed?

Symbrachydactyly is apparent at birth and may also be visible before birth by ultrasound. In most cases, the underlying muscles, nerves, tendons, ligaments and bones of your child’s hand will be affected. Your doctor will use x-rays to look more closely at the underlying structure of your baby’s fingers and determine a course of treatment. If there are any other abnormalities, other x-rays or tests may be needed.

Symbrachydactyly is often confused with a hand disorder called constriction ring syndrome, but the two are different. The main difference between the two is that in symbrachydactyly the underlying structures of the hand, such as the muscles, nerves and bones, are usually malformed, while in constriction ring syndrome they aren’t.

How is symbrachydactyly treated?

Many forms of symbrachydactyly are treated surgically. Initial surgery is usually done when the child is between 6 and 18 months old. Sometimes, a series of additional surgeries need to be performed over a period of years.

Treatment of symbrachydactyly varies from child to child. In some cases, no surgery or only minor skin and soft-tissue corrections are needed.

Surgical options for symbrachydactyly

If your child has a more serious case, he may need to have bones transferred, usually from the toes, to add length to the affected fingers.  In some cases, a toe or multiple toes are transplanted to the affected hand (a process called toe transfer or toe-to-hand transfer) so that your child will eventually be able to pinch, pick up and hold objects.

Complications right after surgery are uncommon and usually minor. But medium- to longer-term complications can include:

  • infection
  • poor bone healing
  • stiff knuckle joints
  • finger dislocation

After surgery, your child is usually placed in an above-elbow cast for three weeks to help immobilize and protect the hand. Once the cast is removed, a splint that slides in between the fingers and keeps them apart is used for an additional six weeks. During this time, your child's doctor may recommend occupational or physical therapy to help reduce scarring, stiffness and swelling and improve function.

Doctors will want to see your child for follow-up visits to ensure that healing is proceeding well and function has returned. In some cases, follow-up will continue for years to evaluate whether additional surgery is needed to improve the function or appearance of your child's hand.

What is the long-term outlook for a child with symbrachydactyly?

Surgery can be very successful in helping the use and appearance of the hand. If your child's case is severe, they may need additional reconstructive surgery or multiple surgeries to achieve greater function and improve their hand's appearance. But to some extent, the hand will always look different and function differently. As your child grows, they may use prosthetics for some sports and activities. 

Your child may need to be followed for a number of months or years to: 

  • ensure that the healing has gone well
  • check that function has returned to your child's hand
  • determine whether additional surgery is needed to improve the function or appearance of the hand as your child grows (additional procedures often needed to deepen the web space between fingers using skin grafts)