KidsMD Health Topics


  • Overview

    If your baby or child has been born with short fingers that are webbed or conjoined, a condition called symbrachydactyly, the specialists at Boston Children’s Hospital can help.

    Here is some basic information about symbrachydactyly:

    • In symbrachydactyly, the fingers are abnormally short and webbed (or “conjoined”). The bones, muscles, ligaments, and nerves of the hand are usually affected.
    • Symbrachydactyly is rare, occurring in only about one in 32, 000 newborns. It doesn’t run in families, and affects boys and girls equally.
    • It usually affects just one hand.
    • In symbrachydactyly, the thumb and small finger can be larger than the middle fingers, forming a u-shaped pattern of the fingers.
    • The condition can range from fairly mild to severe.
    • It can be associated with a genetic condition called Poland syndrome, which also involves underdevelopment or absence of the chest muscle on one side of the body.
    • Many forms of symbrachydactyly are treated surgically. Surgery is usually done when the child is between 6 and 18 months old. Sometimes, a series of surgeries performed over a period of years is needed.

    How Boston Children's Hospital approaches symbrachydactyly

    You can have peace of mind knowing that the experts in our Orthopedic Center’s Hand and Orthopedic Upper Extremity Program and our Plastic and Oral Surgery Department’s Hand and Reconstructive Microsurgery Program have treated thousands of babies and children with hand problems that range from the simple to the highly complex.

    • Our Orthopedic Center is nationally known as the preeminent center for the care of children and young adults with a wide range of developmental, congenital, neuromuscular, sports related, traumatic and post-traumatic problems of the musculoskeletal system.
    • As one of the largest pediatric plastic surgery centers in the United States, our Department of Pediatric Plastic and Oral Surgery provides comprehensive care and treatment for a wide variety of congenital and acquired conditions, including hand deformities. 

    The Hand and Orthopedic Upper Extremity Program

    The Hand and Orthopedic Upper Extremity Program provides comprehensive care involving occupational and physical therapy, splinting, casting and reconstructive surgeries for infants, children and adolescents with complex congenital, neuromuscular, sports-related oncologic and traumatic upper limb conditions.

    The Hand and Reconstructive Microsurgery Program

    The specialists in the Hand and Reconstructive Microsurgery Program at Children's are experts in the management of congenital and acquired hand deformities. We recognize the social elements involved in pediatric hand surgery, so an essential part of these operations has been making the child's hand as symmetrical as possible with his unaffected hand.

    Symbrachydactyly: Reviewed by Donald S. Bae, MD
    © Boston Children’s Hospital; posted in 2012

  • In-Depth

    At Boston Children’s Hospital, our Orthopedic Center and Department of Pediatric Plastic and Oral Surgery have developed innovative surgical treatments for children with all variations of symbrachydactyly. 

    What is symbrachydactyly?

    Symbrachydactyly isa congenital (present at birth) condition in which the fingers are abnormally short and webbed or conjoined. The roots of the word are from the Greek: “syn/sym” (joined); “brachy” (short); “dactyl” (finger, digit). 

    Are there different forms and different levels of severity with symbrachydactyly?

    Yes. The three main levels of severity are:

    • The thumb is essentially normal, but the remaining fingers are short and stiff and can be webbed (least severe)
    • Only the thumb or the thumb and little finger are present (moderately severe)
    • All the fingers are missing; small skin stumps are located where fingers should have developed (most severe)

    How common is symbrachydactyly?

    Symbrachydactyly is a rare congenital hand defect, affecting about one out of every 32,000 babies. In most cases, it affects only one hand. 

    Will my child be OK?

    While the hand will always look and work differently, after surgery most of our patients can use it in their daily activities. 

    Young children readily learn to adapt. Later in childhood, your child may be able to use a prosthesis for some sports and other activities.. It’s also possible that he may need additional surgery to improve the hand’s function and appearance.


    Most cases of symbrachydactyly happen for no known reason and without any other abnormalities in the child. It isn’t thought to be inherited.

    In some cases, symbrachydactyly is an accompanying defect in a genetic syndrome called Poland syndrome, in which there is underdevelopment of the chest muscle on one side of the body.

    Signs and symptoms

    • Symbrachydactyly is visible at, or shortly after, birth (sometimes it is seen on ultrasound before birth).
    • Your child’s fingers will be short and webbed.
    • In severe cases, your child’s fingers will be small stumps of skin and soft tissue. Because of these differences, your child may have trouble using his affected hand.
  • Tests

    • 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 also 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 (also called amniotic band 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.

  • At Boston Children's Hospital, experts in our Orthopedic Center's Hand and Orthopedic Upper Extremity Program and our Plastic and Oral Surgery Department's Hand and Reconstructive Microsurgery Program provide comprehensive care for symbrachydactyly—including diagnosis, surgery and follow-up care. 

    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.

    What happens during surgery?

    Treatment of symbrachydactyly varies from child to child.

    • In some cases, no surgery or only minor skin and soft-tissue corrections are needed.
    • 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 after surgery

    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 

    Caring for your child after surgery

    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.

    What is the follow-up treatment plan?

    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.

    Long-term outlook

    Surgery can be very successful in helping the use and appearance of the hand. If your child's case is severe, he may need additional reconstructive surgery(ies) to achieve greater function and improve his hand's appearance. But to some extent, the hand will always look different and function differently. As he grows, your child 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

    Coping and support

    At Boston Children's Hospital, we want to make your child's—and your own—hospital experience as pleasant as possible. Visit The Center for Families for all you need to know about: 

    • Getting to Boston Children's
    • Accommodations
    • Navigating the hospital experience
    • Resources that are available for your family 

    In particular, we understand that you may have a lot of questions when your child is diagnosed with symbrachydactyly. Boston Children's can connect you with extensive resources to help you and your family through this stressful time, including: 

    • Patient education: From doctor's appointments to physical therapy and recovery, our nurses and physical therapists will be on hand to walk you through your child's treatment and help answer any questions you may have.
    • Parent-to-parent: Want to talk with someone whose child has been treated for symbrachydactyly? We can often put you in touch with other families who've been through the same process that you and your child are facing, and who will share their experiences.
    • Faith-based support: If you're in need of spiritual support, we'll connect you with the Boston Children's chaplaincy. Our program includes nearly a dozen clergy— representing Protestant, Jewish, Muslim, Roman Catholic and other faith traditions—who will listen to you, pray with you and help you observe your own faith practices during your hospital experience.
    • Emotional support: Our social workers and mental health clinicians have helped many families in your situation. We can offer counseling and assistance with issues such as coping with your child's diagnosis, stresses relating to coping with illness and dealing with financial difficulties.
  • Research & Innovation

    Improving outcomes for upper extremity disorders

    The Boston Children's Hospital Hand and Orthopedic Upper Extremity Program is dedicated to the comprehensive care of all upper limb conditions in infants, children and adolescents.

    Under the direction of Peter M. Waters, MD, and Donald S. Bae, MD, patients with congenital, neuromuscular, sports-related, oncologic and traumatic or post-traumatic conditions of the upper extremity receive multi-disciplinary care that includes occupational and physical therapy, splinting/casting and reconstructive surgery.

    In addition, the Hand and Orthopedic Upper Extremity Program does clinical and basic science research that will have an impact on how we care for our patients in the future. We are currently studying the treatment of a wide variety of upper limb conditions, including:

    • Reconstruction of the congenitally deficient hand
    • The use of microsurgical techniques in reconstructive surgery for congenital upper extremity differences
    • Instability of the sternoclavicular and glenohumeral joints of the shoulder
    • Post-traumatic stiffness and deformity of the elbow
    • Surgical correction of forearm deformity following previous fracture
    • Ligament and/or cartilage injuries of the wrist
    • Microsurgical techniques in reconstructive surgery after limb salvage for bone and soft-tissue tumors and treatment for sports-related injuries to the upper limb

    Many of these investigations have resulted in national and international presentations or peer-reviewed medical publications—and all have increased our ability to provide the highest standard of patient care.

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