Cleft Hand | Diagnosis & Treatment

How is cleft hand diagnosed?

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.

If your child is diagnosed with a cleft hand, their 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

In diagnosing the condition, your child’s doctor will likely classify —  based on an assessment of the first web space (the space between the thumb and index ray) — as one of five types:

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

What are the treatment options for cleft hand?

Not all children need surgery for a cleft hand, particularly if your child has good use of their hand and the deformity is not too severe. However, if your child's hand has significant functional or cosmetic problems, the doctor may recommend surgery.

Surgeons will perform surgery early in a child's life if the cleft hand's deformities are progressive (will worsen over time) — such as syndactyly (joining) between the thumb and index finger or transverse bones between the digits. If the cleft hand doesn't have progressive deformities, surgery can take place when the child is 1 or 2 years old.

If surgery is needed to repair cleft hand, there are many different surgical approaches available. The timing and sequence of procedures will vary from child to child, but in general, the first procedure is usually done when a child is 1 year old. In general, the goals of surgery are:

  • close the cleft and make sure your child can use his hand effective
  • create a good working space between his thumb and index finger to allow for pinch and fine motor function
  • reorganize the skin and soft tissue
  • stabilize or transfer the bones of the hand
  • correct any deformities of the fingers or thumb

For about four to six weeks after surgery, your baby will be in a long-arm cast stabilized by pins.

Following removal of the cast, your child will wear a splint to bed for several weeks to maintain alignment and help with scar reduction. They'll receive occupational therapy until they achieve supple active motion and developmentally appropriate use of the hand, during which time the doctor will monitor progress monthly.

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

The quality of the reconstruction of your child's thumb and digits depends to a large extent on how severe the original malformation was. As a result of surgery, you can expect your child will have active, functional grasp, pinch and release, and an improvement in the aesthetics of the hand. The alignment of the fingers should also improve.

As your child grows, some gaps and deformities that were reconstructed by the original surgery can recur. In these cases, additional procedures may be needed.