It is a limitation of the extension and deformity of the interphalangeal joint of any finger.
The word camptodactyly is derived from Greek and is translated as ” bent finger .”
In clinical terms, it is used to describe a non-traumatic flexion deformity of the proximal interphalangeal joint of the little finger.
Camptodactyly describes digital angulation in the anteroposterior plane and is distinct from clinodactyly, representing a nontraumatic flexion deformity with angulation in the radioulnar plane.
Camptodactyly usually does not show improvement or progresses gradually unless treated.
Progression will generally stop at the end of growth.
Three categories of camptodactyly have been proposed:
- Congenital (infantile) appears in childhood and affects boys and girls equally.
- Preadolescence (acquired), which occurs between the ages of 7 and 11, is progressive and affects mainly girls.
- Syndromic, involving several digits on both hands, can be associated with various syndromes.
Camptodactyly commonly involves the proximal ulnar interphalangeal joints, especially the proximal interphalangeal joints of the little finger.
The cause of camptodactyly is unknown, but this deformity represents a combination of proximal interphalangeal joint abnormalities secondary to an imbalance of the flexor and extensor tendon systems.
The incidence of camptodactyly is challenging to assess, but the incidence has been reported to be less than 1%.
The age of presentation is bimodal, and most of these deformities occur in infants and young children or adolescents.
Camptodactyly is a rare condition in which a finger (or fingers) fixes in a bent position at the middle joint and cannot be fully straightened.
Camptodactyly is most often found on the little finger and can occur in one or both hands.
The symptoms of camptodactyly often go unnoticed in the first few years of a child’s life because the condition rarely causes pain and, in most cases, does not affect hand function.
Treatment varies depending on the severity of the condition but may include stretching, splinting, and surgery.
Causes of camptodactyly
While the origin of camptodactyly remains unknown, it is believed to have a genetic component and may be linked to prenatal developmental disorders.
Camptodactyly can be caused by:
- Abnormal muscles in hand.
- Differences in the shape of the bone.
Signs and symptoms
The main symptom of camptodactyly is a slightly flexed posture of the middle joint, where the finger cannot be fully straightened.
It is most common on the little finger, but it can also affect other fingers.
The condition can worsen over time and is often worse during periods of growth.
In most cases, the condition does not cause pain or significantly affect the function of the hand.
Camptodactyly does not cause swelling, inflammation, or warmth in the area.
Bilateral fifth toe deformities are, in most cases, cosmetic concerns.
Family history is often positive.
Deformities are often noticed at the time of growth.
Functional complaints are related to musical instruments and keyboards, among others.
Diagnosis of camptodactyly
Differential diagnosis includes:
- Trigger fingers locked.
- Boutonnière deformities from unrecognized injuries.
- Dupuytren contractors.
- Hypoplastic extensor tendons.
- Delta phalanx.
Camptodactyly can also be part of a syndrome complex such as:
- Marfan syndrome.
- Juvenile rheumatoid arthritis.
- Congenital collagen disorders.
Camptodactyly diagnosis usually begins with a physical exam of the child’s fingers and hand.
In some cases, doctors may recommend an X-ray to confirm the diagnosis.
X-rays produce images of the bones and help doctors identify the underlying structure of the hand.
In addition to a physical exam and X-rays, your child may also have:
- Range of motion tests to determine if the condition affects movement and agility.
- Nerve evaluation tests to choose if the state has damaged or compressed any nerves.
An accurate diagnosis helps determine the best course of treatment for the child.
The goals of treatment are:
- Decrease the deformity.
- Accept the deformity.
- Control pain if present.
In cases where you have a mild chance of camptodactyly (less than 30 degrees of curvature in the finger that does not affect the function of the hand), a nonoperative treatment will be recommended.
Conservative treatment involves:
- Advise the patient and his family to accept the deformity.
- Perform passive stretching exercises, especially for young patients with multiple digits involved. The finger and joint are extended to extend the range of motion of the affected finger or fingers.
- Static and dynamic splints or casts in series should be attempted before surgery to hold the bent finger in a straight position.
Most cases of camptodactyly do not require surgical intervention.
If camptodactyly is severe, worsens over time, or affects the function of your hands, surgery may be recommended.
Surgery is most effective if it is done when the child is still young and the bones are not fully mature.
However, when surgical treatment is performed, it is based on:
- Release of the palmar fascia (up to 4 years).
- Flexor tendon release.
- Tendon Transfer (Ages 13-19).
- Lumbar release or excision.
- Elongation of soft tissue distraction.
- Proximal phalanx neck osteotomy (older patients and patients with bone changes).
- Arthrodesis of the proximal interphalangeal joint, especially for older patients and patients with joint pain
In rare cases, when camptodactyly is related to abnormal bones or bone structure, doctors may need surgery to repair, remove, or fuse a bone to optimize hand function.
During this process, some range of motion in the joint may be lost.
After surgery, the finger, hand, or arm may be put in a cast, splint, or sling to immobilize it while it heals.
Conservative treatment with static and dynamic splints will improve mild deformities and prevent the progression of some moderate deformities.
Surgical treatment can improve the deformity and range of motion, but the result may be unchanged and, in some cases, worsen the deformation and movement.
Treatment for camptodactyly will depend on your child’s condition’s severity, age, and development.
Follow-up care for camptodactyly will depend on the treatment needed.
When non-surgical treatment is done, it should be monitored regularly to ensure the condition does not worsen.
Complications of camptodactyly
Complications are generally related to surgery; among them, we have:
- Neurovascular damage, primarily if the proximal interphalangeal joint is supported in extension without checking capillary filling.
- Loss of skin
- Tendon exposure.
- Decreased range of motion (flexion at the proximal interphalangeal joint) due to scar formation within the tendon sheath or ligaments of the proximal interphalangeal joint.
The long-term outlook for children with camptodactyly is excellent.
Although most children with the condition can avoid surgery, those who do need it generally have good results.