Congenital and Acquired Hand Defects

What are Congenital Hand Differences?

Conditions present at birth that cause an abnormal appearing/functioning upper extremity. Differences range from duplicate fingers to the complete absence of the limb. For further information specific conditions, please use this link to the American Society for Surgery of the Hand.

Why do congenital hand differences occur?

Some conditions are linked to genetics. Other conditions are linked to environmental causes - either outside or inside the uterus, while other conditions have no known cause.

What to do about them?

A team approach is encouraged that includes the parents/guardians, the primary physician, a qualified hand surgeon, therapists, and, in some cases, the affected child. All children diagnosed with a congenital hand condition should be referred to a qualified hand surgeon as soon as possible. Each child's condition is unique and requires a thorough assessment by a hand surgeon to formulate a treatment plan. The treatment plan may require therapy, urgent surgical management or surgical management when the child reaches an appropriate age. It may be that your child requires staged surgeries.

List of Physicians Who Treat Congenital Hand Defects

It is important to find a physician who has specialized training in caring for all conditions of the hand, wrist and forearm, ranging from acute, limb-threatening injuries to chronic, degenerative diseases. At the University of Michigan Hand Center, all of our physicians are board certified surgeons with specialization in plastic surgery and additional fellowship training in hand surgery.

For details about education, experience, and specialty in this clinical area, please visit these physician profile pages:

Kevin C. Chung, M.D.

Scheduling an Initial Consultation

If you are considering treatment, the first step is to schedule an initial consultation with a plastic surgeon. To schedule an appointment at the University of Michigan Hand Clinic, please call (734) 998-6022.

What to Expect During the Initial Consultation

Depending on the complexity of your condition, you may visit with more than one physician, surgeon, therapist or physician extender. You should plan on your consultation lasting between 1-2 hours. During this important visit, you should expect:

To provide a complete medical history, including information about previous surgical procedures; past and present medical conditions; and any medications or herbal supplements you are taking.
To undergo a physical examination.
To discuss possible options for treatment of your condition, including whether surgery is recommended.
To discuss in detail the surgical procedure recommended; the recovery and rehabilitation period, and the probable outcome in terms of function and appearance.
To discuss possible risks and complications of the procedure.
To ask your surgeon if there is anything about the procedure you don't understand.

Hand Therapy and Rehabilitation

Treatment plans are tailored to fit your condition, living and work requirements. The ultimate goal is the restoration and optimization of your hand function, renewed independence and overall quality of life.

Whether as a non-surgical option or to enhance your recovery from hand surgery, the plastic surgeon may recommend a course of rehabilitation (physical and occupational therapy) under the direction of a trained hand therapist. Hand therapy is provided on site at the University of Michigan's Hand Center by our team of Occupational and Physical Therapists. Referrals can be arranged closer to your home when that is more convenient.

Click here for a listing of hand therapy and rehabilitation providers recommended by the University of Michigan Hand Center if treatment is pursued off-site.

Preparing for Your Surgery

If your plastic surgeon recommends surgery to treat the condition, you'll work with the Hand Center scheduling nurse to set a date for the operation. You will be given a pre-operative information packet that explains everything you should do and know before your surgery date. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. You should arrange for someone to drive you home after your surgery, and to help you out at home for a day or two.

Where Your Surgery Will Be Performed

The majority of these procedures are completed on an out-patient basis. Your procedure will take place at the University of Michigan Hospitals which provides state-of-the-art surgical suites and recovery areas.

Types of Anesthesia

In some cases, general anesthetic is not necessary. Your surgeon will discuss the best anesthetic options to make you feel comfortable and relaxed during the procedure, including local anesthesia in your hand and/or an anesthetic block near the shoulder. Keep in mind anesthetics can have side effects such as nausea, drowsiness, depression and confusion.

After Your Surgery

Click here for information about how to care for yourself after the surgery and what to expect during your recovery. It is very important that you follow your surgeon's instructions. Your post-operative rehabilitation may include hand exercises, heat and massage therapy, electrical nerve stimulation, splinting, traction, and special wrappings to control swelling. Keep in mind that surgery is just the foundation for recovery. It's crucial that you follow the therapist's instructions and complete the entire course of therapy if you want to regain the maximum use of your hand. Also, remember that the child may be one handed for up to six to eight weeks after their procedure. This can affect school and after-school activities as well as bathing, eating and dressing.