Congenital deformities are deformities that are present at birth. Any kind of deformity becomes a challenge as children grow older. Those that affect the hands and the rest of the arm are particularly disabling as children learn to interact with their environment through the use of their hands. These anomalies range from simple to severe and examples of this spectrum are having fewer or more than 5 fingers, having non-bending fingers that are too short or too long, which are joined together, having arms that are curved, joints that are not. completely formed and do not move as expected or have parts of the arm that are not formed.

Some of these deformities arise associated with other problems but others arise in isolation.

What causes them?

There are many causes for congenital deformities, some can be explained but others have no known causes. The process of developing the baby from the fertilized egg is very complex, involves millions of complicated steps and in any of these there may be mistakes. The upper limb, which comprises the arm, forearm and hand, forms between the 4th and 7th week of pregnancy when the baby is less than 2.5 cm. It is estimated that 1 in 20 babies will have any imperfections of greater or lesser severity and complexity.

Some congenital anomalies are inherited, but may skip generations or may result from the combination of genetic anomalies carried by parents. Other genetic alterations are unprecedented in the family, having the child the anomaly for the first time but presenting the risk of transmitting it to their descendants.

Other congenital deformities have non-genetic causes. Some medicines, such as the well-known thalidomide and some medicines used in chemotherapy, are known to be responsible for birth defects. Alcohol, tobacco and drugs affect fetal development but are not specifically related to upper limb malformations.

Congenital constrictive braces, commonly called amniotic brids, are amniotic bands that are equivalent to wires that when wrapped around the upper (arm, forearm and hands) or lower limbs (thigh, leg and foot) can lead to various deformities, from the most creased. or less deep to amputations.

In other situations the reason for the malformation is not known. One of the numerous steps of fetal development is not completed effectively resulting in the changes found.

How to react?

While it is normal for parents to feel shocked, disillusioned, or guilty, it is important to realize that they could rarely have done anything that would interfere with the baby’s development and prevent the malformation from occurring. The baby, despite the deformity, has the same needs of any newborn and has no pain or any suffering associated with the deformity it has.

Shortly after birth, a hand surgery appointment should be scheduled. Although surgery is not immediately or always indicated, it is important to define the need for rehabilitation with physiotherapy or occupational therapy and eventual referral for genetics consultation.

What can be done?

The goal for any child with a congenital malformation is to have the limb function involved as close to normal as possible.

To achieve this goal may require rehabilitation with physical therapy or occupational therapy, the use of splints or prostheses or surgery. Each child should be assessed individually and treatment should be chosen not only for the present deformity, but also for difficulties with function.