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Congenital Hand Disorders

of the Upper Limb

Weeks 4 to 6

  • The critical APICAL ECTODERMAL RIDGE exerts an inductive influence on the limb mesenchyme that promotes growth & development of the limbs.  Factors play a vital role in this process.
  • The upper extremity, with pronated forearms begins to rotate externally.   
  • Developmental disturbances during this period gives rise to major congenital malformations. Early suppresion of limb development causes AMELIA (complete abscence of a limb); Late suppression causes MEROMELIA (partial abscence).

    Weeks 7 to Birth

    • By week 7 the ten finger rays appear and continue to differentiate till week 12 - 13 when the hands appear. 
    • The fingers develop as a result of cell death in the tissue between the digits (failure of this causes syndactyly). 


    • Failure of Formation
      • Transverse Arrest / Aplasia
        • Amputations: arm, forearm, wrist, hand, digits
      • Longitudinal Arrest
    • Failure of Differentiation

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