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).
INTERNATIONAL (FDD.OUC)
- Failure of Formation
- Transverse Arrest / Aplasia
- Amputations: arm, forearm, wrist, hand, digits
- Longitudinal Arrest
- Failure of Differentiation
- A. Synostosis: elbow, forearm, wrist, metacarpals, phalanges
- B. Radial head dislocation
- C. Symphalangism
- D. Syndactyly
- Simple
- Complex
- Associated syndrome
- E. Contracture
- i. Soft tissue
- ii. Skeletal
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Specific Nerve Injuries & Tendon Transfers
