Camptodactyly

Camptodactyly

Camptodactyly is the progressive flexion deformity of the PIPJ. This article details the aetiology, features, classification and management of this congenital hand condition.

Summary Card


Definition
Progressive flexion deformity of the PIPJ

Clinical Features
Often bilateral and little finger. An X-Ray may show secondary complications.

Classification
Classified based on onset of deformity and severity of the flexion.

Management
Serial splinting and education for most patients. Surgery has a low success rate.


Definition of Camptodactyly

Camptodactyly is the progressive flexion deformity of the proximal interphalangeal joint. Swanson classifies as a 'failure of differentiation'.

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Tip: the progressive nature of this condition is a key differentiator to arthrogryposis. 


Features of Camptodactyly


Key Point

Camptodactlyly is a flexion deformity of the PIPJ that is usually the little finger and bilaterally. Radiology may show secondary sequelae. It is classified based on onset of deformity.


Clinical Features

Camptodactyly is characterised by the progressive flexion deformity of the proximal interphalangeal joint.  Some key points include:

  • Abnormal flexion posture of PIPJ.
  • Painless without swelling
  • Often bilateral and involves the little finger

Often caused by abnormal lumbrical insertion (HINT: pain on passive extension), short FDS tendon, abnormal extensor mechanism.  

The differential diagnosis includes:

  • Traumatic PIPJ injury
  • Arthrogrposis: congenital, ulnar deviation, multiple joints
  • Symphalangism (failure of joint formation) if no skin creases.  

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Tip: Examining PIPJ extension with MCPJ flexed can differentiate between intrinsic and extrinsic causes.

Radiological Signs

Generally speaking, an X-Ray will not show any primary cause for the camptodactyly as its aetiology is of soft tissue origin. It can show some secondary changes, such as:

  • Morphological changes to the proximal phalanx
  • Decrease in proximal phalanx head convexity
  • Flattening at the base of the middle phalanx.
  • Loss of PIPJ joint space with volar subluxation.

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Tip: a flattened dorsal phalanx is often not surgically correctable. 


Classification of Camptodactyly

Camptodactyly classification is based on the onset of flexion deformities.

  • Type I: occurs during infancy (the most common type)
  • Type II: occurs during pre-teenage years
  • Type III: severe, multiple digits, associated with syndromes  

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Fun Fact: Type II camptodactyly can progress to Type III.


Management of Camptodactyly


Key Point

The majority of the patients with camptodactyly can be treated conservatively with splinting and education. Surgery is difficult to achieve a successful outcome.


Patients with camptodactyly can be treated by conservative or surgical options. This depends on their extent of their severity.

The majority of patients can be managed in an outpatient setting by:

  • Education
  • Physiotherapy
  • Serial Splinting  or casting

In a select number of patients with severe disease, surgical considerations can include:

  • FDS transfer to extensor surface
  • Angulation osteotomy
  • Fusion

Surgery should be performed in a step-wise manner to release and reconstruct structures until the flexion deformity is corrected.


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