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Clinical features

Authoring team

Patients with cleft hand present with a spectrum of clinical features:

  • commonly, absence of third ray structures:
    • middle finger absent
    • may be associated with hypoplasia or absence of the middle finger metacarpal
  • less frequently, absence of neighbouring digits:
    • typically, loss of three central rays leading to a two-fingered phenotype
    • if they are present, these bordering digits may exhibit relative hypertrophy compared to the contralateral side
    • possible syndactyly of digits either side of cleft
  • with worsening of the deficit, the radial side is increasingly affected and at its extreme, a single fifth ray (little finger) may be present
  • phalnageal abnormalities:
    • angulation
    • rotation
    • delta-shaped phalanges
    • longitudinally bracketed epiphyses
    • flexion contractures of proximal interphalangeal joints
  • metacarpal abnormalities:
    • fusion
    • two metacarpals may support one phalanx on one side of the cleft
    • bifid metacarpals supporting one phalanx
    • transverse or 'cross bones' at level of metacarpal; form a triangle attached at either end by a joint of synostosis to the border rays of the cleft
  • tendon abnormalities:
    • both intrinsic and extrinsic tendons present but may insert in an anomalous manner
    • intrinsic muscles of thumb particularly affected

In typical cleft hand, these findings are often bilateral. With split-hand split-foot, clefting can occur in the feet.


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