As one of the only centers in North Carolina specializing in correcting congenital hand conditions in children, Duke’s expert care can help to treat many common conditions affecting the bones, muscles, ligaments, and nerves of the hand. Along with a team of specialists, hand and upper extremity surgeon Warren C. Hammert, MD, helps patients born with hand differences improve function and shape.

Although the hand is formed between four to eight weeks’ gestation, congenital hand differences are frequently not detected until after birth. Common congenital hand conditions include:

• Polydactyly: extra digits
• Syndactyly: webbed or fused digits
• Symbrachydactyly: missing or abnormally short digits
• Thumb hypoplasia: underdeveloped thumb that may vary from smaller to completely missing

The cause of such conditions is usually unknown. “Generally, it’s not something that was or was not done during pregnancy that caused a hand condition; it’s not parents’ fault,” Hammert says.

Other pediatric hand conditions may not be obvious until fine motor skills develop. One common example is trigger thumb, which is often noticed when the child cannot fully straighten the thumb. Occasionally it will pop when straightening. This condition can affect other digits as well. “We see patients for anything that affects the function or appearance of the hand as it’s developing,” Hammert says.

When patients present with missing fingers, extra fingers, or digits that don’t move correctly, a hand specialist can help to evaluate a child’s condition to determine the course of treatment. “We usually meet with parents right after birth to assess their child’s condition, ease their concerns, and discuss treatment,” says Hammert. “Most things we see don’t need to be treated right away. If surgery is required, we usually wait until a child is 12 to 18 months old to operate.”

Surgery is not always necessary, Hammert says. Other modalities for correcting hand conditions include bracing, casting, physical therapy, and occupational therapy.

For conditions not apparent at birth, early treatment is helpful. “We like to address most things before school age,” Hammert says. Allowing time for treatment and recovery gives children the best chance at optimal function as fine motor skills are needed in a school setting.

Even after a patient starts school, however, treatment can be helpful. “We’re happy to see patients at any point,” Hammert says, noting that Duke teams will also coordinate care if a child has other conditions that require treatment.

As a hand specialist, Hammert treats patients from infants to seniors, dealing with congenital, traumatic, or degenerative conditions at Duke Orthopaedics Arringdon and Duke Sports Science Institute. Patients can schedule by calling 919-613-7797.