DEFORMITY
What is deformity?
Deformity means a shape other than the normal. This may be an abnormality from the normal in the general population or a change from that patient’s normal position. Some deformities occur due to congenital problems i.e. are present at birth. Many others occur due to wear and tear problems and others due to injury. They may or may not be associated with other symptoms such as pain, stiffness or weakness. In essence anything in the hand that looks abnormal to a patient can rightly be considered a deformity.
The deformities can be classified as: a change in shape but no change in size; an increase in size; and a decrease in size. (There may well be some cross-over between these).
A change in shape but no change in size: This usually implies an underlying structural abnormality such as a fracture (break of a bone) or a contracture most commonly Dupuytren’s disease (see information sheet), but it can be congenital or developmental (not present at birth but occurring during growth).
An increase in size: This usually implies a growth. Mostly they will be of the soft tissues either a cyst (ganglion) or a solid lump (see information sheets) but they can be bony.
A decrease in size: This usually implies wasting of soft tissues. It may be due to generalised disuse such as after an injury or perhaps a stroke. Commonly it implies muscle wasting due to a nerve problem typically carpal tunnel syndrome or ulnar nerve entrapment (see information sheets).
Why does it occur?
The pathology i.e. underlying abnormality depends upon the condition as described above.
What happens if nothing is done?
(This is referred to as the natural history i.e. what happens if Nature runs its own course.) This depends upon the diagnosis.
A change in shape but no change in size: If this is due to a bony problem it will probably not change as it is most commonly due to a fracture healed with displacement. If it is due to contracture this may be progressive like Dupuytren’s disease or static such as contracture following injury which usually settle out over a few months. Developmental and congenital deformities may progress during growth.
An increase in size: This usually implies a growth. Mostly they will be of the soft tissues either a cyst (ganglion) or a solid lump (see information sheets) but they can be bony. Solid lumps almost always continue to grow, but cysts may settle in part or completely (see information sheets).
A decrease in size: Wasting typically progresses although once the muscle is severely wasted then there may be no more wasting possible and a static position may be reached.
Making the diagnosis
The Hand specialist who sees the patient will ask questions about their symptoms, when they started, how they progressed, what treatment (if any) they have had and other questions relevant to the problems. They will then examine the patient looking at some or all of the elbows, wrists and hands. Careful palpation often confirms the nature of the problem,
What test(s) might be performed?
Tests (also known medically as Investigations) include X-rays, scans, blood tests and particularly in the hand electrical tests (known as EMGs or Neurophysiology). These may be used to help make or confirm a diagnosis after a patient has described their symptoms and been examined.
In many cases the diagnosis is usually obvious after listening to and examining a patient. If not the commonest test is probably an X-ray for bone abnormalities but in theory any investigation may be appropriate.
Treatment:
What are the non-operative and operative treatments?
Treatment should start with non-operative options. These include activity modification (which usually does not give much benefit or has already been tried by the patient), physiotherapy, splints and a steroid injection. These will depend upon the specific diagnoses. Most of all treatment will largely depend upon the patients symptoms:
A change in shape but no change in size: If this is due to a bone abnormality it will need to be rebroken and fixed. We have developed a minimally invasive technique that avoids opening the finger to address many of these deformities. The commonest progressive soft tissue deformity is Dupuytren’s disease. This usually ends up requiring an operation although again that may be a minimal intervention (see information sheet).
An increase in size: If this is due to a cyst e.g. a ganglion it can be aspirated but surgery may be necessary (see information sheet). If this is due to a solid mass that typically continue enlarging and so is best excised sooner rather than later as that is generally technically easier (see information sheet).
A decrease in size: Localised causes e.g. nerve entrapment can be treated and as wasting implies significant nerve dysfunction surgery is usually but not always indicated (see information sheets on carpal tunnel syndrome and ulnar nerve compression).
