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| GENERAL UPPER EXTREMITY PROBLEMS |
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| Congenital Abnormalities of the Upper Extremity |
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| What are they? |
| Congenital abnormalities (also called congenital
anomalies) of the upper extremity are differences
from normal that are present at birth. The differences
can range from mild to severe. Examples of
congenital abnormalities in the hand include:
having more than or fewer than five fingers; fingers
that won't bend; fingers that are too short, crooked,
or webbed; and constriction bands on the fingers
and/or hand. Examples of congenital abnormalities
in the arm include: an arm that is bowed, bones and
joints that have not formed normally, and a part of or
whole arm that has not formed at all. Some of these
differences are known to happen along with other
problems, while some are isolated differences. |
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| What causes them? |
| There are many causes of congenital abnormalities.
Some can be explained and others have no known
causes. The process of development of a baby from
a fertilized egg involves millions of complicated
steps, any of which can go wrong. The upper limbs
form between the fourth and seventh week of
pregnancy; the baby is less than an inch long during
this phase of development. It is estimated that one in
20 babies born will have some imperfection, major
or minor. |
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| Some congenital problems are inherited, just like
eye or hair color for example. Some of these
inherited problems may skip generations or show up
in the children of parents who each pass on a trait to
the child. Some genetic problems are new
occurrences where the new baby is the first to have
the condition, but that child may pass it on to his or
her children. |
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| Other congenital problems have non-genetic cause.
Certain drugs, such as thalidomide and
chemotherapy agents, are known to cause birth
defects. Street drugs, tobacco, and alcohol all
affect the development of a baby but are not
generally connected with specific upper extremity
problems. Congenital constriction bands, where
threads of the amniotic membrane separate from
the lining and become wrapped around the fingers
and/or hand, can cause deformity in some babies
during pregnancy. Although we understand how
constriction bands happen, the cause is mostly
unknown. |
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| Congenital problems sometimes happen with no
explanation as to when, why, or to whom. One of the
many steps in the development of the baby went
wrong and changed the arm or hand. Your
physician can help you find answers to your
questions about what happened and, if possible,
why it happened. Your physician may refer you and
your child for more studies and possibly a visit to a
geneticist to help with a specific diagnosis and
determine whether the condition is hereditary. |
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| Coping with your emotions. |
| Shock, anger, and guilt are normal emotions after
the birth of a child with a congenital abnormality. All
of your dreams of the perfect baby did not take
place, and now each family member must cope
with their feelings. Rarely is there anything parents
could have done differently— yet they blame
themselves. |
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| Your newborn doesn't realize that he or she is
different. The baby has all the normal needs of any
newborn. The way the baby has formed is normal for
him or her; without pain and without a sense of loss.
After your grief has eased, questions will follow: Is
there any treatment for this problem? Will surgery
help? Will my child be able to tie shoes or hold a
pencil? Talk to your pediatrician and hand surgeon
about resources available such as support groups,
therapists, and caring physicians to help you and
your child. |
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| © American Society for Surgery of the Hand 2000 |
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