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Updated: May 22 2021


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  • summary
    • Camptodactyly is a rare congenital condition of the hand that is characterized by a digital flexion deformity that usually occurs in the PIP joint of the small finger.
    • Diagnosis is made clinically.
    • Treatment is usually observation with passive stretching in the majority of cases. Surgical management is indicated in cases of progressive deformity leading to functional impairment.
  • Epidemiology
    • Prevalence
      • less than 1%
    • Anatomic location
      • unilateral (33%) or bilateral (66%)
        • if bilateral, can be symmetric or asymmetric
  • Etiology
    • Pathophysiology
      • typically caused by either
        • abnormal lumbrical insertion/origin
        • abnormal (adherent, hypoplastic) FDS insertion
        • other less common causes include
          • abnormal central slip
          • abnormal extensor hood
          • abnormal volar plate
          • skin, subcutaneous tissue, or dermis contracture
    • Genetics
      • most often sporadic
      • can be inherited with autosomal dominant inheritance with incomplete penetrance/variable expressivity
    • Associated conditons
      • can be associated with more widespread developmental dysmorphology syndromes
  • Classification
      • Benson Classification
      • Type
      • Characteristics
      • Treatment
      • Type I
      • Isolated anomaly of little finger, presents in infancy and affects males and females equally
      • Most common form
      • Stretching/splinting
      • Type II
      • Same clinical features as Type I, presents in adolescence
      •  Affects girls more often than boys.
      • Form abnormal lumbrical insertion, abnormal FDS origin or insertion
      • If full PIP extension can be achieved actively with MCP held in flexion, digit can be explored and abnormal
        FDS tendon transferred to radial lateral band
      • Type III
      • Severe contractures, multiple digits involved, presents at birth
      • Usually associated with a syndrome
      • Non-operative (unless functional deficit exists after skeletal maturity), then consider corrective osteotomy/fusion
      • Kirner's Deformity
      • Specific deformity of small finger distal phalanx with volar-radial curvature (apex dorsal-ulnar)
      • Often affects preadolescent girls
      • Often bilateral
      • Usually no functional deficits
  • Presentation
    • Symptoms
      • often goes unnoticed as usually only affects small finger and is very rarely associated with any significant compromise in function
      • typically painless and without motor/sensory deficits
    • Physical exam
      • flexion deformity of small finger PIP joint
        • flexible (correctable) or fixed (non-correctable) deformity
        • progressively worsens over time if untreated
        • may rapidly worsen during growth spurts
      • normal strength, sensation, perfusion
      • usually normal DIP and MCP joint alignment, however compensatory contractures can develop
      • no swelling, erythema, or warmth; not associated with inflammation
  • Imaging
    • Radiographs
      • often normal, especially in early stages
      • later stages: possible decrease in P1 head convexity; possible volar subluxation and flattening of base of P2
  • Treatment
    • Nonoperative
      • passive stretching, splinting
        • indications
          • nonoperative treatment is favored in most cases
          • best for PIP contracture < 30 degrees
        • technique
          • passive stretching + static splinting
        • outcomes
          • variable outcomes
          • best outcomes with early intervention
    • Operative
      • FDS tenotomy +/- FDS transfer
        • indications
          • progressive deformity leading to functional impairment
        • technique
          • must address all abnormal anatomy
          • passive (correctable) deformities
            • FDS tenotomy, or
            • FDS transfer to radial lateral band if full active PIP extension can be achieved with MCP flexion
      • osteotomy vs. arthrodesis
        • indications
          • severe fixed deformities
        • outcomes
          • variable outcomes
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