Bilateral Fifth-Finger Camptodactyly

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Excerpt

A 31-yr-old woman was referred to the physical medicine and rehabilitation clinic with bilateral deformities of the fifth fingers, which began in her early teens. She had no history of major trauma and no pain, swelling, or erythema in her fingers. There was no family history of similar anomalies. Before the physical medicine and rehabilitation evaluation, she had seen several other physicians. An orthopedist with whom she had consulted initially told her that the deformities might have emerged because of unnoticed trauma. At an internal medicine clinic, a thorough work-up, including rheumatoid factor, sedimentation rate, C-reactive protein, hemogram and various biochemical assays, had normal findings. Her physical medicine and rehabilitation examination revealed flexion contractures of the proximal interphalangeal joints of the fifth fingers of both hands; the contracture was more prominent in the left hand (Fig. 1A, B). Her locomotor system and systemic examination findings were normal. She received a diagnosis of camptodactyly and reconsulted with the orthopedic surgeon, who refused surgical intervention.
Camptodactyly is a permanent flexion contracture at the proximal interphalangeal joints. Most cases are limited to fifth-finger involvement; however, other fingers may also be involved.1,2 The incidence of camptodactyly is approximately 1% in the general population, and involvement is frequently bilateral. Although its inheritance is sporadic, an autosomal dominant pattern with variable penetrance and expressivity has been reported. Two types of camptodactyly have been defined: one is notable in the first year of life, and the other manifests after 10 yrs of age for reasons that remain unclear.1,2
Camptodactyly may accompany other anomalies or a number of very rare syndromes. Therefore, physicians should carefully examine patients for other musculoskeletal deformities.1 Isolated camptodactyly is not a rare condition; however, it may be overlooked if it is restricted to the fifth fingers and does not influence hand function. The condition can be mistaken for other rheumatologic disorders, including rheumatoid arthritis and Dupuytren contracture. The diagnosis of this deformity at the onset is of utmost importance because the use of splints and stretching at that time may be useful. Early identification of the condition will also prevent unnecessary diagnostic work-up and patient anxiety. If the condition is left untreated for several years, the position of permanent fixation leads to contracture in the joint.2 Surgery may be considered if conservative measures have failed.
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