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How are CHDs managed by the health service?

  • Hand differences are rare, and each hand difference is unique.
  • Not all hand differences actually need any treatment. A personalised management plan will need to be made by discussing your child’s hand difference when you see a Hand Surgeon who specialises in treating children’s hand differences.
  • Most hand differences do not need immediate treatment – the exception being arthrogryposis and some conditions with wrist and elbow involvement, when early intervention with therapy including stretching and splints can be helpful.
  • Diagnostic information from x-rays may not be helpful until the child is older because the bones are very soft in the first few months after birth.
  • Surgery, if appropriate, will aim to improve function by improving the way the hand and arm works. Consideration is also given to the appearance/cosmesis of the hand
  • Occasionally the hand difference in your child might be part of a ‘syndrome’ which includes other abnormalities. Your clinician may therefore offer to refer you and your child to a geneticist especially if you have a family history of limb differences. However the majority of childfren with congenital hand differences are otherwise healthly.

Hand Therapy:

  • Hand therapy is the non-surgical management of hand disorders and injuries using physical methods such as exercise, splinting and wound care.
  • The hand therapist can assist with emotional and psychological support, as well as with restoration of hand function.
  • Hand therapy has a crucial role in the recovery from hand surgical operations. Hand therapy is integrated into the hand surgery team.


  • The aim of all surgical procedures is to improve function and cosmesis. It is not possible for surgery to restore a normal hand.
  • The best time for a surgical procedure is often between 12 and 18 months of age when the child is old enough to safely undergo an elective procedure. At this age recovery from surgery is relatively quickly achieved.
  • A protective bandage will be worn after the surgery until the wounds are healed. A child of this age is less distressed when a bandage prevents movement. Removing a bandage is also relatively stress free in this age group.
  • However sometimes it is better to wait until a fuller pattern of use of the hand is seen before reconstructive surgery is offered.
  • There is no right or wrong decision with regards to surgery! Children will adapt extremely well and will become independent adults who contribute to society with or without a surgical intervention.