Congenital Disorders

Congenital disorder involves defects or damage to a developing fetus. It may be the result of genetic abnormalities, the intrauterine (uterus) environment, errors of morphogenesis, or a chromosomal abnormality. The outcome of the disorder will further depend on complex interactions between the pre-natal deficit and the post-natal environment.[1] Congenital disorders vary widely in causation and abnormalities. Any substance that causes birth defects is known as a teratogen.

Other terms and definitions

  • A congenital physical anomaly is an abnormality of the structure of a body part. An anomaly may or may not be perceived as a problem condition. Many, if not most, people have one or more minor physical anomalies if examined carefully. Examples of minor anomalies can include curvature of the 5th finger (clinodactyly), a third nipple, tiny indentations of the skin near the ears (preauricular pits), shortness of the 4th metacarpal or metatarsal bones, or dimples over the lower spine (sacral dimples). Some minor anomalies may be clues to more significant internal abnormalities.
  • A congenital malformation is a congenital physical anomaly that is deleterious, i.e. a structural defect perceived as a problem. A typical combination of malformations affecting more than one body part is referred to as a malformation syndrome.
  • Birth defect is a widely-used term for a congenital malformation, i.e. a congenital, physical anomaly which is recognizable at birth, and which is significant enough to be considered a problem. According to the CDC most birth defects are believed to be caused by a complex mix of factors including genetics, environment, and behaviors,[1] though many birth defects have no known cause.
  • Genetic disorders or diseases are all congenital, though they may not be expressed or recognized until later in life. Genetic diseases may be divided into single-gene defects, multiple-gene disorders, or chromosomal defects. Single-gene defects may arise from abnormalities of both copies of an autosomal gene (a recessive disorder) or of only one of the two copies (a dominant disorder). Some conditions result from deletions or abnormalities of a few genes located contiguously on a chromosome. Chromosomal disorders involve the loss or duplication of larger portions of a chromosome (or an entire chromosome) containing hundreds of genes. Large chromosomal abnormalities always produce effects on many different body parts and organ systems.
  • A congenital metabolic disease is also referred to as an inborn error of metabolism. Most of these are single gene defects, usually heritable. Many affect the structure of body parts but some simply affect the function.

Hand Injuries

Most common hand surgeries include repairing injures of hands, nerves, tendons, blood vessels and joints. Bone fractures, burns and cuts are the other injuries to the skin that needs proper treatment and surgical correction and medication.

Plastic surgeons use numerous techniques to repair the damages done. Skin grafting, Flap Surgery, replantation and transplantation are the various surgical methods to restore the hands of its deformities.

Grafting: Grafting is transfer of nerves, tissues, skin and bone from other healthy parts of the body to repair the injured portion of the hand.

Flap Surgery requires moving from the healthy part of the body to the injured part, skin with the fat layer underneath, muscles, vessels and tissues.

Replantation involves microsurgery usually performed under magnification. These injuries are generally performed on accidentally amputated hands and may require various operations over a continued period of time.

Surgery of the hands may restore feelings and may function naturally after a period of time. Complete post operation therapy is needed for proper function.

Carpal Tunnel Syndrome
The wrist has a passageway called the carpal tunnel which carries tendons and one of the major nerve's of the hand. Due to various reasons such as injury, overuse, fluid retention during pregnancy or rheumatoid arthritis pressure may build up within the carpal tunnel. This results in a tingling sensation in the hand, ache and numbness.

Treatment
Anti-inflammatory medicine or splinting of the hand is done to relieve the problems. However if there is no relief surgery has to be performed. The surgery is performed by making an incision in the midsection of the palm till the wrist. The tissue building pressure on the nerve is then cut off. Splints are used to dress up the wound and restrict movement and promote healing.

Rheumatoid Arthritis
Rheumatoid Arthritis is a crippling disease of the hand that restricts function as well as affects the appearance. The finger joints inflame and bend the fingers which restricts them from proper movement.

When therapy of the hands does not solve the problem surgery is the best option. Surgery does not cure rheumatoid arthritis so a regular visit to rheumatologist is needed for continuing care. The Surgeon repairs the part of the hand by eliminating the tissue from the swollen joints, repositions the tendons and implants artificial joints. Surgery can help one to make significant use of the hand.

Dupuytren's Contracture

It is a disorder of the skin in the palm area. The tissue underneath the palm gets thick and extends till the fingers. The thickened tissue extending till the palm pulls them towards the palm thus restricting proper movement. This is a disease which occurs in middle age but has no particular cause and is generally hereditary disease.
Surgery is the only treatment where the surgeon works on the thickened tissues by separating each of them carefully so as not to damage the nerves and free the tendons to allow significant movement of the hand. Sometimes skin grafts are also needed.