Hand Surgery Source

Clinodactyly - observation

Test, Exam and Signs

Historical Overview

  • The term clinodactyly derives from the Greek “kleinen,” to bend, and “daktylos,” finger.1
  • In 1896, Smith published the first X-ray photo of clinodactyly.1

Description

  • Clinodactyly most often affects the middle phalanx of the little finger, although it can affect other digits. Patients with clinodactyly present with an angulation of 15-60° in the radial ulnar plane, as opposed to camptodactyly, which is in the flexor extension plane.
  • Clinodactyly is common in children with Down’s syndrome. Parents or guardians may find evidence of clinodactyly when a child is aged 2-10 years.2 The child may have difficulty with activities such as playing musical instruments.3
  • A radiographic diagnosis can only be made when the child’s skeletal system is fully developed.3,4

Pathophysiology

  • The clinodactyly test can help to diagnose clinodactyly, brachydactyly, camptodactyly, or Kirner’s deformity.

Instructions

  1. Observe the fingers of the affected hand, with close attention to the middle or proximal phalanx of the little finger.
  2. Check for an angulation of >15° in the radial-ulnar plane.
  3. Confirm the diagnosis by taking a patient history and using radiographs.
  4. Examine the contralateral hand, as clinodactyly is often bilateral.

Variations

  • None

Related Signs and Tests

  • Range of motion (ROM)
  • Radiographs
  • Magnetic resonance imaging (MRI)
Presentation Photos and Related Diagrams
Clinodactyly
  • Clinodactyly left fifth finger
    Clinodactyly left fifth finger
  • The plane of deformity that would be seen in a ulnar deviated clinodactyly is shown in blue.
    The plane of deformity that would be seen in a ulnar deviated clinodactyly is shown in blue.
Definition of Positive Result
  • A positive result occurs when the middle or proximal phalanx of the little finger shows an angulation of 15-60° in the radial-ulnar plane.
Definition of Negative Result
  • A negative result occurs when the middle or proximal phalanx of the little finger does not show any irregular angulation. 
Comments and Pearls
  • For patients younger than 6 years, with clinodactyly secondary to a delta phalanx, early physiolysis can be a useful treatment. Because this treatment tends to show only gradual improvement, careful follow-up is required.2,5
  • For older patients, closing wedge osteotomy can be a beneficial treatment. Be vigilant for distal interphalangeal joint stiffness.6
Diagnoses Associated with Tests, Exams and Signs
References
  1. Poznanski AK, Pratt GB, Manson G, Weiss L. Clinodactyly, camptodactyly, Kirner’s deformity and other crooked fingers. Radiology1969;93(3):573-82. PMID: 5822733
  2. Caouette-Laberge L, Laberge C, Egerszegi EP, Stanciu C. Physiolysis for correction of clinodactyly in children. J Hand Surg Am2002;27(4):659-65. PMID: 12132092
  3. Goldfarb CA, Wall LB. Osteotomy for clinodactyly. J Hand Surg Am2015;40(6):1220-4. PMID: 25892713
  4. StraussNL, Goldfarb CA. Surgical correction of clinodactyly: two straightforward techniques. Tech Hand Up Extrem Surg2010;14(1):54-7. PMID: 20216055
  5. Medina JA, Lorea P, Elliot D, Foucher G. Correction of clinodactyly by early physiolysis: 6-year results. J Hand Surg Am2016;41(6):e123-7. PMID: 26972556
  6. Piper SL, Goldfarb CA, Wall LB. Outcomes of opening wedge osteotomy to correct angular deformity in little finger clinodactyly. J Hand Surg Am2015;40(5):908-13. PMID: 25754787