Hand Surgery Source

Constriction Bands (Amniotic)

Test, Exam and Signs

Historical Overview

  • Amniotic constriction bands have been called by many names, including constriction band syndrome, syndactyly and Streeter’s dysplasia.1

Description

  • Amniotic constriction bands may become visible in utero or at birth. Constriction may occur when fetal parts become entangled by amniotic strands.2
  • A finger or fingers or toes may be intrinsically amputated or may have to be amputated by surgery because of inadequate blood supply.

Pathophysiology

  • The origins of amniotic constriction bands are still uncertain. Origins may include maternal abdominal injury or drug use. Genetic predisposition may also play a part in the condition, but evidence for this is inconclusive.3

Instructions

  1. Amniotic constriction bands are diagnosed by OBSERVATION. This diagnosis is confirmed by completing a history, physical examination and by performing imaging studies if appropriate but careful observation is the basis of the camptodactyly diagnosis.
  2. If possible, obtain an accurate and complete history of the patient’s development in utero.
  3. Observe the patient’s hand for missing or differently formed fingers.
  4. Ask the parent or guardian how their child’s hand function is impeded by the effects of the amniotic constriction bands.
  5. Discuss the possible functional and cosmetic outcomes of surgery with the parents or guardians.1,2
  6. Examine the contralateral hand.
  7. Evaluate the capillary refill distal to all constrictions.

Related Signs and Tests

  • 2-D ultrasound3
  • 3-D ultrasound3
  • Magnetic resonance imaging (MRI)

Diagnostic Performance Characteristics

  • At the end of the first or the beginning of the second trimester ofpregnancy, 3-D ultrasound will provide a more reliable diagnosis of amniotic constriction bands than 2-D ultrasound.3

Related Diagnoses

  • Amniotic constriction bands
  • Syndactyly
  • Streeter’s dysplasia
Presentation Photos and Related Diagrams
Amniotic Constriction Bands
  • Amniotic constriction band mild (arrow), severe (double arrow) and congenital amputations (A) secondary to bands
    Amniotic constriction band mild (arrow), severe (double arrow) and congenital amputations (A) secondary to bands
Definition of Positive Result
  • A positive result occurs when the patient presents with missing or deformed fingers consist with amniotic bands.4
Definition of Negative Result
  • A positive result occurs when the patient does not presents with missing or deformed fingers consist with amniotic bands.4
Comments and Pearls
  • After birth, parents or guardians may consider surgical procedures to separate the child’s fingers. Operative options include excision of amniotic constriction bands plus Z-plasty, release of fenestrated syndactyly, and expanding of digital web spaces.5
  • Occasionally urgent Z-pladsties should be considered because of compromised vascular supply.
Diagnoses Associated with Tests, Exams and Signs
References
  1. Richardson S, Khandeparker RV, Pellerin P. Amniotic constriction band: a report of two cases with unique clinical presentations. J Korean Assoc Oral Maxillofac Surg 2017;43(3):171-7. PMID: 28770158
  2. Kawamura K, Chung KC. Constriction band syndrome. Hand Clin 2009;25(2):257-64. PMID: 19380064
  3. Nardozza LM, Araujo Júnior E, Caetano AC, et al. Prenatal diagnosis of amniotic band syndrome in the third trimester of pregnancy using 3D ultrasound. J Clin Imaging Sci 2012;2:22. PMID: 22616039
  4. Rayan G, Akelman E. The Hand: Anatomy, Examination and Diagnosis. Philadelphia: Lippincott Williams & Wilkins, 2012
  5. Drury BT, Rayan GM. Amniotic constriction bands: secondary deformities and their treatments. Hand (NY) 2018 Epub. PMID: 29319351