Introduction

Clinodactyly is a congenital digital anomaly characterised by the curvature of a finger in the radial or ulnar direction, most commonly affecting the fifth digit (little finger). While frequently benign and asymptomatic, clinodactyly may indicate underlying genetic syndromes and, in some cases, can cause functional or cosmetic concerns.

Definition and Overview

Clinodactyly derives from the Greek words “klino” (to bend) and “dactylos” (finger), describing a lateral deviation of a finger, typically in the coronal plane. The condition is most often seen in the little finger, where the distal phalanx deviates towards the ring finger (ulnar deviation), but any finger can be affected. The deviation is usually painless and non-progressive, but in certain cases, the degree of angulation can interfere with hand function or cause aesthetic concerns leading to psychological distress.

Historical Background

Descriptions of abnormal finger curvature date back to early anatomical texts, but the term “clinodactyly” was popularised in the 20th century as clinical genetics advanced. Early references often associated the condition with syndromic presentations, such as Down syndrome, highlighting its role as a minor anomaly with potential diagnostic significance.

Significance

Although clinodactyly is generally considered a minor congenital anomaly, its presence can serve as a clinical clue to more complex genetic or developmental disorders. Understanding its aetiology, presentation, and management is important for paediatricians, orthopaedic surgeons, geneticists, and allied health professionals involved in the care of affected individuals.

Epidemiology

Prevalence

Clinodactyly is not uncommon, with estimated prevalence rates ranging from 1% to 19% in various populations. The wide variation can be attributed to differences in diagnostic criteria, population genetics, and study methodologies. In the general population, a mild degree of clinodactyly may be observed in up to 10% of individuals, often going unnoticed due to its asymptomatic nature.

Demographic Distribution

The condition is slightly more prevalent in males than females. Bilateral involvement is seen in approximately 60% of cases. Clinodactyly can present as an isolated finding or as part of a broader syndromic picture, particularly in paediatric populations.

Genetic Patterns

Familial cases of clinodactyly have been documented, with autosomal dominant inheritance patterns most commonly observed. However, variable penetrance and expressivity are typical, resulting in diverse clinical manifestations within affected families. Sporadic cases also occur, often with no identifiable genetic basis.

Etiology and Pathogenesis

Genetic Causes

Clinodactyly is primarily a developmental anomaly, frequently resulting from an abnormal shape or orientation of the phalangeal bones, most notably the middle phalanx. The classic anatomical abnormality is a “delta phalanx” or longitudinally bracketed epiphysis, where the bone is triangular or trapezoidal, causing the distal segment to deviate. Genetic factors play a significant role, with numerous familial cases and associations with chromosomal abnormalities.

Syndromic Associations

Clinodactyly is a recognised feature of several genetic syndromes, including:

• Down syndrome (Trisomy 21): Clinodactyly of the fifth finger is a hallmark sign, present in up to 60% of affected individuals.
• Turner syndrome (45,X): Increased incidence of digital anomalies, including clinodactyly.
• Klinefelter syndrome (47,XXY): Occasionally reported as a minor anomaly.
• Silver–Russell syndrome, Rubinstein–Taybi syndrome, and others: Clinodactyly may be part of the phenotypic spectrum.

Developmental Biology

During embryogenesis, the phalangeal bones develop from cartilaginous precursors. Disruptions in the growth plate orientation or ossification process can lead to abnormal bone shape, resulting in angular deformity. The “delta phalanx” arises from an anomalous longitudinal epiphyseal bracket, restricting normal longitudinal growth on one side and producing the characteristic curvature. Environmental factors, such as intrauterine positioning, are not considered significant contributors.

Clinical Presentation

Signs and Symptoms

Clinodactyly is typically identified in early childhood, although milder cases may go unnoticed until later in life. The primary feature is the lateral deviation of the affected finger, most often the fifth digit, at the level of the middle phalanx. The degree of angulation can range from barely perceptible to more than 30 degrees.

The condition is generally painless and does not restrict hand movement. However, in severe cases, the deviation may impair function, hinder the ability to grasp objects, or cause overlapping with adjacent fingers. Cosmetic concerns, particularly in older children and adolescents, may also prompt presentation.

Affected Digits and Severity Spectrum

While the little finger is most commonly involved, clinodactyly can affect any digit. The severity is classified based on the angle of deviation:

• Mild: Less than 10 degrees
• Moderate: 10–20 degrees
• Severe: Greater than 20 degrees

The deformity may be unilateral or bilateral and may occur in isolation or with other digital anomalies such as brachydactyly (shortening of the finger).

Diagnosis

Physical Examination

Diagnosis of clinodactyly is primarily clinical. Inspection reveals a visible lateral deviation of the digit in the coronal plane. Palpation confirms the absence of tenderness, swelling, or signs of inflammation. The range of motion is typically preserved, except in severe cases where mechanical interference may be present.

Radiological Findings

Plain radiographs of the hand are essential for confirming the diagnosis and assessing the underlying bony abnormality. The “delta phalanx” is the most characteristic finding—a wedge-shaped or trapezoidal middle phalanx with a longitudinally bracketed epiphysis. The degree of angulation, bone length, and joint involvement can be quantified on X-rays.

Differential Diagnosis

It is important to distinguish clinodactyly from other causes of finger deviation, including:

• Camptodactyly: Flexion contracture of the finger, often at the proximal interphalangeal joint.
• Madelung deformity: Wrist abnormality causing ulnar and volar deviation of the hand.
• Trauma-related angulation: Previous fractures or injuries leading to malalignment.
• Arthritis or infection: Rare in paediatric populations but can cause digital deformities.

A thorough history and examination, supported by imaging, are crucial for accurate diagnosis.

Associated Conditions

Clinodactyly is frequently seen as a component of syndromic conditions, making its identification significant in the broader context of paediatric and genetic assessment. Some commonly associated syndromes include:

• Down syndrome (Trisomy 21): Fifth finger clinodactyly is a minor diagnostic criterion and may aid in early recognition.
• Turner syndrome: Digital anomalies, including clinodactyly, contribute to the phenotypic spectrum.
• Klinefelter syndrome: Less commonly reported but relevant for comprehensive assessment.
• Other syndromes: Silver–Russell, Rubinstein–Taybi, and numerous rare genetic disorders may include clinodactyly among other features.

Awareness of these associations is vital for clinicians, as the presence of clinodactyly may prompt further genetic evaluation and multidisciplinary care.

Treatment and Management

Non-surgical Management

The majority of clinodactyly cases are mild and asymptomatic, requiring no intervention. Non-surgical management focuses on observation and reassurance. Periodic follow-up may be recommended to monitor for progression, particularly in growing children. Splinting or physiotherapy has limited efficacy due to the bony nature of the deformity.

Surgical Management

Surgical intervention is reserved for cases with significant functional impairment, severe angulation (typically greater than 20–30 degrees), or substantial cosmetic concerns. The goals are to correct the deformity, restore function, and improve appearance.

Common surgical techniques include:

• Closing wedge osteotomy: Removal of a wedge of bone from the affected phalanx to realign the finger. This is the most widely used procedure.
• Opening wedge osteotomy: Insertion of a bone graft to correct the angle, less commonly performed.
• Physiolysis: Resection of the epiphyseal bracket in young children to allow normal growth and correction over time.

Postoperative care involves immobilisation, followed by physiotherapy to restore range of motion. Complications are rare but may include infection, recurrence of deformity, or joint stiffness.

Indications and Outcomes

Surgical correction is generally successful, with most patients achieving satisfactory alignment and function. The risk of recurrence is low, particularly when the underlying bony abnormality is adequately addressed. Early intervention in growing children can prevent long-term functional limitations.

Rehabilitation

Rehabilitation following surgery focuses on restoring mobility and strength through supervised physiotherapy. Adherence to postoperative protocols is essential for optimal outcomes. In most cases, children regain normal or near-normal hand function within weeks to months.

Prognosis

The prognosis for isolated clinodactyly is excellent. Most individuals experience no functional impairment or long-term sequelae. Surgical correction, when required, yields favourable results with minimal complications. The quality of life is generally unaffected, except in rare cases with severe deformity or psychological impact due to cosmetic concerns.

In syndromic cases, the overall prognosis depends on the associated condition. Clinodactyly itself does not impact life expectancy but may contribute to the diagnostic process and multidisciplinary management of complex syndromes.

Recurrence following surgical intervention is uncommon, provided that the anatomical abnormality is adequately corrected. Long-term follow-up is recommended to monitor growth and function, especially in paediatric patients.

Nursing Care of Patients with Clinodactyly

As nursing professionals, providing care for individuals with clinodactyly involves holistic, family-centered, and multidisciplinary approaches aimed at optimizing function, comfort, and psychological well-being.

Assessment and Evaluation

Thorough assessment is essential to guide nursing care and management decisions. Nurses play a pivotal role in early detection, functional evaluation, and ongoing monitoring.

Physical Assessment

• Observe the curvature and note which finger(s) are affected.
• Assess for associated symptoms: pain, swelling, limited range of motion, or reduced grip strength.
• Evaluate hand function, dexterity, and patient ability to perform activities of daily living (ADLs).
• Look for cutaneous or skeletal signs indicative of syndromic involvement.

Developmental Assessment

• Monitor developmental milestones, especially in children.
• Assess participation in age-appropriate activities, such as writing, grasping, or playing.
• Screen for other congenital anomalies or syndromic features.

Psychosocial Evaluation

• Discuss aesthetic concerns, self-esteem, and social participation, particularly in school-aged children and adolescents.
• Explore family understanding, coping strategies, and support systems.

Nursing Diagnosis

Common nursing diagnoses for patients with clinodactyly include:

• Impaired physical mobility related to finger deformity.
• Disturbed body image due to visible hand differences.
• Risk for social isolation related to perceived stigma.
• Knowledge deficit regarding the condition and treatment options.

Planning and Goals

The overarching goals of nursing care for clinodactyly are to:

• Promote optimal hand function and independence in ADLs.
• Foster positive self-image and psychosocial well-being.
• Educate patient and family about the condition, management, and prognosis.
• Coordinate multidisciplinary referrals and interventions as needed.
• Advocate for the patient’s rights and inclusion in all activities.

Interventions and Nursing Actions

Physical Care

• Monitoring: Regularly assess the affected digit for changes in curvature, discomfort, or functional loss.
• Supportive Devices: Collaborate with occupational or physical therapists to provide splints or adaptive equipment to improve hand function and comfort.
• Pain Management: Administer analgesics if pain is present; educate on non-pharmacologic pain relief methods (e.g., warm compresses, gentle exercises).
• Facilitate Mobility: Encourage active range-of-motion exercises if prescribed to maintain flexibility and prevent contractures.

Functional and Occupational Support

• Work with therapy professionals to develop hand-strengthening and coordination exercises.
• Recommend adaptive tools (e.g., customized pens, utensils) for children or adults with fine motor difficulties.
• Assess the need for school accommodations (e.g., extra time for writing tasks, technology aids).

Pre- and Post-Surgical Care

In rare cases of severe clinodactyly, surgical correction may be indicated, especially if the deformity interferes with hand function.

• Pre-operative: Prepare the patient and family with education about the procedure, expected outcomes, risks, and recovery.
• Post-operative: Monitor surgical site for signs of infection, edema, or impaired circulation. Provide wound care and pain management.
• Support rehabilitation through therapy and encouragement of gradual increase in hand use.

Psychosocial and Emotional Support

• Offer emotional support, especially to children and adolescents concerned about appearance or peer relationships.
• Facilitate access to counseling or support groups when needed.
• Educate families on strategies to boost resilience and self-esteem in affected children.
• Promote participation in school and social activities, emphasizing abilities and strengths.

Education and Advocacy

• Teach families about clinodactyly, including causes, natural history, and potential complications.
• Provide information on genetic counseling if a hereditary syndrome is suspected.
• Dispel myths and reduce stigma by facilitating open discussions in the home and school setting.
• Advocate for the patient’s inclusion in all environments, challenging discrimination and promoting awareness.

Family-Centered Care

Clinodactyly often impacts not only the patient but also their family. Nurses should practice family-centered care that:

• Respects cultural, individual, and familial values.
• Includes family members in decision-making and care planning.
• Recognizes the importance of emotional and practical support for siblings and caregivers.
• Encourages participation in therapy sessions, education meetings, and community events.

Collaboration with the Multidisciplinary Team

Optimal outcomes for patients with clinodactyly arise from coordinated care involving:

• Pediatricians or primary care providers for medical management and surveillance.
• Orthopedic or hand surgeons for assessment and interventions in severe cases.
• Occupational and physical therapists to maximize hand function and independence.
• Social workers, psychologists, and counselors for psychosocial needs.
• Geneticists for syndromic clinodactyly or family counseling.

Discharge Planning and Long-Term Follow-Up

• Develop individualized discharge plans based on patient age, severity of clinodactyly, and family needs.
• Schedule regular follow-up visits for monitoring of finger curvature, function, and psychosocial adjustment.
• Provide contact information for support services and therapy resources.
• Educate on signs that require prompt medical attention: increasing pain, loss of function, signs of infection post-surgery.

REFERENCES

1. Banda DN, Yaish AM. Clinodactyly. [Updated 2023 Jun 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556068/
2. Merck Manual. Down Syndrome (Trisomy 21)., https://www.merckmanuals.com/professional/pediatrics/chromosome-and-gene-anomalies/down-syndrome-trisomy-21?
3. Moeller A. Clinodactyly., https://journals.lww.com/techortho/fulltext/2019/03000/clinodactyly.5.aspx. Techniques in Orthopaedics. 2019; 34.1; 18-25.
4. Goldfarb C. (2012). Congenital hand andarm differences: Clinodactyly.
   http://congenitalhand.wustl.edu/2012/07/clinodactly.html
5. Banda DN, Yaish AM. Clinodactyly. 2023 Jun 15. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan–. PMID: 32310528.
6. Matošević M, Lamot L, Antičević D. CAMPTODACTYLY AND CLINODACTYLY – NEW UNDERSTANDING OF KNOWN DEFORMITIES. Acta Clin Croat. 2022 Feb;60(3):525-531.

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