1. Dr Bakhtyar Baram

2.  The most important aim in the treatment is to gain the function of the hand.  In Embryo,by 6 weeks the digital rays begin to appear,after that modelling of the limbs and the formation of joints and separate digits. Complitted by 8th week.  Mallformation may occure during embryonic development because of either defective formation or incoomplete separation of mesenchymal components.  2 in every 1000 has deformity.  It is important to gain the confidence of the family and remember that the children are likely to be long term pt.s.  They must be given a diagnosis and idication of prognosis, reassurance about the future and long term plan..  Examination in a child friendly setting may be in parent s lap. Toys.  May be part of alarge syndrome, or genetic problem.

3.  Function, using it in everyday, how important.  Progression of deformity,  Appearance, self-confidence, the child will hide it.  Pain, like construction ring syndrome.

4.  Transverse arrest, may be in proximal forearm, protheses when adult or fingers  Longitudinal arrest,  Radial dysplasia which is rare and it may be apart of other assosiated disease. And the treatment if it is mild just learn the parrents gentle stretching. Or surgical soft tissue correction, attension must be paid to the deformity of the elbow joint in the same time.  Ulnar dysplasi almost same but surgery littel different.  Central dysplasia,v shaped cleft in the hand, may be assosiated with one or more fingers.

5.  Syndactyly, conjoined digits is the commonest type, may be simple only soft tissue or complex,skin and bone, or complete which affecting the entire web or incomplete which affect part of the web. In central digigits may need no treatmering but in the border digits like thumb to index or littel to ring finger may cause progressive deformity and surgery will be indicated in the early age.  Camptodactyly, bent finger is a flexion deformity of the pip joint usually little finger. Splinting or surgery may be indicated.  Duplication, polydactyly or extra digit, common in the littel finger can be removed easy in first 4 monthes,  Overgrowth, or macrodactyly, must be distinguished from other causes like in neurofibromatosis,  Undergroth brachydactyly, common,surgery like oppostion transfer.

6.  Very common, arises from leakage of synovial fluid from ajoint or atendon and contains a glairy, viscous fluid.  Back of the wrist is the commonest type, a painless swelling or lump, well defined and not move. Sometimes causing compression on the nerves like on the deep branch of ulnar nerve.  Normally no treatment, but it is indicated when there is sign of compression or cosmotic  Recurrence is possible after the operation.

7.  Caused by thickening of the first extensor compartment sheath on the extensor pollicis brevis and abductor pollicis longus.  Middel aged women complain of pain on the radial side of the wrist,there may be history of hard or ubnormal activity,,there is tenderness on the radial stylodid and may be swelling.  Finkelsteins sign is pathognomotic, hold the pt thumb in full flexion and turn the wrist to adduction the pt feel sharp pain and tenderness in that area.  DD is arthritis in the basis of thumb or scaphoid non union or intersection syndrome.  Treatment by local cortison injection,,ultrasoun or splintage can be used  Or surgery which is slitting of the thckened sheath, care must be taken to the dorsal sensory branch of the radial nerve

8.  Other cases of tenosynovitis or tenovaginitis like in intersection syndrome which is pain and swelling over the tendons of of extensor pollicis brevis and abductor pollicis longus proximal to the site of de quervains disease.mostly weight lifter and even rest og cortison injection or surgery in widening of second compartment.  Other types is in extensor carpi radialis brevis at the common extensor compartment by trauma  In flexor region mostly in flexor carpi radialis and ulnaris.  All of them has relation to the occupation and hard work, need rest og anti inflammatory medicine, cortison injecion, splintage or surgery.

9.  In the wrist, normally after trauma or fracture or may be after rhumatic diseases. Or lunatum malacia.normally all syptoms and signs of osteoarthritis can be seen like pain and tenderness and limited movement and in x ray sclerosing with narrowing of joint space osteophute and joint distruction.treatment is splintage, anti inflammotory medicine, arthrodese or joint replacement  In the basis of the first metacarpal bone is common espically middelaged women or older, tenderness in the region with pain in movement, cortison ilocal injection or tendon interpositions arthroplastic.  DIP joint OA, same, arthrodese is one of the good treatment.  Pisiform bone, tenderness TULNART AND VOLART SIDE,removal of the bone without affecting flexor carpi ulnaris tendon.