Mesoaxial Polydactyly

Mesoaxial polydactyly of the fingers means there is an extra finger in the middle part of the hand, usually next to the index, middle, or ring finger. Doctors call it “central polydactyly” because the extra finger appears in the central three fingers, not at the thumb side (preaxial) or little-finger side (postaxial). It is a rare birth difference that happens while the baby’s hand is forming in the womb. The extra finger can be small or fully formed, and it may share bones and joints with the normal fingers.Frontiers+1

Mesoaxial polydactyly is present at birth and is a type of congenital limb malformation. It can occur in just one hand or in both hands. Sometimes it appears alone (isolated), and sometimes it is part of a larger genetic syndrome that also affects the feet, face, heart, or other organs. Because the central fingers are important for grip and fine movements, this condition can affect how the hand works, especially if joints are stiff or fingers are joined together.malacards.org+1

Mesoaxial polydactyly of the fingers means a person is born with one or more extra fingers in the middle part of the hand, usually around the third or fourth finger. The extra finger is often joined to the nearby finger by bone (osseous syndactyly), so the bones and joints may be fused or shared. This type of extra finger is different from extra thumbs (pre-axial) or extra little fingers (post-axial). It is a rare congenital (present at birth) hand difference and may appear alone or as part of genetic syndromes such as Bardet–Biedl or Pallister–Hall.NCBI+1

In mesoaxial polydactyly of fingers, the main problems are finger alignment, joint stability, grip strength, and hand appearance. Children may have difficulty holding pencils, buttons, or small objects, and older patients can feel pain, stiffness, or social embarrassment. Diagnosis is usually based on physical examination and X-rays to study the number of bones, joints, and shared structures.Cleveland Clinic+1

Other names for mesoaxial polydactyly of fingers

Doctors, geneticists, and classification systems use several names for the same or very similar problems. Common alternative names include:

• Central polydactyly of fingers

• Central hand polydactyly

• Mesoaxial hand polydactyly

• Polydactyly of the middle three fingers

• Polydactyly affecting the 2nd finger (index), 3rd finger (middle), or 4th finger (ring)

• Intercalary or insertional polydactyly (terms used in some genetic databases)

These names appear in medical databases such as MedGen, SNOMED CT, and the Human Phenotype Ontology, and they all describe an extra finger in the central axis of the hand.monarchinitiative.org+2NCBI+2

Types of mesoaxial polydactyly of fingers

Researchers and surgeons describe different “types” based on which finger is duplicated and how the bones are arranged. These are simple list descriptions in plain words:Frontiers+1

• Type 1 – Extra index finger: An extra finger next to or partly sharing bones with the index finger.

• Type 2 – Extra middle finger: Duplication of the middle finger, which may be the most noticeable because this finger sits in the center of the hand.

• Type 3 – Extra ring finger: An extra finger near the ring finger, which may share tendons and joints.

• Type 4 – Partial duplication of a phalanx: Only part of a finger bone is doubled, so the fingertip or middle part of a finger is split or wider than normal.

• Type 5 – Complete separate extra digit: A fully formed extra central finger with its own bones and joints.

• Type 6 – Extra finger that shares a joint: The extra digit and the normal finger share the same joint or metacarpal bone.

• Type 7 – Complex duplication with syndactyly: Extra central finger combined with fused fingers (syndactyly).

• Type 8 – Bilateral central polydactyly: Extra central fingers in both hands.

• Type 9 – Central polydactyly with split-hand or split-foot changes: Extra central fingers seen with deep clefts in the hand or foot, as in split-hand/foot malformation.malacards.org+1

• Type 10 – Central polydactyly in a known syndrome: Any central polydactyly that clearly occurs as part of a named genetic syndrome (for example, some GLI3-related conditions).Springer+1

These “types” are not the same as every formal surgical classification, but they help explain the different patterns that can appear in the clinic.NCBI+1

Causes of mesoaxial polydactyly of fingers

Many causes of mesoaxial polydactyly are genetic, meaning they are related to changes in genes that control limb development. In most cases, there is no single thing the parents did or did not do that caused it.Frontiers+1

1. Isolated familial mesoaxial polydactyly (autosomal dominant inheritance)
   In some families, central polydactyly appears in several generations. A child may inherit one changed gene from an affected parent and have a 50% chance of showing extra fingers. This pattern is called autosomal dominant inheritance, and the condition may be limited to the hands without other health problems.Lippincott Journals

2. GLI3 gene mutations
   The GLI3 gene helps control the hedgehog signaling pathway, which guides how the front-to-back axis of the hand forms. Mutations in GLI3 are a well-known cause of different types of polydactyly, including central or mesoaxial patterns in some families.Springer+1

3. SHH (Sonic Hedgehog) pathway regulatory changes
   The Sonic Hedgehog (SHH) pathway is very important for where and how many fingers form. Changes in DNA regions that control SHH expression (such as the ZRS enhancer) can lead to extra digits. While many such changes cause thumb-side or little-finger-side polydactyly, they can also contribute to central duplication in some situations.Amegroups+1

4. DLX5 and DLX6 gene variants
   DLX5 and DLX6 are genes that help shape the skeletal pattern of the hands and feet. Variants affecting these genes or their control regions in chromosome 7q21.3 are strongly linked with split-hand/foot malformation and mesoaxial polydactyly patterns.genopedia.com

5. WNT10B gene mutations
   Biallelic (two-copy) variants in WNT10B have been reported in people with split-hand/foot malformations, which can include central extra digits. This means both parents carry one changed copy, and the child inherits both.genopedia.com+1

6. HOXD cluster regulatory changes (2q31 region)
   Structural changes near the HOXD gene cluster on chromosome 2q31 can disturb limb patterning. These changes may shift the “map” that tells the hand where to form each finger, leading to central extra fingers along with other patterns.genopedia.com+1

7. TP63 gene variants
   TP63 is another limb-patterning gene. Pathogenic variants can cause split-hand/foot malformations with central extra digits, as well as problems with skin, teeth, or cleft lip/palate. In such syndromes, mesoaxial polydactyly is one feature among many.genopedia.com+1

8. Chromosome 7q21.3 rearrangements
   Deletions, duplications, or complex rearrangements at 7q21.3 can disrupt important control “switches” for DLX5/DLX6, leading to split-foot malformation–mesoaxial polydactyly syndrome. Hands and feet may both be affected.genopedia.com

9. Other chromosomal copy-number variants
   Some children have mesoaxial polydactyly as part of larger chromosome changes (extra or missing sections of DNA). These copy-number variants can change expression of several limb-development genes at once and lead to complex hand anomalies.Frontiers+1

10. GLI3-related syndromes (e.g., Greig cephalopolysyndactyly, Pallister-Hall)
    Certain GLI3 mutations cause broader syndromes with head, brain, and limb differences. In these conditions, polydactyly may be central, preaxial, postaxial, or mixed; central involvement is sometimes seen when syndactyly or clefts are present.Springer+1

11. Split-hand/foot malformation (SHFM) syndromes
    SHFM is a group of conditions where the central part of the hand or foot is split or missing. In some families, instead of a deep split, there is a central extra finger or toe, so mesoaxial polydactyly is part of the same disease spectrum.genopedia.com+1

12. Other skeletal dysplasia syndromes with polydactyly
    Some skeletal dysplasias (disorders of bone growth) can feature multiple patterns of extra digits, including central ones. These conditions often include short stature, abnormal bones, or heart problems as well as polydactyly.Frontiers+1

13. Consanguinity (parents related by blood) in recessive conditions
    When both parents share some ancestry, they are more likely to carry the same rare recessive gene variant. In such families, autosomal recessive limb malformation syndromes with central polydactyly can appear.Frontiers+1

14. New (de novo) gene mutations
    Sometimes a genetic change appears for the first time in the child, and neither parent has it. These de novo mutations can affect genes like GLI3 or regulators near DLX5/DLX6 and cause mesoaxial polydactyly without any family history.genopedia.com+1

15. Mosaic genetic changes
    In mosaicism, not all cells have the same DNA change. If only some limb-bud cells carry the variant, one hand may be more affected than the other, or only a few fingers may show duplication. This can explain very uneven or asymmetrical central polydactyly in some patients.genopedia.com+1

16. Undiagnosed single-gene disorders
    Even with modern tests, some patients show central polydactyly but no known genetic cause. Doctors believe these cases still result from single-gene changes in yet-unknown limb development genes.WJGNet+1

17. Maternal diabetes in early pregnancy (possible risk factor)
    Babies of mothers with poorly controlled diabetes have a higher risk of some limb anomalies. Although the strongest links are with other hand and foot problems, polydactyly has also been reported more often in these pregnancies, so this may be a contributing factor in some cases.WJGNet

18. Certain teratogenic medicines and environmental exposures (possible)
    Some medicines or toxins taken early in pregnancy can disturb limb bud development. The evidence for a direct link to central polydactyly is limited, but teratogens are known to cause a range of limb differences, so they are sometimes considered in the history.WJGNet+1

19. In-utero mechanical influences in complex limb anomalies
    Very rarely, mechanical factors like severe uterine constraints can interact with genetic susceptibilities and change how limbs grow, contributing to unusual patterns of polydactyly. These influences usually act on top of an underlying genetic risk.EPOS+1

20. Truly unknown cause (idiopathic cases)
    In a number of children, no clear genetic or environmental cause is found even after detailed testing. These cases are called idiopathic. The condition is still real, and parents should not blame themselves, because many limb malformations arise from complex factors we do not fully understand yet.Frontiers+1

Symptoms and functional problems

Not every child with mesoaxial polydactyly has the same symptoms. Some only have cosmetic differences, while others have problems with fine movement or grip.NCBI+1

1. Visible extra finger in the middle of the hand
   The most obvious sign is one or more extra fingers between the thumb and little finger. Parents usually notice this at birth. The extra digit may look normal or may be smaller, bent, or shaped differently.NCBI+1

2. Widened or split appearance of a central finger
   Sometimes the finger looks wide or “split” because the bones inside are duplicated but share skin and soft tissues. This can make the finger appear as two partial fingers stuck together.malacards.org+1

3. Syndactyly (fused fingers)
   In many central polydactyly cases, two or more fingers are joined by skin or deeper tissues. This is called syndactyly and can limit independent finger movement.Medscape+1

4. Abnormal finger alignment (angulation or deviation)
   Extra bones and shared joints can pull the finger to one side, so it bends toward the thumb or little finger. This angulation may get worse as the child grows if not corrected.orthobullets.com+1

5. Stiff joints in the involved fingers
   The joints of the extra or main finger may be stiff because of abnormal joint surfaces or tight soft tissues. This can make it hard for the child to fully bend or straighten the finger.orthobullets.com

6. Weak grip strength
   Because the central fingers are important for power grip, duplication with poor alignment or stiffness can weaken overall grip and make it harder to hold heavy objects firmly.NCBI+1

7. Reduced pinch and fine motor control
   Tasks like holding a pencil, using buttons, or picking up small objects may be harder. The extra finger can get in the way or make coordination more complicated for the child.NCBI+1

8. Hand fatigue or discomfort with heavy use
   Misaligned joints and altered tendon pull can cause the hand to tire quickly or feel uncomfortable when the child does sports or long writing tasks.orthobullets.com+1

9. Skin irritation or rubbing between crowded fingers
   When many fingers are packed into a small space, skin can rub and get sore, especially if the extra finger is partly mobile and moves against its neighbor.NCBI+1

10. Self-consciousness or emotional distress about hand appearance
    Older children and teenagers may feel shy or worried about how their hand looks. They might hide their hands or avoid some activities because of fear of teasing.MD Searchlight+1

11. Difficulty fitting into standard gloves or tools
    Extra fingers or unusual shapes can make it hard to use normal gloves, musical instruments, or sports equipment, which may need special adaptation.NCBI+1

12. Associated foot differences
    In some syndromes, the feet also have central polydactyly or split patterns. This can affect balance, walking, or shoe fitting, although some people adapt well.genopedia.com+1

13. Associated limb or skeletal differences
    Because mesoaxial polydactyly can be part of a wider syndrome, there may be other skeletal changes such as limb length differences, vertebral anomalies, or chest differences.Frontiers+1

14. Other organ or system involvement in syndromic cases
    Some genetic syndromes that include central polydactyly can also affect the heart, kidneys, face, or nervous system. These problems are not caused by the extra finger itself but by the shared genetic cause.ResearchGate+1

15. No functional problem (cosmetic difference only)
    In a number of children, the extra central finger does not cause pain or major functional limits. The main concern may be cosmetic appearance or future risk of joint problems as the hand grows.NCBI+1

Diagnostic tests for mesoaxial polydactyly of fingers

Doctors use a mix of clinical examination and tests to understand the exact structure of the hand, look for related problems, and identify possible genetic causes. Not every child needs all tests; the choice depends on how complex the hand looks and whether a syndrome is suspected.NCBI+2orthobullets.com+2

Physical examination tests

1. Visual inspection and counting of digits
   The doctor carefully looks at both hands (and often the feet) to count the number of digits, note which fingers are duplicated, and see if the condition is on one or both sides. They check for symmetry, nail shape, and any skin clefts or fusions. This simple step guides all later tests.NCBI+1

2. Palpation of bones and joints
   By gently feeling the bones and joints, the doctor can tell whether the extra finger has its own bones or shares bones with the neighboring finger. They feel for joint lines, bumps, and areas of tenderness. This helps plan surgery if needed.orthobullets.com+1

3. Assessment of range of motion
   Each finger is moved through bending and straightening to see how well it moves. The doctor notes which joints are stiff, hypermobile, or blocked. This shows how much the duplication affects actual function, not just appearance.orthobullets.com+1

4. Neurovascular examination (nerve and blood supply check)
   The examiner checks capillary refill (how quickly blood returns to the fingertip after pressing), skin color, warmth, and sometimes light-touch and pin-prick feeling. This confirms that each finger has good blood flow and nerve function before and after any treatment.orthobullets.com

5. General physical and dysmorphology examination
   The doctor looks at the child’s overall growth, head shape, face, chest, spine, and other limbs for signs of a genetic syndrome. This whole-body check is important because central polydactyly is often part of a larger pattern of anomalies.Frontiers+1

Manual and functional tests

6. Grip strength test
   For older children, a small hand dynamometer or simple “squeeze my fingers” test shows how strong the grip is. Comparing right and left sides helps decide whether surgery might improve, worsen, or not change overall strength.orthobullets.com+1

7. Pinch strength test
   The child is asked to pinch objects between thumb and index finger, or between thumb and a central finger. The doctor watches how the extra finger helps or interferes with the pinch and whether the child prefers certain fingers for fine tasks.orthobullets.com+1

8. Fine motor and dexterity testing (pegboard or small objects)
   Simple tasks such as placing pegs into holes, picking up coins, or stringing beads show how well the child controls each finger. These tests reveal practical problems in daily life that may not be clear just by looking at the hand.orthobullets.com+1

9. Joint stability and ligament testing
   The doctor gently pushes the finger sideways and forwards/backwards at each joint to see if the ligaments are stable. Unstable joints in duplicated fingers may sway or give way, which affects the choice of which finger to keep and how to reconstruct the joint.orthobullets.com+1

10. Functional task observation (writing, self-care tasks)
    The child may be asked to write, draw, button clothing, or hold a cup while the doctor watches. This “real life” testing shows how the extra finger influences everyday activities and helps decide if surgery is mainly cosmetic or also functional.NCBI+1

Lab and pathological tests (mainly for genetics)

11. Chromosomal microarray analysis (CMA)
    This lab test looks for extra or missing pieces of chromosomes (copy-number variants) across the whole genome. It can detect changes like deletions or duplications at 7q21.3, 2q31, or other regions that are known to cause limb malformations and mesoaxial polydactyly.genopedia.com+1

12. Targeted limb-malformation gene panel
    A gene panel tests many known limb development genes at once (for example, GLI3, DLX5, DLX6, WNT10B, TP63 and others). It is useful when the pattern of limb anomalies suggests a genetic syndrome but the exact gene is not obvious.Frontiers+2Springer+2

13. Single-gene testing for GLI3
    When the child’s features match a GLI3-related syndrome, or when central polydactyly appears along with certain facial or skull findings, a specific GLI3 test may be ordered. Finding a GLI3 mutation can confirm the diagnosis and guide family counselling.Springer+1

14. Single-gene testing for TP63 or other candidate genes
    If the hand pattern suggests split-hand/foot or if the child has tooth, skin, or clefting problems, the lab may test TP63. Other single genes can be added based on the clinical picture. This focused approach can be quicker and cheaper than broad testing in some cases.genopedia.com+1

15. Whole-exome or whole-genome sequencing
    When standard tests are negative, doctors may recommend sequencing most or all coding genes. This broad test can discover rare or new gene changes linked to mesoaxial polydactyly and related anomalies, especially in complex or syndromic cases.WJGNet+1

Electrodiagnostic tests

16. Nerve conduction studies (NCS)
    In most simple polydactyly cases, nerve tests are not needed. However, if the child has numbness, weakness, or suspected nerve injury (for example, after previous surgery), nerve conduction studies can check if signals travel normally along the digital nerves of the hand.WJGNet+1

17. Electromyography (EMG)
    EMG measures how muscles respond to nerve signals. It is rarely required just for mesoaxial polydactyly, but may be used if doctors think there is a broader neuromuscular problem or if muscle function is unclear before complex reconstruction.WJGNet+1

Imaging tests

18. Plain X-ray of both hands
    X-rays are the main imaging test for polydactyly. They show the number, shape, and arrangement of bones, the presence of shared joints, and any missing bones. Surgeons rely heavily on these images to decide how to remove or reshape bones while preserving function.orthobullets.com+1

19. Prenatal ultrasound
    Sometimes, extra fingers are seen on fetal ultrasound during pregnancy. Central polydactyly is harder to see than postaxial or preaxial types, but careful scanning of the hands and feet can suggest a limb malformation and prompt planning for postnatal evaluation.Wikipedia+1

20. 3D imaging (CT or MRI) in complex cases
    In very complicated hand differences, or when bones are fused in unusual ways, 3D CT or MRI can give detailed pictures of bone and soft tissue. These tests are not routine but can help the surgical team plan more precise reconstruction in selected patients.orthobullets.com+1

Non-pharmacological treatments

1. Detailed parent and patient education
   Education sessions explain what mesoaxial polydactyly is, why it happened, and what treatment options exist. The doctor and therapist use simple drawings and models to show how the bones and joints look and how surgery can help. Clear education reduces fear, supports realistic expectations, and helps families take active roles in decision-making and home care.Cleveland Clinic+1

2. Observation and regular follow-up
   In very mild cases or before surgery age, doctors may simply watch the hand over time. Regular check-ups track growth, function, and any pain or skin problems. This gentle approach avoids early surgery and lets the team plan the best timing for operation based on the child’s development and family preference.Cleveland Clinic+1

3. Hand therapy and range-of-motion exercises
   Certified hand therapists teach safe movements for the fingers, wrist, and hand. Gentle stretching keeps joints flexible and stops stiffness after surgery. Strengthening exercises are introduced slowly as healing progresses. Regular practice improves grip, pinch, and fine motor control, helping the child use both hands in daily life.handsurgeryresource.net+1

4. Occupational therapy for daily activities
   Occupational therapists focus on real-life tasks such as dressing, writing, using tools, and self-care. They break tasks into simple steps and suggest easier ways to hold objects or change hand position. Therapy may happen through games and school-like activities, making learning fun and less stressful for the child.Cleveland Clinic+1

5. Fine motor skills training
   Special exercises target small, precise movements, such as picking up beads, using tweezers, threading strings, and doing puzzles. These activities train coordination between eyes and fingers, which may be affected by finger duplication or stiffness. Improved fine motor skills help with writing, art, and classroom tasks.Cleveland Clinic+1

6. Splinting and custom orthotic devices
   Therapists may use soft or rigid splints to support fingers after surgery, keep them straight, and protect repaired joints and tendons. Sometimes splints are used before surgery to maintain alignment or reduce strain on weak joints. Custom orthoses are designed to be comfortable, removable, and easy for parents to manage.handsurgeryresource.net+1

7. Scar management and massage
   After surgery, scars can become thick or tight and may limit motion. Scar massage with simple creams, along with silicone gel sheets or pressure garments, can soften scar tissue and improve appearance. This also reduces tenderness, making it easier for the child to use the hand without discomfort.handsurgeryresource.net+1

8. Desensitization therapy
   Some children feel extra sensitivity or “electric” sensations around scars and surgical areas. Desensitization therapy uses gentle rubbing with different textures (cotton, cloth, sponge) to slowly retrain the nerves and brain. Over time, this reduces unpleasant feelings and helps the child tolerate touch during daily activities.handsurgeryresource.net+1

9. Strength and endurance training
   Simple exercises like squeezing soft balls, putty, or springs slowly build muscle power in the hand and forearm. As strength improves, the child can hold heavier objects, play sports, and participate more fully in school and play. Exercises are carefully progressed to avoid overloading healing bones or joints.handsurgeryresource.net+1

10. Play-based therapy
    Therapists often use toys, games, and art activities as “hidden therapy.” Building blocks, drawing, musical instruments, and video games that require hand control keep children engaged while they practice movement and coordination. This playful approach reduces anxiety and makes long-term therapy more acceptable to families.Cleveland Clinic+1

11. School accommodations
    Some children need extra time for writing, larger grips on pencils, or permission to use a keyboard. Occupational therapists can recommend simple classroom adjustments to teachers. These changes reduce frustration, prevent hand fatigue, and support equal participation in school activities.Cleveland Clinic+1

12. Adaptive devices and modified tools
    Special grips, wide-handled cutlery, easy-open jars, and modified sports equipment can make daily tasks easier. These tools are chosen based on the child’s specific hand pattern after surgery. They reduce strain on joints, decrease pain, and allow more independence at home and school.Cleveland Clinic+1

13. Psychological counselling and support
    Children and parents may feel worried or sad about the appearance of the hand or the idea of surgery. Counselling provides a safe space to talk about feelings, build self-esteem, and learn coping skills. Psychological support helps families make informed decisions and adjust to life before and after treatment.Cleveland Clinic+1

14. Peer and family support groups
    Meeting other families who have children with congenital hand differences can reduce loneliness and fear. Support groups share real experiences about surgery, recovery, and long-term outcome. Families can learn practical tips and see positive examples of children living active, happy lives.Cleveland Clinic+1

15. Tele-rehabilitation and remote follow-up
    Video visits, messaging, and digital exercise plans allow therapists to guide families who live far from specialist centers. Tele-rehab makes it easier to adjust splints, check exercises, and answer questions without frequent travel. This improves adherence and continuity of care over months or years.PubMed+1

16. Ergonomic training for older children and adults
    For older patients, therapists may teach better ways to lift, carry, and type to avoid strain on the reconstructed finger. Adjusting desk height, keyboard position, and gripping style reduces pain and protects joints from long-term wear and tear.handsurgeryresource.net+1

17. Sports and activity counselling
    Doctors and therapists help families choose safe sports and activities that match hand strength and joint stability. With proper protection and gradual training, many patients can take part in athletics, music, or hobbies while protecting the operated finger from injury.Cleveland Clinic+1

18. Pre-operative planning sessions
    Before surgery, the team discusses the operative plan, possible risks, expected scars, hospital stay, and rehabilitation steps. Pre-operative planning reduces anxiety, improves cooperation after surgery, and ensures that parents understand consent and realistic outcomes.PubMed+1

19. Post-operative wound and skin care training
    Parents are taught how to keep bandages clean and dry, watch for infection signs, and manage dressings at home. Good wound care lowers complications, promotes faster healing, and protects the reconstruction. Clear written instructions and demonstrations are very helpful.Medscape+1

20. Vocational guidance for adults
    Adults with mesoaxial polydactyly (treated or untreated) may need guidance when choosing jobs that match their hand abilities. Vocational counsellors and therapists assess hand function and suggest suitable careers or workplace adaptations, helping the person maintain long-term employment and quality of life.handsurgeryresource.net+1

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Drug treatments

(Doses below are general example ranges from FDA-based labeling; always follow the exact dose, timing, and duration prescribed by the treating doctor.)

1. Acetaminophen (paracetamol)
   Acetaminophen is a widely used pain and fever medicine. It helps manage mild to moderate pain before and after surgery. Typical total adult dose is up to 4,000 mg per day from all sources, divided into several doses; children’s doses are weight-based and strictly limited. It works mainly by blocking pain signals in the brain. Main risks include liver damage at high doses or when combined with other acetaminophen products.FDA Access Data+1

2. Ibuprofen (oral NSAID)
   Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID) used for pain, swelling, and stiffness after surgery. It blocks cyclo-oxygenase enzymes and reduces prostaglandin production, which lowers inflammation. Adult over-the-counter doses are often 200–400 mg every 4–6 hours, with a maximum daily dose guided by the label; children get weight-based doses. Side effects include stomach irritation, kidney strain, and increased risk of heart and gut problems if used too long or at high doses.FDA Access Data+1

3. Prescription-strength ibuprofen (e.g., IV or high-dose)
   In the hospital, ibuprofen may be given in higher oral doses or intravenously for stronger pain relief. It has the same mechanism as regular ibuprofen but requires careful monitoring of kidney function, blood pressure, and bleeding risk. It is usually used for short periods after surgery and then switched to milder options.FDA Access Data+1

4. Combination acetaminophen + ibuprofen products
   Some products combine acetaminophen and ibuprofen in one tablet or solution to improve pain control while possibly reducing the amount of each drug. They use different pathways in the body, so together they can give better relief. However, they carry the combined risks of both medicines, especially liver and gastrointestinal side effects if dosing limits are exceeded.FDA Access Data+1

5. Short-acting opioids (e.g., morphine, fentanyl in hospital)
   For severe post-operative pain, doctors may use opioids such as morphine or fentanyl under close monitoring in hospital. These drugs act on opioid receptors in the brain and spinal cord to reduce the perception of pain. They are used for a short time and at the lowest effective dose to reduce risks like drowsiness, nausea, constipation, and dependence.FDA Access Data+1

6. Oral opioid combinations (e.g., hydrocodone–acetaminophen)
   After leaving the hospital, some patients may receive a very short course of opioid–acetaminophen tablets. They provide stronger pain relief than acetaminophen alone, but the duration is usually only a few days. Doctors carefully limit dose and time to lower the risks of addiction, liver injury, and other side effects. Non-opioid options are preferred whenever possible.FDA Access Data+1

7. Local anaesthetic injections (e.g., lidocaine, bupivacaine)
   During and after surgery, surgeons may inject local anaesthetic around nerves in the hand. These medicines block nerve signals so pain is reduced during the first hours after surgery. Longer-acting agents may provide relief for many hours. Side effects are rare when correct doses are used but can include numbness, metallic taste, or, at high doses, heart rhythm problems.PubMed+1

8. Regional nerve blocks (e.g., brachial plexus block)
   Anaesthetists sometimes perform nerve blocks that numb the entire arm. They inject local anaesthetic near nerve bundles to give excellent pain relief during surgery and early recovery. The effect wears off gradually. Risks include temporary weakness, prolonged numbness, or, rarely, nerve injury, so these procedures are done only by trained specialists.PubMed+1

9. Antibiotics – first-generation cephalosporins (e.g., cephalexin)
   After surgery, doctors may prescribe antibiotics such as cephalexin to prevent or treat infection in the operated hand. These drugs interfere with bacterial cell wall formation, killing susceptible bacteria. Doses and duration vary with age and infection risk. Side effects can include allergic reactions, stomach upset, or changes in gut flora.Medscape+1

10. Penicillin-class antibiotics (e.g., amoxicillin-clavulanate)
    If there is a higher infection risk or specific bacteria are suspected, amoxicillin-clavulanate may be used. Amoxicillin blocks bacterial cell wall synthesis, and clavulanate protects it from breakdown by certain enzymes. The medicine is taken with food to reduce stomach upset. Common side effects include diarrhoea, rash, and, rarely, liver problems.Medscape+1

11. Clindamycin (for penicillin-allergic patients)
    Clindamycin is used when patients are allergic to penicillins or when infections involve particular bacteria. It blocks protein synthesis in bacteria, helping the immune system clear them. It is effective but can sometimes cause diarrhoea and a serious condition called C. difficile colitis, so doctors monitor closely and avoid unnecessary use.Medscape+1

12. Non-opioid adjuvants (e.g., gabapentin)
    In some cases, medicines like gabapentin may be used to manage nerve-related pain or hypersensitivity after surgery. They modulate calcium channels and reduce abnormal nerve firing. Doses are slowly increased and then later reduced. Side effects include dizziness and sleepiness, so they are used carefully in children.FDA Access Data+1

13. Muscle relaxants (short-term use)
    Sometimes, muscle relaxant drugs are prescribed briefly if muscle spasms around the shoulder or arm increase pain after hand surgery. They act on the central nervous system to reduce muscle tone. Because they can cause drowsiness and falls, they are generally avoided in young children and used only when clearly needed.FDA Access Data+1

14. Anti-nausea medicines (e.g., ondansetron)
    Anaesthesia and opioid drugs can cause nausea and vomiting after surgery. Medicines like ondansetron block serotonin receptors and help control these symptoms. They allow patients to eat and drink sooner and keep pain medicines down. Side effects are usually mild but can include headache or constipation.FDA Access Data+1

15. Proton-pump inhibitors or H2 blockers
    If NSAIDs are needed for several days, doctors may prescribe drugs to protect the stomach, such as proton-pump inhibitors or H2 blockers. These medicines reduce stomach acid and lower the risk of ulcers and bleeding. They are especially useful in older patients or those with previous stomach problems.FDA Access Data+1

16. Topical antibiotic ointments
    After the wound has closed, some doctors recommend short-term use of topical antibiotic ointments on the skin to reduce superficial infection risk and support healing. These are applied in a thin layer and covered with clean dressings. Overuse can lead to skin irritation or allergic reactions.Medscape+1

17. Topical NSAID gels
    In some older patients, topical anti-inflammatory gels may be used over surrounding joints to reduce mild soreness without exposing the whole body to high NSAID doses. They work locally and may have fewer systemic side effects, though skin irritation is possible.FDA Access Data+1

18. Vitamin D and calcium prescriptions (when deficient)
    If tests show low bone mineral status, doctors may prescribe vitamin D and calcium to support bone strength and healing after osteotomy and reconstruction. These supplements help normal bone metabolism but must be dosed carefully to avoid high calcium levels or kidney problems.PubMed+1

19. Iron or multivitamin preparations (as needed)
    In patients with anaemia or poor nutrition, iron or full multivitamins may be given before or after surgery to support general recovery. They do not treat the finger anomaly directly but help the body make blood cells, repair tissues, and resist infection. Side effects depend on the specific product (e.g., stomach upset with iron).Cleveland Clinic+1

20. Sedative or anxiolytic medicines around surgery
    For very anxious children or complex surgery, anaesthetists may use mild sedative medicines before the operation to reduce stress and improve cooperation. These act on brain receptors to calm the patient. They are given in carefully controlled doses and monitored to avoid breathing or heart problems.PubMed+1

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Dietary molecular supplements

These supplements may support general healing and recovery but do not remove the extra finger. Always check with the doctor before starting any supplement, especially for children.

1. Vitamin C – Supports collagen formation and wound healing, helping surgical incisions close properly and scars mature.

2. Vitamin D – Helps the body absorb calcium and maintain healthy bones, which is important after bone reshaping in the finger.

3. Calcium – Works with vitamin D to support bone strength and repair following osteotomy or reconstruction.

4. Omega-3 fatty acids (fish oil) – May gently reduce systemic inflammation and support heart and brain health during recovery.

5. Zinc – Plays a key role in wound healing, immune function, and tissue repair after surgery.

6. Protein supplements (e.g., whey protein) – Extra protein can help the body build new tissue, muscles, and immune cells during recovery.

7. B-complex vitamins – Support nerve health, energy metabolism, and red blood cell production, which may help during long rehabilitation.

8. Collagen peptides – Provide building blocks for connective tissue and may support skin and tendon healing, though evidence is still emerging.

9. Probiotics – Help maintain healthy gut flora, which can be disturbed by antibiotics used around surgery.

10. Multivitamin/mineral formulas – In children with poor diet, a balanced multivitamin can help close nutritional gaps that may slow healing.PubMed+1

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Immunity-booster, regenerative and stem-cell-related drugs

1. Vitamin D (prescription form)
   Beyond bone health, adequate vitamin D supports normal immune function. Doctors may prescribe higher-dose vitamin D in patients who are deficient to improve overall resistance to infection after surgery. It is not a direct “immunity booster,” but correcting deficiency supports healthier immune responses.PubMed+1

2. Protein-rich nutritional formulas
   Medical-grade nutritional drinks with balanced protein, vitamins, and minerals help undernourished patients recover from surgery. Stronger nutrition supports immune cells, collagen formation, and muscle rebuilding. These products are used under dietitian guidance when normal diet is not enough.Cleveland Clinic+1

3. Mesenchymal stem cell therapies (experimental)
   Research in orthopaedics looks at mesenchymal stem cells to help repair bone, cartilage, and soft tissue. So far, these therapies are experimental and not standard treatment for mesoaxial polydactyly. They may in the future assist healing after major reconstruction, but must be used only in approved clinical trials.PubMed+1

4. Platelet-rich plasma (PRP) (experimental)
   PRP uses the patient’s own blood, spun down to concentrate platelets and growth factors, then injected into tissues. It may enhance healing in some tendon and ligament problems, but evidence is still mixed and limited. It is not routine care for finger polydactyly reconstruction.PubMed+1

5. Topical growth-factor dressings (research use)
   Some advanced wound dressings contain growth factors or materials that encourage tissue repair. They are sometimes used in complex wounds but are not specific to polydactyly. Their role is to improve local healing and reduce scarring, not to change bone structure.Medscape+1

6. Haematopoietic or systemic stem-cell therapies (not indicated)
   Stem-cell transplants used for blood cancers or bone marrow failure have no direct role in treating isolated mesoaxial polydactyly of the fingers. They are included here mainly to emphasise that such powerful treatments are not appropriate unless there is another serious blood disorder.PubMed+1

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Surgical treatments

1. Excision of the extra central digit
   The main surgery removes the extra finger in the middle of the hand. Surgeons choose which finger to keep based on bone quality, joint stability, and tendon alignment. The aim is to create one straight, stable finger that can move well and look natural.handsurgeryresource.net+1

2. Reconstruction of ligaments and tendons
   After removing the extra digit, surgeons carefully rebuild ligaments and tendons to centre the remaining finger and restore active motion. This may include transferring parts of ligaments or tendons from the removed digit to the preserved one. Proper reconstruction is critical for a strong grip and stable joints.handsurgeryresource.net+1

3. Bone reshaping and osteotomy
   If the bones of the preserved digit are angled or too wide, the surgeon may cut and realign them (osteotomy). Plates, wires, or sutures can hold bones in place while they heal. This step improves finger alignment and appearance and reduces long-term joint wear.PMC+1

4. Syndactyly release and web-space reconstruction
   Many mesoaxial polydactyly cases include fusion of fingers (osseous or soft-tissue syndactyly). Surgery separates the fused digits and reconstructs the skin between them (web space) using flaps or grafts. This allows independent movement of each finger and improves overall hand function.handsurgeryresource.net+1

5. Revision surgery and scar correction
   Sometimes a second operation is needed to refine alignment, correct stiffness, or improve scars as the child grows. Revision surgery might include tendon balancing, joint release, or scar revision. The goal is to maintain good function and hand appearance through growth and adulthood.PubMed+1

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Prevention

1. Most mesoaxial polydactyly is genetic or due to early limb-bud development errors, so it cannot usually be fully prevented.Wikipedia+1

2. Pre-pregnancy counselling and folic acid supplementation support general foetal development.

3. Avoiding harmful medicines, alcohol, and tobacco during pregnancy helps reduce overall birth-defect risks.

4. Managing maternal illnesses such as diabetes or thyroid problems supports healthy foetal growth.

5. Avoiding exposure to known harmful chemicals or radiation during pregnancy is important.

6. Genetic counselling is recommended for families with a history of polydactyly or related syndromes.Wikipedia+1

7. Regular prenatal check-ups and ultrasound allow early detection and planning.

8. Healthy diet and weight control during pregnancy support general foetal health.

9. Good control of chronic infections and vaccination as recommended can reduce some pregnancy risks.

10. If polydactyly recurs in a family, specialist genetic evaluation can guide future family planning options.Wikipedia+1

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When to see a doctor

You should see a doctor or specialist hand surgeon if:

• A baby is born with extra fingers, especially in the middle of the hand, or with fused digits. Early assessment allows good planning of timing and type of surgery.Cleveland Clinic+1

• The child has trouble using the hand for daily tasks, writing, or playing because of finger shape or stiffness.

• There is pain, swelling, redness, or discharge around the extra finger or previous surgical site, which may mean infection or joint problems.Medscape+1

• The hand deformity is getting worse with growth, or new deformity appears after previous surgery.

• There are signs of a possible genetic syndrome (such as kidney problems, vision issues, or developmental concerns) together with polydactyly; this needs evaluation by a geneticist.Ovid+1

• Parents or the patient feel embarrassed or distressed about appearance or function and want to discuss surgical or non-surgical options.

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What to eat and what to avoid

1. Eat plenty of fruits and vegetables – They provide vitamins, minerals, and antioxidants that support wound healing and immune function.

2. Choose lean proteins – Fish, eggs, beans, and lean meat supply amino acids needed to build new tissue after surgery.

3. Include whole grains – Brown rice, oats, and whole-wheat bread give long-lasting energy for recovery and rehab exercises.

4. Stay well hydrated – Water supports blood flow, temperature control, and nutrient transport to healing tissues.

5. Use healthy fats – Nuts, seeds, olive oil, and oily fish provide essential fatty acids that support cell membranes and reduce mild inflammation.

6. Limit sugary snacks and drinks – Too much sugar can promote weight gain and may worsen general inflammation.

7. Avoid very salty processed foods – Excess salt can cause fluid retention and may affect blood pressure around surgery.

8. Avoid heavy alcohol (for adults) – Alcohol can interfere with wound healing, liver function, and medicine safety.

9. Avoid smoking and second-hand smoke – Smoking reduces blood flow and oxygen to tissues and slows bone and wound healing.

10. Follow any special advice from surgeons or dietitians – For example, fasting rules before anaesthesia and food re-introduction after surgery.PubMed+1

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Frequently asked questions

1. Can mesoaxial polydactyly of fingers go away on its own?
   No. Because it is a structural difference in bones and soft tissues, the extra finger does not disappear by itself. Only surgery can remove or reshape the digit. Therapy and other measures can improve function but cannot change bone number.Wikipedia+1

2. Is it dangerous to leave the extra finger untreated?
   In some mild cases, the extra finger causes little trouble and can sometimes be left alone. However, many patients have functional or cosmetic issues that worsen with growth. A specialist can explain potential long-term problems and help decide if and when surgery is best.handsurgeryresource.net+1

3. What is the best age for surgery?
   Many surgeons prefer surgery between about 6 and 24 months of age, when bones are still small and joints can be shaped, but the child is strong enough for anaesthesia. Timing may change based on severity, health, and local practice.Hospital for Special Surgery+1

4. Will my child have a normal hand after surgery?
   The goal is a hand that looks and works as normally as possible. Most children gain good function and improved appearance, although the finger may remain slightly different in size, shape, or motion compared with a typical finger.PubMed+1

5. Is mesoaxial polydactyly always caused by a genetic syndrome?
   No. It can appear alone or with other anomalies. However, some genetic syndromes strongly feature mesoaxial polydactyly, so doctors may recommend genetic evaluation and other tests, especially if there are additional health issues.Ovid+1

6. Does surgery need to be repeated later?
   Sometimes yes. As the child grows, bones and joints may change shape, or scars may tighten. A second operation can fine-tune alignment, correct stiffness, or improve appearance. Many patients need only one carefully planned surgery.PubMed+1

7. How long is recovery after surgery?
   Recovery time depends on the extent of surgery. Children usually wear a cast or splint for several weeks, followed by months of hand therapy. Most can return to light play early but may need more time before heavy activities or sports.Medscape+1

8. Will my child feel a lot of pain?
   Doctors use modern pain-control plans that combine local anaesthetics, acetaminophen, and NSAIDs, with opioids only when strongly needed. This “multimodal analgesia” aims to keep pain low while reducing strong-opioid use and side effects.FDA Access Data+1

9. Can exercises really help after surgery?
   Yes. Hand therapy supports joint motion, strength, and coordination. Without exercises, the finger may become stiff or weak, and the final result may be less satisfying. Therapists adapt programmes to the child’s age and interests.handsurgeryresource.net+1

10. Is the condition my fault as a parent?
    No. Mesoaxial polydactyly is usually due to genetic factors or early developmental changes that parents cannot control. Healthy lifestyle and prenatal care are important for many reasons, but they cannot fully prevent this specific anomaly.Wikipedia+1

11. Will my next child also have polydactyly?
    The chance depends on the underlying cause. In some families, there is a clear hereditary pattern; in others, it appears only once. Genetic counselling and, in some cases, testing can help estimate recurrence risk for future pregnancies.Ovid+1

12. Can physical therapy alone replace surgery?
    No. Therapy can improve strength and coordination but cannot remove or reshape extra bones and joints. For significant deformity, surgery remains the main corrective treatment, with therapy as a very important partner afterwards.handsurgeryresource.net+1

13. Are there any medicines that can shrink or dissolve the extra finger?
    No medicines can remove or shrink the extra finger. Drugs are used to control pain, infection, and inflammation during and after surgery. Claims that pills or injections can “dissolve” bone or extra fingers are not supported by scientific evidence.Wikipedia+1

14. Is stem-cell therapy a proven cure for this condition?
    Currently, stem-cell and regenerative therapies for limb reconstruction are experimental and mostly limited to research settings. They may help healing in the future, but they are not established, routine, or guaranteed treatments for mesoaxial polydactyly of fingers.PubMed+1

15. Where should I seek care for my child?
    It is usually best to see a multidisciplinary team with experience in paediatric hand surgery, including congenital hand surgeons, anaesthetists, therapists, and, when needed, geneticists and psychologists. These teams can provide integrated, evidence-based care and long-term follow-up.handsurgeryresource.net+1

Disclaimer: Each person’s journey is unique, treatment plan, life style, food habit, hormonal condition, immune system, chronic disease condition, geological location, weather and previous medical  history is also unique. So always seek the best advice from a qualified medical professional or health care provider before trying any treatments to ensure to find out the best plan for you. This guide is for general information and educational purposes only. Regular check-ups and awareness can help to manage and prevent complications associated with these diseases conditions. If you or someone are suffering from this disease condition bookmark this website or share with someone who might find it useful! Boost your knowledge and stay ahead in your health journey. We always try to ensure that the content is regularly updated to reflect the latest medical research and treatment options. Thank you for giving your valuable time to read the article.

The article is written by Team RxHarun and reviewed by the Rx Editorial Board Members

Last Updated: December 18, 2025.