Acheiria

Acheiria means a person is born without one hand (unilateral) or both hands (bilateral). It is a type of congenital limb reduction where the hand does not form in the womb. The forearm bones may be normal, short, or partly missing. Acheiria can occur alone or with other limb differences. It is not the fault of the child or the parents. Most children with acheiria are healthy and can learn to do almost everything with practice, therapy, and the right tools or prostheses. There is no medicine that grows a new hand. Care focuses on safe movement, independence in daily life, pain prevention, good body mechanics, and emotional well-being.

Acheiria means a person is born without a hand. It can be one hand (unilateral) or both hands (bilateral). Doctors call it a congenital limb reduction defect of the hand. “Congenital” means it happens before birth while the baby is growing in the womb. In acheiria, the bones, muscles, nerves, skin, and blood vessels that make a normal hand do not fully form. The missing part is usually at the end of the forearm where the hand should be. Sometimes the forearm is also shorter than usual.

Acheiria can happen by itself (isolated) or together with other problems in the body (syndromic), such as heart, kidney, or spine differences. Most cases are not caused by anything the parents did. Very often the exact reason is unknown. Babies with acheiria can still grow, learn, and live well with the right care, early therapy, family support, and, when helpful, a prosthetic hand.

Other names

• Hand agenesis

• Aplasia of the hand

• Terminal transverse limb deficiency (hand)

• Congenital absence of the hand

• (Sometimes grouped within) symbrachydactyly spectrum or transverse limb deficiencies

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Types

1. By side

   • Unilateral acheiria: one hand is absent (left or right). This is the most common.

   • Bilateral acheiria: both hands are absent. This is less common and usually has bigger daily-life impact.

2. By association

   • Isolated: only the hand is affected; other organs are normal.

   • Syndromic: happens with other body differences (for example, heart, spine, ribs, kidney, or chest muscle differences).

3. By limb pattern

   • Terminal transverse deficiency: the hand is missing at the end of the forearm (the most typical pattern in acheiria).

   • Intercalary/segmental deficiency: a middle part of the limb is missing with the end part also absent or small (less typical for pure acheiria).

4. By symmetry and severity

   • Symmetric vs. asymmetric: in bilateral cases both sides may look similar or different.

   • Complete vs. partial: a full hand is absent (classic acheiria) vs. only small hand parts formed (border with severe symbrachydactyly).

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Causes

1. Amniotic band sequence
   Thin strands from the inner womb lining can wrap around a tiny growing limb and cut off blood flow. This can stop the hand from forming or lead to loss of the hand early in growth.

2. Vascular disruption (blood-supply problem)
   Very early in pregnancy, a temporary block or drop in blood flow to the limb bud can happen. Without steady blood, the hand tissues do not develop.

3. Apical ectodermal ridge (AER) failure
   The AER is a small, important tissue at the limb tip that sends “grow forward” signals. If it is damaged or missing, the end of the limb (the hand) may not form.

4. Sonic hedgehog (SHH) pathway disturbance
   SHH is a key signaling pathway that tells the limb where the thumb side and little-finger side go. If disrupted, major hand parts may not form.

5. FGF (fibroblast growth factor) signaling problems
   FGF signals help lengthen the limb. If these signals are weak or missing, the distal limb (hand) can fail to develop.

6. HOX gene changes (patterning genes)
   HOX genes set the map for body parts. Some changes can prevent distal limb segments from forming, causing hand absence.

7. TBX5 gene variants (e.g., in Holt–Oram spectrum)
   TBX5 helps form the upper limb and heart. Certain changes may cause serious hand/forearm differences along with heart issues.

8. WNT7A and related gene changes
   WNT signaling is needed for dorsal–ventral limb patterning. Disruption can cause severe hand malformations or near-absence.

9. Thalidomide exposure (historic teratogen)
   A medicine once used for morning sickness caused limb reduction defects. Exposure early in pregnancy can lead to missing hands.

10. Maternal pre-gestational diabetes
    High blood sugar early in pregnancy can raise the risk of limb reduction defects, including absence of a hand.

11. Maternal smoking
    Smoking can affect fetal blood flow and oxygen, raising the risk of some limb defects.

12. Maternal alcohol use (heavy)
    Alcohol can disturb early embryo development and increases certain birth defect risks, sometimes including limb reduction.

13. Very early chorionic villus sampling (CVS before 10 weeks)
    Doing CVS too early has been linked to limb reduction defects in some reports, likely from blood-flow disturbance.

14. Maternal infections (early pregnancy)
    Some infections (for example, rubella) can interfere with organ formation, occasionally including limbs.

15. Maternal high fever or heat exposure
    Hyperthermia at a critical window might affect cell growth and limb formation.

16. Uterine constraint or severe oligohydramnios
    Very tight space and low amniotic fluid can deform limbs. In extreme early cases, it may contribute to severe limb reduction.

17. Radiation exposure (significant, early)
    High, harmful radiation can damage rapidly dividing cells, possibly causing limb defects.

18. Chromosomal anomalies
    Some chromosome conditions (e.g., trisomy 13) can include limb differences, rarely up to near-absence.

19. Inherited limb deficiency syndromes / consanguinity
    In families with certain inherited conditions, important limb genes may be altered, raising the chance of severe hand defects.

20. Idiopathic (unknown cause)
    In many cases, no clear cause is found even after testing. The likely reason is a brief, early developmental disturbance.

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Symptoms

1. Visible absence of the hand at birth
   The baby has a forearm that ends early, with no palm or fingers.

2. Shorter forearm or small residual limb (“stump”)
   The bone may stop above the wrist level, making the arm shorter.

3. Limited grasp and fine motor skills
   Without a hand, pinch, grip, and manipulation are not possible on that side.

4. Need for one-handed strategies
   Children learn to dress, eat, write, and play using one hand or assistive tools.

5. Slower development of two-hand tasks
   Tasks like tying laces or opening jars are harder and slower to master.

6. Overuse of the other hand
   The intact hand does extra work, which can lead to fatigue or pain.

7. Shoulder, neck, and back strain
   People may change posture or movement patterns, causing aches and stiffness.

8. Skin problems on the residual limb
   Friction, dryness, or breakdown may happen where the limb touches surfaces or a prosthesis.

9. Neuroma pain
   Tiny nerve endings at the limb end can form painful lumps (neuromas).

10. Phantom sensations
    Some people feel tingling, warmth, or a “hand that is not there.”

11. Phantom pain
    Less common in congenital cases than in amputations, but some still feel painful phantom feelings.

12. Hypersensitivity at the limb end
    The skin can be extra sensitive to touch, pressure, or cold.

13. Emotional stress
    Feelings of sadness, worry, or frustration are normal and deserve support.

14. Social challenges
    Children may face questions or stares and need kind counseling and peer support.

15. Learning curve with prosthetics or devices
    If a prosthesis is used, there is a training period with therapy to use it well.

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Diagnostic tests

A) Physical examination

1. Full newborn/child exam
   The doctor checks overall health, growth, heart sounds, lungs, abdomen, skin, and other limbs to see if the difference is isolated or syndromic.

2. Focused limb inspection and palpation
   The clinician looks at the length, shape, soft tissue, skin condition, and any tender spots or neuromas at the limb end.

3. Range-of-motion testing (shoulder and elbow)
   The joints above the missing hand are checked for movement limits, which guides therapy and device choices.

4. Neurovascular exam
   Sensation, reflexes, temperature, pulses, and capillary refill are tested to ensure nerve and blood supply are sound where present.

B) Manual / functional tests

5. Manual Muscle Testing (MMT)
   The therapist grades muscle strength around the shoulder and elbow, and in the intact limb, to plan strengthening and tasks.

6. Grip and pinch strength (intact hand)
   Using a dynamometer and pinch gauge, strength of the other hand is measured to watch for overuse or weakness.

7. Box and Blocks Test (BBT)
   Times how many blocks can be moved to another box. It measures gross manual dexterity and tracks therapy progress.

8. Jebsen–Taylor Hand Function Test (JTHFT)
   Timed tasks like writing, lifting small objects, and feeding movements to assess functional speed in daily activities (usually on the intact hand or with devices).

9. DASH or QuickDASH questionnaire
   A short, self-reported survey about arm, shoulder, and hand function in daily life to capture real-world impact and change over time.

C) Laboratory / pathological tests

10. Chromosomal microarray (CMA)
    Looks for small missing or extra DNA pieces (copy-number changes) that can be linked to congenital differences.

11. Karyotype
    Studies the chromosome number and structure to detect larger changes sometimes associated with limb and organ differences.

12. Targeted gene panel
    Genes important for limb patterning (for example TBX5, HOXA13, WNT-pathway, SHH-pathway genes) may be checked when history or findings suggest a syndromic cause.

13. Maternal medical testing (when evaluating a newborn)
    Tests like HbA1c for pre-gestational diabetes or selected infection screens can help understand risk factors in some cases.

D) Electrodiagnostic tests

14. Nerve conduction studies (NCS)
    If the person has pain or tingling at the limb end, NCS can check for nerve injury or neuroma that might need treatment.

15. Electromyography (EMG)
    EMG shows how muscles and nerves work around the residual limb. It also helps decide if a myoelectric prosthesis could be controlled well.

16. Somatosensory evoked potentials (SSEP)
    In special cases, SSEPs test the sensory pathway from limb to brain, useful in complex neurologic assessments.

E) Imaging tests

17. Prenatal ultrasound
    During pregnancy, ultrasound can show limb differences as early as the end of the first trimester or in the second trimester, helping with planning and counseling.

18. Fetal MRI (selected cases)
    Gives clear images of soft tissues and can confirm the extent of limb absence and look for other organ differences before birth.

19. Postnatal X-rays of the limb
    X-rays show the bones of the forearm, elbow, and any wrist bones, helping plan therapy, surgery, or prosthetics.

20. Targeted imaging for associated anomalies
    For example, echocardiography if a heart difference is suspected; spine or kidney imaging if other findings suggest a syndromic condition.

Non-pharmacological treatments

A) Physiotherapy interventions

1. Early Range-of-Motion (ROM)

• Description: Gentle shoulder, elbow, and forearm movements from infancy onward.

• Purpose: Prevent stiffness and maintain joint health.

• Mechanism: Keeps the joint capsule and muscles flexible; stimulates synovial fluid.

• Benefits: Better reach, easier dressing, smoother play and sports.

2. Residual-Limb (Stump) Desensitization

• Description: Daily rubbing/tapping with soft to rough textures.

• Purpose: Reduce tenderness and prepare for prosthetic wear.

• Mechanism: Gradual sensory input retrains nerves and brain maps.

• Benefits: Less discomfort, improved tolerance of sockets and sleeves.

3. Strength Training of Shoulder Girdle

• Description: Age-appropriate resistance for deltoids, scapular stabilizers, rotator cuff.

• Purpose: Build power for lifting and reaching.

• Mechanism: Muscle hypertrophy and neuromuscular adaptation.

• Benefits: Better function, posture, and reduced overuse pain in the intact limb.

4. Core and Trunk Conditioning

• Description: Planks, bridges, pelvic control drills.

• Purpose: Create a stable base for arm tasks and sports.

• Mechanism: Improves proximal stability → finer distal control.

• Benefits: Safer transfers, better balance, lower back protection.

5. Postural Re-education

• Description: Cueing, mirror feedback, ergonomic seating and standing.

• Purpose: Counter shoulder elevation and spinal tilt.

• Mechanism: Motor learning, scapulothoracic coordination.

• Benefits: Less neck/shoulder strain; improved breathing and endurance.

6. Functional Task Training (Occupational Therapy partner)

• Description: Practice dressing, feeding, writing, keyboarding, tool use.

• Purpose: Build independence and speed.

• Mechanism: Task-specific repetition strengthens neural pathways.

• Benefits: Greater autonomy at home and school/work.

7. Prosthetic Pre-training

• Description: Learn limb positioning, weight bearing, and donning/doffing before first device.

• Purpose: Smooth transition to a prosthesis.

• Mechanism: Familiarity reduces anxiety; prepares skin and muscles.

• Benefits: Higher acceptance and daily use time.

8. Myoelectric Control Training

• Description: EMG biofeedback teaches the child to “fire” targeted muscles to control a myoelectric hand.

• Purpose: Improve device control accuracy.

• Mechanism: Operant conditioning using visual/auditory feedback.

• Benefits: More precise grasp/release; less frustration.

9. Socket Fit & Skin Care Program

• Description: Regular checks; sock/liner hygiene; pressure-spot mapping.

• Purpose: Prevent skin breakdown and bursitis.

• Mechanism: Load redistribution, moisture control.

• Benefits: Comfortable wear; fewer clinic visits for sores.

10. Overuse-Injury Prevention for Intact Hand

• Description: Alternating tasks, rest breaks, ergonomic grips, voice input.

• Purpose: Protect the dominant/intact hand from tendonitis.

• Mechanism: Reduces repetitive strain and peak forces.

• Benefits: Sustained productivity without pain.

11. Mirror Therapy (functional focus)

• Description: Use a mirror to create the visual illusion of two hands moving.

• Purpose: Reduce phantom sensations/pain; improve motor imagery.

• Mechanism: Visual feedback recalibrates cortical maps.

• Benefits: Less discomfort; better movement planning.

12. Kinesiology Taping or Soft Bracing

• Description: Elastic tape or lightweight brace around shoulder/forearm.

• Purpose: Proprioceptive cueing, posture support.

• Mechanism: Cutaneous stimulation enhances joint position sense.

• Benefits: Less fatigue; improved control with or without a prosthesis.

13. Adaptive Sport and Play Integration

• Description: Swimming, cycling with adaptations, climbing, wheelchair sports if needed.

• Purpose: Fitness, confidence, social participation.

• Mechanism: Cardiovascular and neuromotor conditioning.

• Benefits: Stronger body, better mood, community inclusion.

14. Gait and Balance (for bilateral cases or when using heavy prostheses)

• Description: Balance boards, dynamic walking drills.

• Purpose: Maintain whole-body symmetry and endurance.

• Mechanism: Vestibular and proprioceptive training.

• Benefits: Safer mobility; fewer falls.

15. Home Exercise Program with Caregiver Coaching

• Description: Short, daily, fun routines; progress sheets.

• Purpose: Consistency outside clinic.

• Mechanism: High-frequency practice drives neuroplasticity.

• Benefits: Faster skill gains; reduced therapy costs.

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B)  Mind–Body therapies

16. Cognitive Behavioral Therapy (CBT)

• Description: Structured counseling to reframe thoughts and behaviors.

• Purpose: Ease anxiety, low mood, device rejection.

• Mechanism: Cognitive restructuring and exposure.

• Benefits: Improved coping, higher school/work engagement.

17. Acceptance and Commitment Therapy (ACT)

• Description: Values-based strategies to live well with a difference.

• Purpose: Reduce avoidance and distress.

• Mechanism: Psychological flexibility, mindfulness.

• Benefits: Greater life satisfaction and participation.

18. Mindfulness-Based Stress Reduction (MBSR)

• Description: Breath awareness, body scans, simple meditation.

• Purpose: Pain modulation, sleep improvement.

• Mechanism: Down-regulates stress reactivity; alters pain appraisal.

• Benefits: Calmer mood, better attention and self-care.

19. Guided Motor Imagery

• Description: Mentally rehearsing tasks using an imagined hand or device.

• Purpose: Improve planning and speed during real tasks.

• Mechanism: Activates motor networks without physical strain.

• Benefits: Smoother execution with the prosthesis or intact hand.

20. Peer-Support Groups / Mentorship

• Description: Connect with others with limb differences.

• Purpose: Share tips, normalize feelings, inspire goals.

• Mechanism: Social learning and modeling.

• Benefits: Confidence, practical hacks, reduced isolation.

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C) Gene-related (context & counseling)

21. Genetic Counseling (and realistic view on gene therapy)

• Description: Review family history; discuss recurrence risk; explain current science.

• Purpose: Family planning, expectations, and screening for associated syndromes.

• Mechanism: Risk assessment, education about non-invasive prenatal testing and ultrasound.

• Benefits: Informed decisions; reduced anxiety.

Note: There is no approved human gene therapy to regenerate a missing hand. Any “gene therapy” for limb formation is research-only and not a clinical treatment.

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D) Educational therapy & environment

22. Self-Care and Prosthesis Education

• Description: Step-by-step device use, charging, hygiene, troubleshooting.

• Purpose: Maximize daily wear and function.

• Mechanism: Skill acquisition through teach-back.

• Benefits: Fewer breakdowns, more independence.

23. School/Workplace Accommodations

• Description: Extra time, alternative input devices, modified PE, lab aids.

• Purpose: Fair access to tasks and exams.

• Mechanism: Universal design and reasonable adjustments.

• Benefits: Better performance and participation.

24. Assistive Technology Training

• Description: One-handed keyboards, trackballs, speech-to-text, page-turners.

• Purpose: Efficiency and comfort.

• Mechanism: Task redesign reduces strain.

• Benefits: Faster, less tiring workflow.

25. Caregiver and Sibling Coaching

• Description: Teach safe helping, positive language, and fostering independence.

• Purpose: Healthy family dynamics and resilience.

• Mechanism: Consistent support and expectations.

• Benefits: Child confidence, smoother routines.

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Drug treatments

Important: No medicine can “grow” a missing hand. Drugs are used for pain, skin care, overuse, mood, or sleep. Always confirm doses with your clinician.

1. Acetaminophen (Paracetamol) – Analgesic

• Typical dose: Adults 500–1000 mg every 6–8 h (max 3–4 g/day); pediatric weight-based.

• Time/Purpose: Short-term pain or fever.

• Mechanism: Central COX modulation.

• Side effects: Rare liver injury at high dose/alcohol.

2. Ibuprofen / Naproxen – NSAIDs

• Dose: Ibuprofen 200–400 mg q6–8h; Naproxen 250–500 mg q12h.

• Purpose: Overuse tendonitis, musculoskeletal pain.

• Mechanism: COX inhibition → ↓ prostaglandins.

• Side effects: Stomach upset, ulcer/bleed risk, kidney strain.

3. Topical NSAIDs (diclofenac gel)

• Dose: Apply thin layer to sore areas up to QID.

• Purpose: Local pain with fewer systemic effects.

• Mechanism: Local COX inhibition.

• Side effects: Skin irritation; minimal systemic effects.

4. Topical Lidocaine 4–5%

• Dose: Patch or gel up to 12 h on/12 h off.

• Purpose: Focal neuroma/skin hypersensitivity.

• Mechanism: Sodium-channel blockade.

• Side effects: Local rash; rare systemic absorption.

5. Capsaicin (low-dose cream)

• Dose: 0.025–0.075% cream TID–QID.

• Purpose: Desensitize nerve endings.

• Mechanism: TRPV1 activation then defunctionalization.

• Side effects: Burning at application site initially.

6. Gabapentin – Neuropathic pain modulator

• Dose: 100–300 mg at night, titrate to 900–1800 mg/day in divided doses.

• Purpose: Neuroma/phantom limb sensations.

• Mechanism: α2δ calcium-channel modulation.

• Side effects: Drowsiness, dizziness.

7. Pregabalin – Neuropathic pain modulator

• Dose: 50–75 mg BID, titrate to 150–300 mg BID if needed.

• Purpose: Similar to gabapentin with quicker titration.

• Mechanism: α2δ binding → ↓ excitatory release.

• Side effects: Sedation, edema, weight gain.

8. Amitriptyline (low dose at night) – TCA

• Dose: 10–25 mg HS; can titrate.

• Purpose: Neuropathic pain, sleep help.

• Mechanism: Serotonin/norepinephrine reuptake inhibition, anticholinergic.

• Side effects: Dry mouth, constipation, morning grogginess; avoid in some heart conditions.

9. Duloxetine – SNRI

• Dose: 30 mg daily → 60 mg daily.

• Purpose: Neuropathic pain and mood.

• Mechanism: Increases descending inhibitory pathways.

• Side effects: Nausea, sweating, BP changes.

10. Muscle Relaxants (e.g., Cyclobenzaprine short term)

• Dose: 5–10 mg HS for brief flares.

• Purpose: Spasm from overuse or socket posture.

• Mechanism: Central sedation.

• Side effects: Drowsiness, dry mouth.

11. Botulinum Toxin (focal injections)

• Dose: Units tailored to muscle groups every 3–4 months.

• Purpose: Painful spasm or problematic co-contraction.

• Mechanism: Blocks acetylcholine release.

• Side effects: Weakness at site, bruising.

12. Short-course Opioids (rare, acute only)

• Dose: As prescribed for brief severe pain (post-op).

• Purpose: Post-surgical pain only.

• Mechanism: μ-opioid receptor agonism.

• Side effects: Sedation, constipation, dependence risk—avoid chronic use.

13. Topical Barrier Creams (zinc oxide, petrolatum)

• Dose: Daily under sockets/liners as directed.

• Purpose: Prevent friction rash and maceration.

• Mechanism: Moisture barrier, reduces shear.

• Side effects: Minimal; watch for dermatitis.

14. Antibiotics (only if infection)

• Dose: According to organism/site.

• Purpose: Treat skin infection under liners or post-op wounds.

• Mechanism: Bactericidal or bacteriostatic.

• Side effects: GI upset, allergy; use only when confirmed.

15. Sleep Aids (behavioral first; melatonin if needed)

• Dose: Melatonin 1–3 mg HS short term.

• Purpose: Sleep disruption from discomfort.

• Mechanism: Circadian entrainment.

• Side effects: Morning grogginess; prioritize sleep hygiene.

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Dietary molecular supplements

Always check with your clinician, especially for children, pregnancy, kidney/liver disease, or if taking other medicines.

1. Vitamin D3 – 1000–2000 IU daily (adults; pediatric per clinician)
   Supports bone and muscle; modulates pain perception via neuroimmune pathways.

2. Calcium (diet first; supplement 500–1000 mg/day if intake low)
   Assists bone health to handle asymmetric loading.

3. Omega-3 (EPA/DHA 1–2 g/day)
   Anti-inflammatory; may reduce musculoskeletal soreness and support cardiovascular health.

4. Protein/Whey (20–40 g/day total protein boost as needed)
   Provides amino acids for muscle repair and conditioning.

5. Creatine Monohydrate (3–5 g/day)
   Improves high-intensity strength training outcomes for shoulder/core.

6. Magnesium Glycinate (200–400 mg/day)
   Aids muscle relaxation and sleep; supports energy metabolism.

7. Collagen Peptides (10 g/day) + Vitamin C
   Supports connective tissue; may help tendons/skin under sockets.

8. Curcumin with Piperine (500–1000 mg/day)
   Anti-inflammatory; may ease overuse discomfort (avoid with anticoagulants).

9. Vitamin B12 (dose per level; often 500–1000 mcg/day orally if low)
   Supports nerve health and energy; test levels before supplementing.

10. Iron (only if iron-deficient; dose per labs)
    Improves fatigue and exercise capacity when deficiency exists.

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Regenerative, stem cell drugs

Clear safety note: There are no approved regenerative or stem-cell drugs that regrow a human hand. The items below are research topics or adjuncts for soft-tissue/nerve issues. Use only within regulated clinical trials.

1. Mesenchymal Stem Cells (MSCs) for Nerve/Soft Tissue (Investigational)

• Function/Mechanism: Paracrine trophic factors (e.g., NGF, VEGF) may support nerve healing and reduce inflammation.

• Dosage: Trial-defined; not standard.

• Status/Risk: Experimental; risks include infection, ectopic tissue, regulatory concerns.

2. Platelet-Rich Plasma (PRP) for Residual-Limb Soft Tissue (Adjunct/Investigational)

• Function: Concentrated growth factors may speed soft-tissue healing.

• Dosage: Procedure-based.

• Status: Mixed evidence; not limb-regenerating.

3. Peripheral Nerve Growth Factor Modulation (Preclinical/Selected clinical scenarios)

• Function: Encourage axonal sprouting to reduce neuroma pain.

• Status: Limited indications; not restorative of a hand.

4. iPSC-Derived Limb Bud/Organoid Research (Preclinical)

• Function: Model limb development; far from clinical application.

• Status: Not a therapy; lab research only.

5. Bioactive Scaffolds + Cells (Preclinical/Device trials)

• Function: Provide a 3-D matrix for tissue ingrowth at amputation sites.

• Status: Early-stage; may help soft-tissue coverage, not limb regrowth.

6. Exosome-Based Therapies (Early research)

• Function: Cell-free vesicles carrying trophic signals.

• Status: Experimental; no approved indications for acheiria.

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Surgeries

1. Osseointegration for Prosthetic Attachment

• Procedure: A titanium implant is fixed into the forearm bone; a skin-penetrating abutment connects to an external prosthesis.

• Why: Better control and comfort for some users who cannot tolerate sockets.

2. Targeted Muscle Reinnervation (TMR) / Nerve Transfers

• Procedure: Reroute residual nerves to specific muscles to generate clear EMG signals for myoelectric control and reduce neuroma pain.

• Why: More intuitive prosthesis control; less nerve pain.

3. Neuroma Excision and Nerve Capping/Wrapping

• Procedure: Remove painful neuromas and protect nerve ends with biological/synthetic sleeves or relocation into muscle.

• Why: Reduce focal electric-shock pain; improve prosthesis tolerance.

4. Soft-Tissue Contouring and Skin Revision

• Procedure: Shape soft tissue for better socket fit; address scar bands and bursae.

• Why: Comfort, skin protection, cosmetic symmetry.

5. Krukenberg Procedure (selected bilateral cases)

• Procedure: Split the forearm bones and reshape muscles to create a pincer-like grasp with the forearm itself.

• Why: Functional grasp without a prosthesis in resource-limited settings; requires careful selection and counseling.

Other rare options (case-by-case): microvascular toe transfer or pollicization when there is partial hand anatomy; these require specialized teams and careful expectations.

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Preventions

Because acheiria is usually congenital, prevention focuses on pregnancy health and risk reduction:

1. Avoid known teratogens (e.g., thalidomide; certain retinoids).

2. Control maternal diabetes before and during pregnancy.

3. Quit smoking and avoid second-hand smoke.

4. Avoid alcohol and illicit drugs.

5. Prenatal vitamins as advised (folate supports general fetal development).

6. Vaccinate and prevent infections (e.g., rubella, varicella) before pregnancy where appropriate.

7. Review all medications with a clinician when planning pregnancy.

8. Early prenatal care with first-trimester visits and anomaly scans.

9. Occupational/environmental safety (avoid toxic exposures).

10. Genetic counseling when there is a family history of limb differences or syndromes.

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When to see doctors

• Right after birth for full exam and early therapy planning.

• Before first prosthesis fitting (often 6–12 months if appropriate) and at each growth spurt.

• If skin problems (rashes, wounds) develop under a socket/liner.

• If pain increases (neuroma signs: electric shocks, point tenderness).

• If the intact hand/shoulder hurts—possible overuse or tendonitis.

• If function regresses or school/work tasks become hard.

• If mood, sleep, or behavior changes suggest anxiety or depression.

• Before sports seasons for equipment checks and conditioning.

• When considering surgery or device upgrades (myoelectric, osseointegration).

• If planning pregnancy and there is family history of limb differences.

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What to eat and what to avoid

1. Prioritize whole foods: fruits, vegetables, legumes, whole grains.

2. Lean protein at each meal to support training (eggs, fish, poultry, tofu).

3. Healthy fats (olive oil, nuts, seeds; fish twice weekly for omega-3s).

4. Hydration: water first; adjust for activity/heat.

5. Calcium + vitamin D sources (dairy or fortified alternatives; sensible sun).

6. High-fiber choices to maintain energy and gut health.

7. Limit ultra-processed foods high in sugar/salt/fats that increase inflammation.

8. Avoid smoking and alcohol—both impair recovery and sleep.

9. Timing for training: light protein/carb snack within 1–2 h after therapy or workouts.

10. Allergies/intolerances: tailor choices with a dietitian if needed.

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Frequently Asked Questions (FAQs)

1) Can a missing hand grow back?
No. Humans cannot regrow a hand. Treatments focus on function, comfort, and independence.

2) What caused acheiria in my child?
Often the exact cause is unknown. It may relate to early fetal development factors (vascular disruption, amniotic bands, genetic syndromes). Most cases are not due to anything a parent did.

3) Is acheiria genetic?
Usually it is isolated and sporadic. Some cases are part of genetic syndromes. A genetic counselor can review family risk.

4) Will my child be able to do sports and play instruments?
Yes—many children succeed with coaching, adaptive tools, and practice. Choice of sport and device is individualized.

5) At what age should a prosthesis be considered?
Some centers trial a lightweight passive device around 6–12 months; myoelectric devices may be considered later. Timing depends on readiness and goals.

6) Do children always keep using prostheses?
Not always. Some prefer no device for certain tasks. The best plan is task-based and flexible.

7) What is the difference between body-powered and myoelectric prostheses?
Body-powered uses harness/cable motion; myoelectric uses muscle electrical signals and battery power. Each has pros/cons in weight, grip strength, feedback, and maintenance.

8) How do we prevent overuse injuries in the intact hand?
Use ergonomics, task alternation, rest breaks, strength and posture training, and assistive technology.

9) Are surgeries required?
Only when there is a clear reason (painful neuroma, poor socket tolerance, need for better control). Many people do well without surgery.

10) Can mirror therapy help phantom sensations in congenital limb absence?
Some people report benefit for discomfort or body image even with congenital absence; results vary. It is safe to try under guidance.

11) Are stem-cell treatments available to restore a hand?
No approved treatments exist. Be cautious of unregulated clinics. Consider only ethics-approved clinical trials.

12) How often should we see therapists?
Frequency changes with age and goals—more often during new device training, growth spurts, or sports seasons; less often for maintenance.

13) What about school accommodations?
Common supports include typing aids, extended time, lab partners, modified PE, and accessible device charging/storage.

14) How do we talk about acheiria with our child and others?
Use positive, simple language: “different, not less.” Practice short introductions and allow the child to lead the conversation.

15) What is the long-term outlook?
With early therapy, good ergonomics, and supportive environments, most people live healthy, active, independent lives.

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: September 01, 2025.

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