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SynopsisCodesLook ForDiagnostic PearlsDifferential Diagnosis & PitfallsBest TestsManagement PearlsTherapyReferences
Macrodactyly
Other Resources UpToDate PubMed

Macrodactyly

Contributors: Mattie E. Raiford MD, Danielle Wilbur MD
Other Resources UpToDate PubMed

Synopsis

Causes / typical injury mechanism: Macrodactyly (localized gigantism) is a nonhereditary condition that causes congenital enlargement of the digits of the hands and occasionally the feet.

Classic history and presentation: Macrodactyly is most commonly seen in the hands, with 95% of cases being unilateral. It most often involves the preaxial side of the hand or foot. The most common distribution is along the median nerve or the digital nerve distribution.

Although this condition is most often isolated, it may be seen in conjunction with vascular malformations (eg, hemangiomas, lymphangiomatosis), Proteus syndrome, neurofibromatosis, Klippel-Trenaunay syndrome, Maffucci syndrome, tuberous sclerosis, and multiple enchondromatosis.

Prevalence:
  • Age – Generally presents at birth but can progress.
  • Sex / gender – More common in boys than in girls.
Pathophysiology: The pathophysiology is uncertain; however, there are a few hypotheses.
  • There is increased proliferation of fibroblasts and/or osteoblasts between the periosteum and cortical bone. This increased proliferation of cells could then cause increased phalangeal growth.
  • A dysregulation caused by a postzygotic gain in function mutation in PIK3CA, which is part of the mTOR pathway.
Grade / classification system:
Type 1: Macrodactyly with nerve-oriented lipofibromatosis
  • Static subtype – The proportion of enlargement remains constant throughout growth.
  • Progressive subtype – The proportion of enlargement increases with age.
Type 2: Macrodactyly with neurofibromatosis
Type 3: Macrodactyly with hyperostosis
Type 4: Macrodactyly with hemihypertrophy

Codes

ICD10CM:
Q74.0 – Other congenital malformations of upper limb(s), including shoulder girdle
Q74.2 – Other congenital malformations of lower limb(s), including pelvic girdle

SNOMEDCT:
205342008 – Macrodactyly of toes - simple
297195000 – Macrodactyly of hand

Look For

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • Macrodystrophic lipomatosis
  • Lipofibromatous hamartoma – Infiltration and hypertrophy of the median nerve that can cause carpal tunnel syndrome. In children who are unable to voice complaints of pain, manifestations of the condition can include scratching, finger biting, and hand shaking.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed:04/18/2022
Last Updated:04/19/2022
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Macrodactyly
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