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Radial club hand is a congenital (present at birth) hand anomaly where the radius bone in the arm is missing or underdeveloped, causing the hand to be bent towards the body (radially deviated). It is also known as radial ray deficiency or anomaly. One in 75,000 children is born with radial club hand.This page explains about radial club hand, what causes it, how common it is, what functional problems your child might have and how it can be treated.

Radial club hand is classified into four types from mild to severe, but within each type the degree of severity can vary enormously. The four types are as follows:

• Type I – This is at the milder end of the spectrum, with the radius being only a little shorter than normal and the hand mildly radially deviated at the wrist.
• Type III – A large part of the radius is missing and the hand is moderately to severely radially deviated. The wrist lacks support and the ulna is thickened and often bowed. The forearm is short.
• Type IV – The radius is completely absent and the hand is severely radially deviated and the forearm is short. This is regarded as the most common type of radial club hand.
• In all types, the thumb may be smaller than usual (hypoplastic) or absent.

Your doctor will examine your child closely and look at x-rays of your child’s arm to work out the classification of radial club hand. This will influence the treatment options available.

What causes radial club hand?

The majority of cases appear ‘out of the blue’ (sporadically) with no known cause. Radial club hand can affect one arm (unilateral) or both arms (bilateral). The condition affects both arms in about half of children born with radial club hand. It occurs very early in pregnancy between day 28 and 52. In very rare circumstances, exposure to some substances during pregnancy, for instance, thalidomide, can cause problems with the radial bones. Radial club hand is only occasionally diagnosed during routine ultrasound scans before birth.

What is hand function like for children with radial club hand?

The level of hand function will depend on the severity of the radial club hand and whether one or both hands are affected. Radial club hand with wrist deviation and forearm shortening is often associated with thumb underdevelopment or absence, and stiffness of the finger joints with difficulty bending the joints. Corrective surgery aims to improve the appearance and function, but function is always affected for the child with a moderate to severe radial club hand. There will be reduced movement of the fingers with poor pinch and grasp, reduced strength and ability to position the hand, for example to turn the palm upwards.

How can radial club hand be treated?

There are various options for treatment and the doctor will explain which are most suitable for your child. This decision about suitable treatments is influenced by the severity of your child’s radial club hand and their general health including other symptoms.

Non-surgical hand therapy and splints

Your child will be helped to maximise their functional potential through advice, therapeutic exercise and splinting. Non-surgical treatment with stretches and splints is usually required in all types of radial club hand.

Surgery

A series of operations is often recommended to those children with type ll, III and IV radial club hand. Surgery tends to take place in phases. This enables your child to recover from one operation and post-operative care before moving on to the next. There are also some operations that are best done when a child is at a certain age. Your doctor may suggest the following operations:

Re-positioning the hand

This is an operation to remove the fixator and maintain the new position of the hand sitting on the end of the ulna bone. This will either be achieved by a tendon transfer for a radialisation operation where movement is preserved, or a tendon transfer and bone fixation for a centralisation operation, where most of the wrist movement is lost.

Forearm lengthening

Most children with radial club hand have short forearms in the limbs affected. There are operations that can be used to lengthen the forearm but these are complex and rarely produce forearms of the same length. If surgery is possible, this tends to happen during mid to late adolescence.