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.
What causes radial club hand?
The majority of cases appear ‘out of the blue’ with no known cause. Radial club hand can affect one arm (unilateral) or both arms (bilateral). It occurs very early in pregnancy between day 28 and 52. Radial club hand is only occasionally diagnosed during routine ultrasound scans before birth.
Unilateral radial club hand is not generally associated with any other problems and is less likely to be passed on genetically. Bilateral radial club hand is more typically associated with other problems, sometimes as part of a ‘syndrome’ or collection of symptoms often seen together. Syndromes that usually feature radial club hand include Holt-Oram syndrome, TAR syndrome, Fanconi’s anaemia and VATER/VACTERL syndrome, some of which may have a genetic component.
What is hand function like for children with radial club hand?
Generally, most children manage extremely well with functional activities of daily living and they find their own way of managing their tasks to be fully independent.
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. It also depends on you and your family’s feelings about treatment, as some options involve a number of operations and quite involved care at home, which will require determination from all involved. The following options may be available for your child.
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.
A series of operations is sometimes recommended and surgery tends to take place in phases. This enables your child to recover from one operation before moving on to the next. There are also some operations that are best done when a child is at a certain age.