Radial Longitudinal Deficiency (Radial Club Hand) | Diagnosis & Treatments

How is radial longitudinal deficiency diagnosed?

Radial longitudinal deficiency is sometimes picked up on a prenatal ultrasound, but the condition cannot be treated until after your baby is born.

If your child’s condition is detected after birth, a doctor will examine their forearm and take an x-ray. Your child’s doctor will check for other differences or syndromes that are associated with radius deficiency. Additional tests could include blood tests and ultrasounds of the kidneys and possibly the heart.

How is radial longitudinal deficiency treated?

Your child’s treatment will depend on how severely their arm and hand are affected. The goals of treatment are to:

  • correct the position of the wrist
  • increase wrist and finger mobility
  • improve hand function
  • preserve growth of the forearm
  • improve the appearance of the hand and forearm

Exercises and splinting

When your child is an infant, their doctor will talk to you about how to perform gentle stretching exercises for your child’s wrist and elbow to help improve the range of motion in those joints.

Even if your child will eventually need surgery, range-of-motion exercises are extremely important. Any improvement in range of motion achieved through exercise will make surgery more effective and possibly less complex. Your baby will probably need to wear a splint at night throughout infancy and during times when they grow quickly.

If your child’s condition is severe, they may wear a cast or splint to gradually stretch the soft tissues in their forearm.

Types of surgery for radial longitudinal deficiency

Your child’s doctor must weigh the decision to perform surgery against any other medical conditions your child may have, as well as the overall function of their arm.

If your baby has severe radial longitudinal deficiency, they may need surgery after a period of stretching and splinting. Surgery is also an option if problems with the thumb interfere with your child’s use of their hand.

Each part of the arm is treated during separate surgeries that may take place over months or years, typically starting when your child is about 1. Below are surgeries your child may need to treat different parts of their arm and hand. The number and timing of these surgeries will depend on your child and their condition:

Wrist surgery

  • Lengthening takes place before surgery to gently stretch the hand into a straighter position. A frame is surgically placed on the hand and forearm so that pins go through the ulna and hand. The pins are slowly pushed apart. This may be recommended while your child is an infant if their wrist is tight and hard to stretch. It is also used when a child is older and has another deformity or significant shortening of the forearm.
  • Centralization involves repositioning the wrist so the hand sits straight on the end of the ulna. At the time of surgery, surgeons place a pin through the wrist and the ulna. This may stay in place for a year or more after surgery until the ulna broadens and becomes a more stable platform for the wrist.
  • Bilobed flap or soft tissue centralization involves repositioning the soft tissues (skin and muscles/tendons) to improve the motion of the wrist. There is no surgery on the bones, as there would be in a formal centralization.
  • Splinting is usually necessary both before and after bone or soft-tissue centralization.

Forearm surgery

Osteotomy involves cutting a bone into wedges and reshaping it. In cases of radial longitudinal deficiency, the surgeon will perform an osteotomy on the forearm bones in order to straighten them. The wedges of bone are held in place by pins while the bone heals. These pins are removed once the bone has grown strong in its new position.

Thumb surgery

Many children with radial longitudinal deficiency need surgery to reconstruct their thumb. If the thumb is only mildly underdeveloped, a surgical procedure called an opponensplasty can strengthen the thumb muscles. When the thumb is more significantly underdeveloped or missing, the surgeon may perform a pollicization to reposition the index finger as a thumb.

Elbow surgery

Elbow surgery is rarely needed. Some children who have difficulty bending their elbow will undergo a procedure to release tight soft tissues at the back of the elbow that make the elbow stiff. This can be done separately or in combination with procedures to correct the wrist and thumb.

What is the long-term outlook for radial longitudinal deficiency?

Your child’s long-term outlook depends on the severity of their condition and whether they have any associated conditions.

If your child has a mild case of radial longitudinal deficiency, they will need physical therapy as they grow in order to keep their arm and wrist aligned and strong. They may have minor problems moving and using their arm.

If your child has more severe radial longitudinal deficiency, their arm will have limited range of motion, strength, and movement, but there are many possible ways to adapt. Ongoing physical and occupational therapy are often helpful to help your child get the most use of their arm possible as they grow and develop.