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Radial Club Hand

Radial club hand is a rare upper limb condition that affects the way your child’s hand, wrist and arm grow and work. It happens when the radius - the bone on the thumb side of the forearm - doesn’t form completely during pregnancy. This gives the hand a club-shaped appearance.

At Banner Children’s, our specialists are experienced in diagnosing and treating radial club hand. We offer comprehensive care that supports your child’s growth, movement and development. 

What is radial club hand?

Radial club hand is a congenital hand difference. That means it happens before birth. This causes the hand and wrist in the forearm to bend toward the thumb side. This bend creates a club or J-shaped appearance.

There are two bones in the forearm: the ulna and the radius. The ulna is on the outer side of the arm. The radius is on the inner side of the arm. Radial club hand happens when the radius doesn’t form properly. Because the radius supports muscles, blood vessels and nerves, its absence can impact the overall structure and function of the arm.

This hand difference can affect one or both arms. In many cases, the thumb is also small, misshapen or missing. The forearm may be shorter than usual and muscles and nerves in the arm can also be underdeveloped. It may also affect elbow movement. 

Club hand is also known as radial longitudinal deficiency, radius deficiency or radial dysplasia.

Types of radial club hand

There are four types of radial club hand:

  • Type I: The radius is slightly smaller than usual. This causes the wrist to turn in a little bit. Children can move their hand normally and may not need treatment. 
  • Type II: The radius is smaller and more curved. The growth plate may not work correctly and the thumb may be shorter than usual.
  • Type III: A large part of the radius is missing. The wrist and hand bend inward more severely and the hand has limited support. The ulna may also be thick and curved. 
  • Type IV: This is the most common and most severe form. Children with this type are missing the entire radius. Some children may have short fingers and missing digits and they may also experience limited range of motion in their elbows.

What causes radial club hand?

In most cases, the exact cause of radial club hand is unknown. There is no known link between this condition and anything you did or didn’t do during pregnancy. It’s a part of the baby’s development. It usually happens randomly during early pregnancy as the baby’s bones and tissues form. 

Sometimes, it can be part of a genetic syndrome or linked to other health issues, such as heart or kidney problems or other limb differences like club foot. Some genetic conditions linked to radial club hand include:

  • Fanconi anemia
  • Holt-Oram syndrome
  • TAR syndrome (thrombocytopenia with absent radius)
  • Down syndrome
  • Trisomy 18 and 13

Your child’s health care team may recommend genetic testing or other tests for related conditions.

Symptoms of radial club hand

You may notice signs of radial club hand at birth or during a prenatal ultrasound

Common signs include:

  • A wrist that bends toward the thumb side
  • A shorter or curved forearm
  • A missing or small thumb
  • Limited movements in the wrist, hand or fingers
  • Differences in arm muscle size or strength

How radial club hand is diagnosed

Radial club hand is often found during a routine prenatal ultrasound. If not seen before birth, it is diagnosed shortly after a baby is born. 

To understand your child’s condition, your health care team may recommend:

  • Physical exam: To check the position, size and function of the hand and arm
  • X-rays: To see which bones are affected
  • Ultrasound or MRI: To look at soft tissues like muscles, tendons and nerves
  • Blood tests or genetic tests: To check for other health conditions or inherited traits

These tests help your child’s care team plan the best care for your child. Your child may be referred to a pediatric orthopedic or hand specialist for further evaluation and treatment.

Treatments for radial club hand

Treatment for radial club hand focuses on improving the position, function and appearance of the hand and arm. The type of treatment depends on how severe the condition is and how it affects your child’s ability to move and use their hand. 

Non-surgical treatments

In mild cases, surgery may not be needed. Early treatment often begins shortly after birth and may include:

  • Stretching and splinting: Gentle stretching exercises help improve flexibility in the wrist and arm. A splint can help guide the wrist into a straighter position over time.
  • Casting: In more severe cases, a series of casts may be used to slowly move the wrist into a better position. This can help prepare the arm for possible surgery later.
  • Physical and occupational therapy: Therapy can help strengthen muscles, improve movement and support your child’s development. Therapists may also help your child learn how to use their hands and arms for daily tasks.

Surgical treatments

Children with more severe forms of radial club hand may need one or more surgeries as they grow. Surgery is usually done when the child is between 6 and 12 months old, but this can vary depending on their specific needs.

Common procedures include:

  • Centralization or radialization: These surgeries move the wrist to a more central or straight position on the forearm. This can help with alignment and function. 
  • Tendon and muscle transfers: If certain muscles or tendons are missing or weak, surgeons may move others to take over their function and improve movement.
  • Thumb reconstruction or pollicization: If the thumb is small or missing, a new thumb can sometimes be created using a finger from another part of the body, usually the index finger. This tendon transfer surgery strengthens the muscles in a short thumb.
  • Bone (limb) lengthening: If the ulna is much shorter than usual, a procedure may be done to lengthen the bone and balance the arm. 

What is the outlook for radial club hand?

With early care and support, many children with radial club hand grow up to use their hands and arms well. Some children may have visible differences or movement limitations, but they can still participate in school, sports and daily life. 

After surgery or therapy, your child may need:

  • Splints or casts: To protect the arm and help it heal
  • Rehabilitation therapy: To build strength, increase movement and teach new skills
  • Regular follow-up visits: To check progress and adjust treatment if needed

Support for you and your family

We know caring for a child with a limb difference can bring many emotions. At Banner Children’s, we support you every step of the way. Our care team includes pediatric orthopedic specialists, surgeons, therapists and care coordinators who work together to provide expert care. 

We also connect you with:

  • Child life specialists
  • Genetic counselors
  • Family support services
  • Referrals to specialists in cardiology, nephrology or hematology if needed.

Our team works closely with you to ensure your child receives high-quality, compassionate care. We understand the challenges that come with radial club hand and we’re committed to helping your child thrive.

Make an appointment

If your child has been diagnosed with radial club hand or you notice signs that concern you, don’t wait to get help. Early treatment can make a difference in your child’s growth and development.

Schedule an appointment with a Banner Children’s specialist today.

We’re here to answer your questions, explain your options and help your child live their healthiest life.