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Radial club hand is a rare birth defect in which the inner forearm, wrist and hand do not develop properly. This causes the hand to be bent inward toward the thumb with limited movement. In addition your child may be missing or have a smaller underdeveloped thumb.
Scientists don’t know why radial club hand affects certain children, but it’s not believed to be caused by anything the mother does or does not do during her pregnancy. There’s no known genetic link except when the problem is associated with other congenital anomalies or syndromes that are known to have a genetic link.
Radial club hand affects between 1 in 30,000 and 1 in 100,000 babies.
It really depends on the severity of the problem. In the most severe cases, your child may have very limited range of motion at the wrist and sometimes at the elbow. In addition function may be affected by problems with an underdeveloped or missing thumb.
Radial club hand develops early in pregnancy when the bones of the hand and forearm are being formed. It is sometimes picked up on a prenatal ultrasound scan. Diagnosis after birth is usually made through a physical examination and x-rays. If you child is diagnosed with a radial club hand, it’s important that your child is checked for other associated deformities or syndromes, including problems with the heart, kidneys, vertebral column, blood cells, digestive system.
Treatment for radial club hand can be complex. Generally it involves:
With the help of specialist hand therapists we will guide you in performing stretching exercises for your child’s wrist and elbow to improve their position and movement. More severe cases may require splints to support improvements in position gained through stretching exercises. Range of motion exercises are extremely important. Any improvement in range of motion achieved through exercise will make subsequent surgery more effective and perhaps less complex.
Surgical treatment is usually required to correct deviation of the wrist that persists after stretching and splinting. The decision to perform surgery is made carefully and is always aimed at improving your child’s overall function. It is weighed against any other problems that your child may be experiencing from associated medical conditions. Surgery is divided into phases tackling different parts of the hand and arm affected by the disorder over the course of months to years.
In many cases a lengthening procedure is required to gently manipulate your child’s wrist into a straighter alignment. This is followed by a second procedure to stabilise and hold your child’s hand in a straighter and more central position. Splinting in some form is usually required following surgery for at least one year to allow bones and muscles to remodel.
A reconstructive procedure may be required to address underdevelopment of your child’s thumb. This may be achievable through the transfer of tendons in the hand or may require a procedure known as a pollicisation in which the neighbouring index finger is used to make a new thumb. See section on pollicisation.
It depends on the severity of the deformity. In mild cases, your child may have only minimal limitation in movement and function. In the more severe cases, your child’s arm will have limited range of motion, strength and function. Specialist hand therapy will be required as your child grows to maintain alignment and strength.