Radial Clubhand: Symptoms, Causes and Treatment Options
Learn about radial clubhand, its symptoms, causes and treatment options in this comprehensive blog post.
Radial clubhand is a deficiency along the preaxial or radial side of the extremity, characterized by abnormalities of the entire extremity. In this blog post, we will discuss the history, anatomy, etiology, classification, and treatment options of radial clubhand.
Anatomy
The clinical features of radial deficiency are dramatic, with abnormalities of the entire extremity. The humerus may or may not be short, and deficiencies of the capitellum and trochlea are common. The forearm is always decreased in length, and the ulna is approximately 60% of the normal length at the time of birth. The wrist is radially deviated and develops a perpendicular relation to the forearm over time. Numerous muscular abnormalities are found throughout the upper extremity, and the radial nerve usually terminates at the elbow.
Etiology
The cause of radial clubhand is thought to be a defect of the apical ectodermal ridge (AER), with the extent of deformity related to the degree and extent of the AER absence. Acquired radial clubhand can arise with postseptic defect nonunions of the radius. Exposure to teratogens, such as thalidomide and radiation, can yield radial deficiencies.
Classification
Radial clubhand is classified into four types according to the amount of radius present:
- Type I deficiency - mild radial shortening
- Type II deficiency - miniature radius with distal and proximal physeal abnormalities
- Type III deficiency - partial absence of the radius with severe wrist radial deviation
- Type IV deficiency - complete absence of the radius with the hand assuming a perpendicular relation to the forearm
Treatment
Treatment of radial clubhand aims to reduce the functional deficit incurred by a short or absent radius, a short ulna, an abnormal muscular anatomy, and a radial deviation of the wrist. Centralization is indicated in severe cases, while thumb hypoplasia requires reconstruction or pollicization to optimize hand function. Lengthening of the ulna can be accomplished using distraction osteogenesis, but complications are common.