Radial Club Hand

Radial Club Hand
February 10, 2016

RCH 1Experience of 25 years in the field has given Dr. Gupta an insight in to this rare congenital deformity and emphatically he puts forth, “This is a deformity which is structured in the child in mother’s womb only when the bones of the child are being formed. This is picked up by Gynecologists in a perennial ultra sound. Treatment starts soon after the child is born.”

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Being invited for a lecture in Plenary session on “Congenital Anomalies of Hand” at Annual Conference of Bangladesh Orthopedic Society held at Dhaka, Bangladesh, Dr. Gupta is well versed with the condition and as per him, “When the radius bone in the child’s hand is either partially or completely absent causing the hand to deviate towards the body it is said that the child is born with a radial club hand. Another distinctive feature of this condition is a shorter arm and absence of, or an underdeveloped and short thumb in the hand.”

Currently heading department of ‘The Hand & Upper Extremity Surgery’ at The Medanta Institute of Bone & Joint Disease as Director, Dr. Gupta highlights, “Extensive research into the causes of Radial Club Hand has proved inconsequential. There is no conclusive proof that this condition is an outcome of any discrepancy on the mother’s part when the child is in the womb. Rather it is considered as a spark off by some other syndrome that is related to genetic conditions like a problem in the spinal column, blood cells, kidneys or heart. A child that has been diagnosed with Radial Dysplasia will necessarily be affected by some other conditional problem.”

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Relentless in his pursuance of providing relief to his patients, Dr. Gupta having performed surgeries for Radial Dysplasia stresses, “The treatment of Radial club hand is as complex as the condition itself. A gentle as well as a skilled hand is customary to perform on a child. Each part of the hand that is affected by the condition is treated separately as an independent unit to restore functional movement in that part. There are various surgical methods which are adopted henceforth. Relatively speaking non surgical methods involve motion exercises by a hand specialist and casting or splinting of the hand which again observes improvement after surgical implementations.”

Lastly he emphasizes, “Radial Dysplasia essentially needs complete after care as it can re occur in the child and the exercises need to be continued for a lifetime to provide stability to the hand. It is most conclusively a complex disease that affects the hand depending on its severity and should be treated by a skilled hand.”

FAQ – Radial Club Hand

It is a defect by birth where the radius bone of the forearm is either missing or underdeveloped. This affects the wrist, hand and inner forearm and the hand bents inward towards the body i.e. it is termed as radially deviated. It is also known as Radial Dysplasia.
Scientists and doctors have found no concrete reasons as to why some children are born with Radial Club Hand. Over the years it has been evaluated that there is no link between this condition and what a mother intakes during pregnancy. Rather it is sparked off by some other syndrome or congenital anomalies which have genetic effects. Some congenital anomalies with which Radial Club Hand could be affected are conditions related to heart, kidneys, digestive system or blood cells.
Distinctive features of radial club hand are- The child may not have the thumb or have a short sized, underdeveloped thumb in the affected hand. The affected arm is shorter and bent towards the body at the forearm.
It is a very rare disease and one out of say 50,000 to 1,00,000 children may be affected from it.
No, Radial Club Hand is not usually painful but the fingers and wrist of the affected hand may be stiff.
If the radial club hand is mild then the wrist will be just minimally deviated and will not cause much problems to the child hand functioning but in severe cases the child will have constrained movement.
Radial dysplasia is diagnosed in mother’s womb only, when the bones of the hand and forearm of the baby are being formed. It usually gets picked up during an ultrasound but if somehow missed is ascertained by X-rays or physical examinations by the doctor. When a child is diagnosed with radial club hand, the doctor customarily conducts tests to confirm any other deformities related to heart, digestive system, kidneys, spinal column or blood cells.
No, it varies. According to severity of the condition it is divided into four types-

TYPE1/ MILD FORM: This is the mildest form of Radial Dysplasia where the wrist is mildly deviated, with a possibility of an underdeveloped thumb. There is no loss of movement as such in this case and there are surgical techniques by which the thumb could be treated.

TYPE 2 / LIMITED FORM: This type observes very limited growth of the radius bone on both sides with the thumb significantly underdeveloped or absent. The wrist is seen to be deviated towards the radius.

TYPE 3 / COMPEX FORM: The severity in this type becomes enhanced with the radius seen partially absent in this type. Ulna is affected in this case too and the wrist is severely deviated with limited range of movement. In this type the fingers are also affected with the thumb.

TYPE 4 / SEVERE FORM: This is the severest form in which radius and thumb are completely missing affecting the forearm, elbow, wrist and hand movement of the child.
Yes, there are both non surgical and surgical treatment techniques for Radial club hand. Though they are not simple as the condition itself is rare and complex.

Non-Surgical Treatment: This involves emphatic exercises under guidance of an extremely skilled hand specialist who will try to stretch the tissues of the child’s elbow and wrist. To support the exercises or when the condition is severe the doctor might put a cast or splint on the hand along with the exercises.

An improvement in the motion of the hand might further be made more effective by surgery.

Surgical Treatment: This involves surgeries on each part of the hand that is affected by radial dysplasia. It should tentatively start in the first year and continue for a period of years.

Surgical treatment of the wrist- By surgical methods such as centralization, radialization, splinting or pre surgical lengthening procedures the tissues of the wrist are tried to be stretched and made normal.

Surgical treatment of the forearm- surgical methods are adopted to cut the bones and then rearrange them in a straight position holding them by the same pin used to hold the wrist together.

Surgical treatment of the thumb- under surgical method known as pollicization the thumb is tried to be reconstructed by transferring tendons. It is usually done after treatment of the wrist and forearm.

Surgical treatment of the elbow- in very rare cases the stiff muscles that hamper movement also need to be surgically treated.

The child will never completely have a normal hand but yes after treatment it will become copable. Depending on the severity of the condition the child will regain motion in the wrist and forearm. The therapy exercises will be on continual basis as they will help provide strength and alignment to the hand.
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