A club hand is a congenital malformation of the forearm. A distinction can be made between a so-called radial and an ulnar form.
What is a club hand?
A club hand is a flexion contracture of the hand, which can be differentiated between a radial and an ulnar form. The metacarpophalangeal joints of the fingers also very often show a flexion contracture, whereas end and middle joints tend to have extension contractures. Most of the time, the hand also lags behind in growth. See AbbreviationFinder for abbreviations related to Club Hand.
Causes
A radial club hand usually occurs spontaneously and is not usually hereditary, but is considered an independent malformation. The misalignment is caused by a missing or shortened radius. As a result, the hand deviates from the normal position, whereby the radius is more often affected.
Malformations of the ulna and radius are often genetically determined, with the so-called TAR syndrome, VATER syndrome or Rothmund-Thomson syndrome, among others, being able to cause a radial club hand. Possible causes of an ulnar clubhand are, for example, the Cornelia de Lange syndrome or the femur-fibula-ulna syndrome.
Symptoms, Ailments & Signs
A typical feature of a club hand is the shortened forearm, and the hand also deviates at right angles and radially. The function of the hand is therefore very limited and grasping can only be carried out by squeezing things between the forearm and the hand. In most cases, anomalies of the wrists or hypoplasia of the long fingers and thumb also occur.
In addition, a distinction can be made between a primary and a secondary clubhand. A primary club hand is understood to mean a hereditary condition in which certain muscle groups are shortened or poorly differentiated. The bones develop normally. In the radial form, the radial forearm muscles or the biceps are predominantly affected, while in the ulnar form, changes occur in the forearm muscles and the triceps.
The secondary club hand is due to a congenital ulna or radius defect. The hand deviates to the side and the misalignment worsens as growth progresses. Malformations can also occur in the neighboring joints or in the fingers. With an ulnar clubhand, the palm faces the body and the wrist and elbow are unstable.
In addition, pronounced finger defects and accompanying malformations affecting the muscles and the skeletal system occur. In a radial clubhand, the back of the hand is toward the body, the wrist is dislocated, but the elbow is stable. Those affected mainly suffer from thumb defects, whereas the ulnar fingers are completely normal. Concomitant malformations primarily affect the gastrointestinal and cardiorespiratory systems.
Diagnosis & course of disease
A club hand is very noticeable because the arm is shortened and the forearm is bent outwards or inwards. There are different individual characteristics. It is possible for the elbow to be completely stiff and unstable, the ulnar fingers may also be missing, and the other fingers may develop what is known as camptodactyly (flexion contracture) or syndactyly (malformation of the phalanges). The malformations of the elbow joint, wrist and hand are very clearly visible in the X-ray image .
Complications
The club hand usually causes malformations in the lower part of the patient’s arm. This can lead to severe limitations in the everyday life of the patient. Child development is also often disrupted by this malformation. Likewise, the usual grasping or lifting can no longer be carried out easily.
Most patients cannot pick up objects unless they pinch them between their hand and forearm. It is not uncommon for muscles to be weak and the patient’s resilience decreases. It may also no longer be possible to carry out certain sporting activities. It is not uncommon for fingers or joints to be affected by the deformities.
Children can also suffer from mental health problems or depression from the club hand when teasing or bullying occurs. The clubhand can be treated relatively well, with no particular complications. With the help of therapies or surgical interventions, the symptoms can be remedied. There are no other complications. The life expectancy is not reduced by a club hand.
When should you go to the doctor?
A clubhand is usually recognized and treated with surgery immediately after birth. A minor malformation does not necessarily need to be corrected, but should still be examined by a doctor. The affected child often requires physiotherapy and orthopedic aids, which must be organized in cooperation with a specialist. Severe malformations must always be treated surgically. Parents of affected children should arrange for an operation at an early stage so that the clubhand can be corrected before the child grows up and the deformity may become even more severe.
If the club hand only develops in the course of the first years of life, medical advice must also be obtained. Malformations in the wrist, hand and elbow joint are a reason for a doctor’s visit. You should also go to the doctor with a club hand if it occurs as part of an already diagnosed disease such as TAR syndrome or VATER syndrome. Depending on the cause and severity of the club hand, parents can consult a general practitioner, an orthopedist or an internist. Hereditary diseases should be examined and treated in a specialist clinic for hereditary diseases.
Treatment & Therapy
Club hand therapy is either surgical or conservative. Conservative treatment is usually indicated for milder forms, whereby this form of therapy is intended to counteract the contracture and compensate for the shortening of the arm. The arm is fixed with a splint or plaster cast.
However, more severe misalignments can usually only be corrected by surgery. These corrections are made from the first year of life, whereby the fingers are separated or bony parts are removed during an operation. Today, the following surgical procedures are mainly used for this purpose:
- Radius hypoplasia: At the age of two to three years, the radius is lengthened with this method. The operation may need to be repeated as the child grows.
- Subtotal or total radius plasia: Centralization of the ulna occurs at the age of two to three months, six months or in the third or fourth year of life.
Clubhands often lack the thumb or have receded. Since a gripping function is not possible without the thumb, it has to be reconstructed. There are two options for a reconstruction: either a finger is converted into a thumb or a toe is transplanted.
The surgical procedure in which a thumb is reproduced is called pollicization, whereby the index finger is usually used for this. Interventions on the elbow and forearm normally only take place during puberty so that the growth plates are not endangered. An exception is the surgical method according to Walther Blauth, which is already carried out in preschool age. In this case, the surgeon severs the soft tissues at the wrist and then bolts the ulna to the wrist.
After the operation, the arm is immobilized for about four to six weeks, and constant monitoring by a specialist is required until growth is complete. The treatment of hand deformities in children often proves to be extremely tedious and can last for years. Due to the growth, new corrective interventions are often necessary. In the case of very severe malformations, it is usually only the functions that can be improved, but not the cosmetic result, which is why psychological care is also part of the therapy concept.
Outlook & Forecast
Club hand is a congenital malformation of the skeletal system. This cannot be changed either through self-help measures or through the use of alternative or natural healing methods. An alleviation of the symptoms can only be achieved with the possibilities of conventional medicine.
Without the use of medical care, impairments can increase over the course of life. The movement restrictions worsen, there is a risk of pain and severe emotional stress. A change and optimization of the skeletal system is aimed for in an operative intervention or through the use of conservative methods. The use of the methods used is associated with various risks and side effects. In addition, several interventions are often necessary during the growth and development process of the child. This can lead to complications and consequential damage.
Under optimal conditions, doctors can achieve good functioning of the arm, hand and fingers in long-term treatment. Fingers are often simulated and then mobilized in targeted training sessions. Nevertheless, mental irregularities are to be expected in many patients due to the visual abnormalities and limitations in everyday life. These must be taken into account when making the overall prognosis, as they are often lengthy and associated with a reduced quality of life.
Prevention
Since a club hand is a congenital malformation, it cannot be prevented.
Aftercare
The actual aftercare takes place until the end of puberty. Then the growth comes to a standstill at the latest. A reduction in suffering from clubhand is then unlikely. The patient can live with a cosmetic improvement in everyday life, but mobility remains restricted. The aim of aftercare for adults can therefore not be, as usual, to prevent a recurrence of the disease.
The hand treated in the growth phase is in a rigid form. Those affected have to spend their everyday life with the corresponding restrictions in the private and professional sphere. Psychotherapy may be indicated if the immovable circumstances result in mental suffering. Children must be monitored after an initial procedure. Because the club hand often entails the need for another operation.
Even then, some things can change in the affected hand due to the growth phase. In order to achieve the desired result, quarterly or semi-annual appointments with the doctor treating you are recommended. This is the only way to avoid complications and unforeseen developments. Orthoses or splints can be adapted to changed conditions at short notice. X-rays, which make the malformations clearly visible, serve as diagnostic tools.
You can do that yourself
Milder forms of clubhand can often be treated with conservative methods. Less pronounced malformations can be corrected by wearing a plaster cast or splint. At the same time, the doctor will recommend that the patient rest the affected hand.
If an operation is necessary, the affected hand must then be rested for at least four to six weeks. In addition, constant monitoring by a specialist is required. Major physical work can only be carried out again after the doctor has given his consent. In children with club hands, the parents should initiate an operation as early as possible, otherwise further complications can occur in the development process.
If the club hand is a heavy burden on the patient and has possibly already caused mental problems, therapeutic treatment is indicated. Participation in a self-help group can give those affected courage and thus make it easier to deal with the deformity. A club hand should always be monitored by a doctor. Even with milder forms, complications such as premature joint wear or circulatory disorders can arise, which must be clarified and, if necessary, treated. If symptoms appear suddenly, a doctor should be consulted.
