What is Radial Longitudinal Deficiency?

Radial longitudinal deficiency (RLD), also referred to as radial deficiency or radial club hand, is a rare birth defect where the radius bone in the forearm does not form properly causing the hand to bend towards the thumb side of the forearm causing limited movement. In addition, the thumb may be small or missing. The severity of the condition is different in each patient.

Causes of RLD

A baby’s arms begin to form during the fourth week of pregnancy and are fully formed by the eighth week of pregnancy. Sometimes the baby’s arms are completely formed before a woman even knows she is pregnant.

Environmental factors, such as infections or exposure to certain drugs, genetic factors, or other unknown reasons may cause the baby’s arms to form abnormally. Oftentimes, hand deficiencies like radial longitudinal deficiency occur for no apparent reason and are not inherited.

Symptoms of RLD

The following are the most common symptoms associated with radial longitudinal deficiency:

  • The arm is shorter than the other
  • A very small or missing thumb
  • Abnormal curving of the forearm, wrist or hand
  • Curvature of the ulna
  • Stiffness in the wrist or fingers

Diagnosis and Treatment of RLD

Radial longitudinal deficiency can be diagnosed during a prenatal ultrasound or after birth through a physical examination or x-ray. The severity of the condition will be determined at the time of diagnosis and will be classified in one of four types, with type 1 being the mildest and type 4 being the most severe.

The goal of treatment for radial longitudinal deficiency is to improve the functionality and the appearance of the hand.

Treatment options for radial longitudinal deficiency can include:

  • Splinting
  • Physical therapy
  • Prosthetics
  • Surgery

If surgery is the chosen course of treatment, the timing of the surgery will depend on the severity of the condition and the patient’s age and overall health.

Surgery for the treatment of RDL is often done before the child reaches school age, but generally not before 6 months of age. In all cases, the goal of surgery is to realign and stabilize the hand and wrist.

Most orthopedic hand surgeries are performed on an outpatient basis, but some may require an overnight stay.

Recovery time can take up to several months, depending on the severity of the condition and the extent of the surgery. Many patients can return to normal activity six weeks after surgery, but complete recovery typically takes three months.

Dr. Charles Goldfarb discusses radial longitudinal deficiency.

To request an appointment with a physician at St. Louis Children's Hospital, call 314.454.5437 or 800.678.5437 or email us. For additional resources about radial longitudinal deficiency and congenital hand deformities, contact our Family Resource Center.