Radial Longitudinal Deficiency (RLD) / Radial Club Hand

Radial longitudinal deficiency (RLD) is a rare congenital condition where the radius bone in the forearm does not form properly.  A congenital condition means that it existed at birth or even before birth. RLD causes the affected hand to be bent inward toward the thumb side of the forearm, often with limited movement.

In addition to the curve of the wrist and forearm, your child may have a missing or small thumb. The severity is different in each child.

RLD is also referred to as radial deficiency or radial club hand.

A baby’s arms form between four and eight weeks of pregnancy, sometimes before a woman even knows she is pregnant. By eight weeks the arms are fully formed, although tiny.

Due to environmental factors (infections, certain drugs, genetic or other unknown reasons), they may not form normally. With hand differences, the genetic changes generally occur for no apparent reason. Less commonly, genetic changes run in families.

Some hand abnormalities have no known cause. In some cases, the hand difference is an isolated event. In other cases, the difference is part of a syndrome that affects multiple parts of the body.

There can be other medical problems linked with radial longitudinal deficiency.  Because the arm and the important internal organs such as the heart, intestines, blood cells and kidney form at about the same time, one factor (genes or environment) can affect all organs. 

Therefore, problems in these other areas need to be evaluated and often treated before the arm is treated.  

RLD can sometimes be seen on a routine prenatal ultrasound. After the baby is born, it is easily identified, and the diagnosis is usually confirmed through a physical exam and X-rays.

When diagnosing the condition, your child’s doctor may classify it as one of four types − with type 1 being the mildest and type 4 the most severe.

The main goal and benefit of treatment is to improve the child’s ability to function with the condition. Another aim is to improve the appearance of the hand and support the child’s self-esteem.

Treatment varies depending on the complexity of the condition and may include:

  • Stretching
  • Splinting or casting
  • Physical therapy (to help increase strength and function)
  • Prosthetics (in the case of missing parts or bones)
  • Surgery

If surgery is the chosen course of treatment, the goal is usually to realign and stabilize the hand and wrist. The timing of the surgery would depend on:

  • The patient’s age and overall health
  • The type and extent of the condition
  • The ability to tolerate treatment
  • The way the condition is expected to progress

In most cases, surgery is done before the child reaches school age but generally not before 6 months of age. In all cases, the goal of surgery is to repair any associated abnormalities, and improve range of motion and function.

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

Recovery varies from one week to several months, depending on the extent of the surgery. Most patients can return to normal activity within three to six weeks of surgery. However, three months is often required for complete recovery.

Call the Hand and Upper Extremity Center at Cincinnati Children’s at 513-803-HAND (4263) if you have questions or concerns. 


Last Updated 09/2013