club hand

Definition: The axis of the wrist is permanently deviated, and the hand is usually closed. Radial and ulnar club hands have different prognosis. They are difficult to differentiate in utero: the differential diagnosis relies upon the identification of the residual forearm bone(s) and upon the type of deviation of the wrist.

Types

 radial club hand

• Radial club hand is the most frequent type of club hands detected in utero: the wrist is radially deviated. Radial club hand is rarely isolated and sporadic. It usually occurs in association with the radial hypoplasia sequence (characterised by preaxial deficit ranging from mild thumb hypoplasia to complete absence of the radius). This malposition is frequently syndromic or associated with aneuploidy.

 ulnar club hand

• Ulnar club hand is secondary to ulnar deficiency. The diagnosis relies upon the identification of the residual radius and the ulnar deviation of the wrist. It is rare, usually nonsyndromic, and frequently isolated. It can be associated with other skeletal anomalies. The malformation affects the postaxial border of the limb.

Etiology

 radial ray anomalies (radial aplasia, radial hypoplasia)

• TAR syndrome (thrombocytopenia and absent radius syndrome)
• Fanconi disease (Fanconi anemia)
• Aase syndrome
• Holt-Oram syndrome
• VACTERL association