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Last reviewed: 05.07.2025
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Clubhand is a severe deformity, the main symptom of which is a persistent deviation of the hand towards the missing or underdeveloped forearm bone: in the absence of the radius - radial clubhand (manus vara), in the absence of the ulna - ulnar clubhand (manus valga). In congenital clubhand, the bone, muscle, vascular and nervous systems of the upper limb are affected, which is expressed in gross functional and anatomical disorders.
ICD 10 code
Q68.8 Other specified congenital musculoskeletal deformities
What causes clubhand?
Often there is a combination of congenital clubhand with developmental defects of other organs and systems, which allows us to classify this disease as an embryopathy.
How does clubhand manifest itself?
Radial clubhand
The hand and forearm are pronated, forming an angle of varying size (from obtuse to acute), open inwards (hence the name - manus vara), i.e. towards the absent or underdeveloped radius. The hand is underdeveloped, flattened due to the absence of the first finger and metacarpal bone, less often - the second and third fingers, shifted proximally in relation to the head of the ulna protruding towards the back. The forearm is shortened and curved with a convexity towards the dorsal side. Hypotrophy of the muscles of the forearm and shoulder is noticeable.
Limited mobility and strength of the fingers due to contracture of varying degrees. The hand is unstable. Rotational movements around the distal ulna are possible. Rotational movements of the forearm are absent, and movements in the elbow joint are limited.
The deformation is accompanied by underdevelopment of the radial nerve and radial artery.
Elbow clubhand
The forearm is also pronated, but with a deviation of the hand towards the underdeveloped ulna, i.e. outwards (mantis valga). The hand is deformed, the third, fourth and fifth fingers with the corresponding metacarpal bones are often underdeveloped or absent. The forearm is curved and shortened, muscle hypotrophy is observed.
Flexion and extension of the hand are not limited, the grasping function is preserved. The alignment with the articular surface of the radius provides sufficient stability of the hand when grasping and holding objects.
The shape of the elbow joint is changed, movements in it are limited or absent, which is associated with dislocation of the head of the curved radius or its synostosis with the humerus.
Diagnostics
The radiographic picture mainly corresponds to the clinical manifestations of the deformation. With radial and ulnar congenital clubhand, regardless of the severity of the disease, with the age of the child, functional disorders increase, which is due to the increase in existing deformation and the progression of rigidity.
How is clubhand treated?
Conservative treatment
From the first month after birth, conservative treatment is recommended, aimed at stretching shortened and contracted soft tissues with bringing the hand into a position along the axis of the forearm. For this purpose, staged corrective plaster bandages are used with a change every 7-10 days depending on age, massage, and therapeutic exercises. After correction of the deformation, a plastic tutor is used to hold the hand, preferably made of thermoplastic material - polyvika. With age, plastic splints are left only at night, and individually made therapeutic devices are used during the day. However, after the cessation of constant passive correction, a relapse occurs.
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Surgical treatment
Only surgically can the deformation be eliminated and the hand stabilized with improved functions, and relapse excluded. Many methods of surgical treatment of congenital clubhand have been proposed. In order to prevent an increase in deformation and rigidity, surgical treatment should be started at the age of 8-12 months, planning the stages of surgical interventions. The most important stage in the treatment of patients with congenital clubhand is surgery aimed at expanding the functional capabilities of the hand in radial clubhand and the functional capabilities of the elbow joint in ulnar clubhand.
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