Medscape is available in 5 Language Editions – Choose your Edition here.


Ulnar Clubhand Workup

  • Author: Minoo Patel, MBBS, PhD, MS, FRACS; Chief Editor: Harris Gellman, MD  more...
Updated: Dec 03, 2015

Imaging Studies

See the list below:

  • Radiographic evaluation of the elbow, forearm, wrist, and hand: Serial radiographs can be useful in assessing the degree and course of the aplasia.
  • Magnetic resonance imaging (MRI): MRI can be used to delineate noncalcified tissues such as the fibrocartilaginous anlage. This modality is also useful for studying the joint surfaces in the largely unossified cartilaginous articulations.

Other Tests

See the list below:

  • All affected patients should undergo a detailed evaluation by a hand and upper limb therapist to assess hand function. Ongoing evaluation during treatment is important to avoid restriction of hand and elbow function (see Complications). In addition, appropriate genetic evaluation and counseling for individuals with syndromic ulnar aplasia is important in certain instances.
Contributor Information and Disclosures

Minoo Patel, MBBS, PhD, MS, FRACS Senior Lecturer, Monash University; Director, Centre for Limb Reconstruction and Deformities, Epworth Centre; Chairman, Cabrini Hospital Orthopaedic Surgery Specialty Group; Orthopaedic Adult/Pediatric Surgeon, Epworth Hospital; Fellowship Director, Epworth Kleos Upper Limb and Limb Reconstruction Fellowship; Consulting Adult/Pediatric Orthopedic Surgeon, Department of Orthopedic Surgery, Monash Medical Center, Australia

Minoo Patel, MBBS, PhD, MS, FRACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Australian Association of Surgeons, Australian Medical Association, Australian Orthopaedic Association, Royal Australasian College of Surgeons, Orthopaedic Research Society, AO Foundation, Orthopaedics Overseas, Indian Orthopedic Association, Bombay Orthopedic Society, Shoulder and Elbow Society of Australia, Australian Paediatric Orthopaedic Society, Australian Limb Lengthening and Reconstruction Society, Victorian Hand Surgery Society, Victorian Shoulder and Elbow Society

Disclosure: Nothing to disclose.


John Herzenberg, MD, FRCSC Head of Pediatric Orthopedics, Director of International Center for Limb Lengthening, Rubin Institute for Advanced Orthopedics, Sinai Hospital of Baltimore

John Herzenberg, MD, FRCSC is a member of the following medical societies: American Academy for Cerebral Palsy and Developmental Medicine, Pediatric Orthopaedic Society of North America, Limb Lengthening and Reconstruction Society, American Academy of Orthopaedic Surgeons

Disclosure: Received educational grant from Smith and Nephew, EBI, Orthofix for none.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Michael Yaszemski, MD, PhD Associate Professor, Departments of Orthopedic Surgery and Bioengineering, Mayo Foundation, Mayo Medical School

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine, Clinical Professor, Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society

Disclosure: Nothing to disclose.

Additional Contributors

Joseph E Sheppard, MD Professor of Clinical Orthopedic Surgery, Chief of Hand and Upper Extremity Service, Department of Orthopedic Surgery, University of Arizona Health Sciences Center, University Physicians Healthcare

Joseph E Sheppard, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, Orthopaedics Overseas, American Society for Surgery of the Hand

Disclosure: Nothing to disclose.

  1. El Hassan B, Biafora S, Light T. Clinical manifestations of type IV ulna longitudinal dysplasia. J Hand Surg [Am]. 2007 Sep. 32(7):1024-30. [Medline].

  2. Aucourt J, Budzik JF, Manouvrier-Hanu S, Mézel A, Cotten A, Boutry N. Congenital malformations of the hand and forearm in children: what radiologists should know. Semin Musculoskelet Radiol. 2012 Apr. 16(2):146-58. [Medline].

  3. Reddy J, Laufer MR. Congenital anomalies of the female reproductive tract in a patient with Goltz syndrome. J Pediatr Adolesc Gynecol. 2009 Aug. 22(4):e71-2. [Medline].

  4. Mougel F, Debarbieux S, Ronger-Savlé S, Dalle S, Thomas L. Methylaminolaevulinate photodynamic therapy in patients with multiple basal cell carcinomas in the setting of Gorlin-Goltz syndrome or after radiotherapy. Dermatology. 2009. 219(2):138-42. [Medline].

  5. Maas SM, Lombardi MP, van Essen AJ, Wakeling EL, Castle B, Temple IK, et al. Phenotype and genotype in 17 patients with Goltz-Gorlin syndrome. J Med Genet. 2009 Oct. 46(10):716-20. [Medline].

  6. Gottschalk HP, Light TR, Smith P. Focal fibrocartilaginous dysplasia in the ulna: report on 3 cases. J Hand Surg Am. 2012 Nov. 37(11):2300-3. [Medline].

  7. Pandeshwar P, Jayanthi K, Mahesh D. Gorlin-goltz syndrome. Case Rep Dent. 2012. 2012:247239. [Medline]. [Full Text].

  8. Menon P, Bae JS, Mioshi E, Kiernan MC, Vucic S. Split-hand plus sign in ALS: Differential involvement of the flexor pollicis longus and intrinsic hand muscles. Amyotroph Lateral Scler. 2012 Oct 22. [Medline].

  9. Swanson AB, Tada K, Yonenobu K. Ulnar ray deficiency: its various manifestations. J Hand Surg [Am]. 1984 Sep. 9(5):658-64. [Medline].

  10. Elliott AM, Kibria L, Reed MH. The developmental spectrum of proximal radioulnar synostosis. Skeletal Radiol. 2010 Jan. 39(1):49-54. [Medline].

  11. Nygaard M, Nielsen NS, Bojsen-Møller F. A biomechanical evaluation of the relative load change in the joints of the wrist with ulnar shortening: a 'handbag' model. J Hand Surg Eur Vol. 2009 Dec. 34(6):724-9. [Medline].

  12. Oberg KC, Harris TE, Wongworawat MD, Wood VE. Combined congenital radial and ulnar longitudinal deficiencies: report of 2 cases. J Hand Surg Am. 2009 Sep. 34(7):1298-302. [Medline].

  13. Ogino T. Clinical features and teratogenic mechanisms of congenital absence of digits. Dev Growth Differ. 2007 Aug. 49(6):523-31. [Medline].

  14. Tetsworth K, Krome J, Paley D. Lengthening and deformity correction of the upper extremity by the Ilizarov technique. Orthop Clin North Am. 1991 Oct. 22(4):689-713. [Medline].

  15. Peterson BM, McCarroll HR Jr, James MA. Distraction lengthening of the ulna in children with radial longitudinal deficiency. J Hand Surg Am. 2007 Nov. 32(9):1402-7. [Medline].

  16. Paley D, Herzenberg JE. Distraction treatment of the forearm. Buck-Gramcko D, ed. Congenital Malformations of the Hand and Forearm. London, UK: Churchill Livingstone; 1998. 90-2.

  17. Sénès FM, Catena N. Correction of forearm deformities in congenital ulnar club hand: one-bone forearm. J Hand Surg Am. 2012 Jan. 37 (1):159-64. [Medline].

  18. Foucher G. [Toe transplantation in congenital malformations of the hand] [French]. Bull Acad Natl Med. 1997 Nov. 181(8):1737-44; discussion 1744-5. [Medline].

  19. Kakarala G, Kavarthapu V, Lahoti O. Distraction osteogenesis to improve limb function in congenital bilateral humeroradioulnar synostosis. Acta Orthop Belg. 2006 Dec. 72(6):765-8. [Medline].

  20. Malpas T, Anderson N, Langley S. Ulnar club-hand and constriction-ring syndrome. Pediatr Radiol. 1995. 25(3):233-4. [Medline].

  21. Minguella-Solá J, Cabrera-González M, Escolá-Teixidó J. [Radial club-hand and contralateral pre-axial polydactyly and ulnar club-hand and contralateral post-axial polydactyly. Report of 2 unusual cases] [Spanish]. An Esp Pediatr. 1999 Jul. 51(1):68-70. [Medline].

  22. Saffar P. Ulna oblique osteotomy for radius and ulna length inequality: technique and applications. Tech Hand Up Extrem Surg. 2006 Mar. 10(1):47-53. [Medline].

  23. Wang AA, Hutchinson DT. Use of the elbow compass universal hinge in pediatric patients. J Pediatr Orthop. 2006 Jan-Feb. 26(1):58-60. [Medline].

All material on this website is protected by copyright, Copyright © 1994-2016 by WebMD LLC. This website also contains material copyrighted by 3rd parties.