Ulnar Clubhand Clinical Presentation

Updated: Apr 20, 2018
  • Author: Minoo Patel, MBBS, PhD, MS, FRACS; Chief Editor: Harris Gellman, MD  more...
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History and Physical Examination

The patient's affected upper limb is examined in supination, pronation, extension, and flexion. Clinical considerations of this condition include the following:

  • Ulnar deviation of the hand
  • Absent ulnar digits [14]
  • Syndactyly
  • Elbow stability
  • Elbow stiffness
  • Limited pronation, supination, or both
  • Radial head subluxation or dislocation
  • Deficient carpal bones
  • Stable wrist
  • Upper limb-length discrepancy


According to the traditional classification, there are four types of ulnar deficiencies of the forearm, which can have varying degrees of radial bow, with or without radial head dislocation.

In this classification, type 1 is defined as ulnar shortening (distally), with minor radial bow, and includes the following:

  • Hypoplasia of the ulna
  • Proximal and distal epiphyses present
  • Hypoplastic or absent ulnar digits
  • Minimal radial bowing

Type 2 is defined as significant ulnar shortening, with a fibrocartilaginous anlage attached to the ulnar carpus, with significant radial bowing, and includes the following:

  • Partial aplasia of the ulna, distal third
  • Distal ulnar anlage
  • Bowed radius with anlage acting as a tether
  • Presence/absence of progressive radial head dislocation

Type 3 is defined as complete absence of the ulna and includes the following:

  • Unstable elbow
  • Straight radius

Type 4 is defined as complete absence of the ulna, with a fibrocartilaginous anlage attached to the ulnar carpus, and includes the following:

  • Radiohumeral synostosis at the elbow
  • Bowed radius

Paley and Herzenberg combined the classifications of Kummel, Ogden, Swanson, and Johnson and Omer to create a classification that relates directly to the treatment strategies of ulnar deficiencies of the forearm as follows [15] :

  • Type 1 – Hypoplastic ulna with the distal epiphysis intact - This type is the most common with congenital dislocation of the radial head
  • Type 2 – Absence of the distal third of the ulna
  • Type 3 – Absence of the distal two thirds of the ulna
  • Type 4 – Complete absence of the ulna
  • Type 5 – Radiohumeral synostosis