Saturday, March 14, 2020

Radial Deficiency Outcome

Radial deficiency (or radial longitudinal deficiency, RLD) is one of the most challenging conditions that I treat.  We classify patients with RLD based on their bone development but that does not capture the underlying muscle and joint abnormalities.  Reports on treatment including surgery have been mixed and that has led hospitals and doctors to have different recommendations on procedures to consider.  And I agree, there is no one correct answer and every patient is different.  Sometimes that is obvious (one side affected vs both sides) or completely missing bones vs partially missing bones.  Other times it is less obvious and related to muscle strength, finger motion, and joint deviation.  I have posted many times before on this topic as you can see HERE.  There are also numerous resources regarding radius deficiency on the internet but many are hospital sites promoting care and others are references to scientific papers.  We in St. Louis have an algorithm for treatment based on what surgeries and interventions that we have found successful.  This includes therapy and different forearm, wrist, and thumb surgeries based on various factors.

I have been fortunate to treat many great patients and families with RLD and other diagnoses.  This is one of those patients/ families who happens to have RLD.  It starts with the perfect sweatshirt!  The right side has an absent radius, limited finger motion, and a radially deviated and flexed wrist.  The left side has better alignment, normal finger motion and a nearly normal radius bone.  The difference in motion of the forearm, wrist, and fingers is striking.  Both sides have had wrist surgery and both sides have had a pollicization (creation of a thumb from the index finger- more information HERE).  The patient clearly favors her left arm but uses both hands together for some activities.

Here are some pictures of the patient with RLD including both arms and an x-ray. 
Patient with RLD, right side more affected than left.

Patient with RLD, right side more affected than left.
Good elbow motion on both sides.  More deformity on the right.

RLD on both sides but more severe on the right.


Here is a video demonstrating function.  Very good overall on the left and pretty good on the right. 




Charles A. Goldfarb, MD              
My Bio at Washington University     
email: congenitalhand@wustl.edu

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