Congenital II: Radial longitudinal deficiency and thumb hypoplasia

Radial longitudinal deficiency (RLD) is the most common upper limb longitudinal deficiency. Initial evaluation not only includes assessment of the upper extremity, but also addresses the high incidence of associated medical conditions and syndromes. Patients with RLD represent a spectrum of pathology ranging from thumb hypoplasia distally to phocomelia affecting more proximal segments. In patients with radial dysplasia, initial treatment focuses on stretching, orthosis fabrication, and assessing developmentally appropriate functional activities with a trend toward less invasive surgical corrections. Treatment of the hypoplastic thumb is based on thumb stability and may require serial examinations with a therapist to determine the appropriate surgical plan. Therapy must take into account not only the pathology and surgical procedures performed, but also the child and parent’s ability to participate in therapy and orthosis wear.