Fetal clenched hands

Last revised by Joshua Yap on 2 Oct 2022

Fetal clenched hands are an antenatal ultrasound observation where the fetal hands are in a constant (permanently) clenched position as if being unable to extend.

Several syndromic conditions are associated with this observation including:

Notably, there is no association with Down syndrome (trisomy 21).

Some authors 3 suggest that the abnormal posture results in part from:

  • muscle variations along the radial margin of the forearm and hand

  • the absence of thenar muscles, anomalous tendons and attachments among the forearm groups

  • fusion among the arm flexor group

Real-time images are best for assessment where the fetal hands can be directly observed in a persistent clenched position. Often there may also be overlapping fetal fingers (particularly the 2nd finger overlapping the 3rd). Its presence in an antenatal ultrasound scan is sometimes classified as a soft sign for aneuploidic anomalies.

On antenatal imaging consider:

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