Examination
Examination of the child with a congenital hand anomaly is carried out in a relaxed environment, ideally with the child interacting with the parent or a play specialist. Various toys or games which require manual dexterity can be used gradually to elucidate function. Once the confidence of child and family have been attained, a full musculoskeletal examination is undertaken:
- hand to chest wall:
- extent of deformity
- attitude of hand
- posture of limb
- wasting or compensatory hypertrophy of muscles eg absence of pectoral muscles with Poland's Syndrome
- passive range of motion
- gross active range of motion at each joint; generally difficult to measure in all but the older child
- examination of contralateral side; many congenital upper limb anomalies are symmetrical
- examination of feet for equivalent anomalies eg syndactyly, clefts
- abnormalities in other systems:
- distinct syndromic facies eg Down's Syndrome, Apert's Syndrome, Freeman-Sheldon Syndrome
- scoliosis
- Sprengel's deformity
- knee deformities
- hypoplastic mandible
- deafness
- ocular abnormalities
- heart murmurs eg due to ventricular septal defects
- cleft lip
- cleft palate
- imperforate anus
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