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