Cambria

Cambria, a 9-year-old girl with right hemiplegia, presented in orthopedic clinic with a concern about the appearance of her arm. She felt other children noticed her deformed arm and some children had called her crippled. Her mother was concerned because Cambria used the arm infrequently and only for activities where she definitely had to use two hands. Cambria was in a regular fourth grade and was completely age appropriately and independent in all activities except she could not tie her own shoes. On physical examination her elbow flexion lacked 10 degrees to full extension, supination lacked 20 degrees to full supination, wrist flexion and extension was full and thumb abduction was full. On attempted active finger extension her wrist flexed to 30 degrees. With the wrist held passively at 30 degrees of dorsiflexion she could extend her fingers fully at the PIP and DIP joints, but lacked 40 degrees of extension at the MCP joints. When she was observed standing, her elbow was flexed 60 degrees, forearm was pronated, wrist flexed, thumb was adducted and the fingers were mid-point between flexion and extension.