Module 34, General Medical Level

The patient is an 11 year old, otherwise completely healthy boy, who presented for evaluation of his left arm. He states he has always had limited range of motion of his left arm, however, his mother states that it was not until recently she became concerned. The patient is right hand dominant. This does not cause him any functional problems and he has no pain. The mother and boy are concerned because the right and left arms are different.

Question 34A

A physical examination should focus on the elbow motion, especially pronation and supination of the elbow.

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Question 34B

Since there is no complaint of pain or functional limitation further concern and investigation is not needed. The mother can be reassured that there are commonly differences between the right and left arms.

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Question 34C

Restriction of elbow motion is found so blood tests should be obtained to rule out arthritis.

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Question 34D

If mainly loss of pronation and supination are found on physical examination, the next test to obtain should be an AP and Lateral x-ray of the forearm to include the elbow.

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Question 34E

The correct position of the elbow to test pronation and supination is with the elbow in full extension.

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