Module 34, General Orthopaedist Level

Order of Xray links: 1. Internal Rotation, 2. External Rotation, 3. AP, 4. Lateral.

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. The left arm demonstrates a shoulder with full range of motion (ROM) and strength 5/5. The elbow has a flexion from 0 to 135 degrees, but the forearm is fixed in 45 degrees of pronation without active or passive supination. The wrist has full ROM with some hyper-mobility, especially in radial and ulnar deviation. The strength is 5/5 in elbow flexion/extension, wrist flexion/extension and grip. He is neurovascularly, intact. The right arm also demonstrates normal motion at the elbow with flexion from 0-135 degrees but limited supination from 0-50 degrees and pronation from 0-20 degrees. The remainder of his exam was normal.

Question 34A

The right arm is normal and the left arm has radioulnar synostois.

Question 34B

The cause of this is most likely a fracture in childhood which was missed.

Question 34C

Surgical excision of this synostosis with fat interposition should yield significant improvements in elbow ROM.

Question 34D

This will have not effect on the length of the arm at maturity.

Question 34E

Because he is asymptomatic now, surgery should not be considered.