Paediatric Upper Limb

This chapter is divided into four sections. 1. Shoulder: (a) Obstetric brachial plexus injuries are usually secondary to traction, about 90 % recover. The function of biceps brachii is the best indicator of recovery. Differential diagnoses should always be considered. (b) Pseudoarthrosis of the clavicle occurs due to a failure of fusion of the secondary ossification centres. Patients present with a palpable lump for which surgery is rarely indicated. 2. Elbow: The pneumonic CRITOL for secondary ossification centres around the elbow is a useful aide when diagnosing elbow injuries. (a) Congenital radial head dislocation is the most common congenital anomaly of the elbow. 60 % of patients have other anormalities. Patients present with restricted forearm rotation and elbow extension. Non operative treatment is recommended. Surgery in the form of radial head excision is an option if symptomatic after skeletal maturity. 3. Wrist: (a) Madelung’s deformity occurs due to premature fusion of the volar and ulna aspects of the distal radius, which leads to volar and ulna tilt of the distal radial surface. 4. Hand: Swanson’s classification is the most widely used for congenital hand abnormalities. It is broken down into seven types. The most common abnormalities are syndactyly and polydactyly. The most common acquired hand deformity is trigger thumb, spontaneous resolution occurs in 50 % cases, resolution is unlikely if it has not occurred before the age of 3 and surgery in the form of releasing the A1 pulley may be indicated.