CHIR12007

Clinical Assessment and Diagnosis

Portfolio Exercises Week 8

Self-directed learning:

The following conditions are congenital disorders or alterations in development that may have
clinical consequences and may mimic other conditions.

Investigate the following conditions. Include a description of the condition, relevant clinical history,
any associated clinical findings, associated clinical or systemic features and any additional
information you feel may be important as a chiropractor.

A. Congenital Radioulnar Synostosis

- A rare condition which involves an abnormal connection (synostosis) of the radius and
ulna at birth.
- The condition can be present unilaterally however in 60% of cases it presents bilaterally.
- People that suffer from this condition generally have limited rotational movement of
their forearm.
- In severe cases of fixed forearm pronation deformity, a patient cannot compensate
which in turn causes functional limitations by using scapular and glenohumeral motion.
- Hypermobility at the midcarpal and radiocarpal joints can disguise the lack of forearm
rotation, particularly with neutral or mild pronation deformities.

B. Ulna Minus Variant

- Physical findings for this congenital disorder show that the ulnar is abnormally
shortened compared to the radius and plays an important role in wrist pathology.
- There has been increased incidence of this anomaly in patients with carpal ligamentous
instabilities.
- Patients with ulna minus variant along with histories of suggestive ligamentous
instability should undergo radiologic evaluation to assure early diagnosis of carpal
disruptions.
C. Madelung’s Deformity

- Congenital dyschondrosis of the distal radial physis which can lead to partial deficiency
of growth of distal radial physis, ulnar carpal impaction & excessive radial inclination.
- Predominantly found in adolescent females and common in gymnasts.
- Symptoms include ulnar impaction & median nerve irritation.
- Physical exam leads to radial and volar displacement of hand and restricted forearm
rotation.
- MRI and X-rays conducted to determine severity of deformity.
- Treatment involves release of Vickers ligament; radial corrective osteotomy & distal
ulnar osteotomy.

D. Syndactyly

- Common congenital defect that often runs in the family.

- Syndactyly affects both hands (bilateral) about 50 percent of the time and most often
occurs between the middle and ring fingers.
- Classifications of syndactyly vary from either incomplete webbing, complete webbing,
fingers joined by soft tissue and complex; fingers joined by bone or cartilage along with
soft tissue.
- Syndactyly is caused in embryonic development whilst the baby is in the womb. The
hand forms into a paddle shape and at the 7 th week of gestation splits into separate
fingers. Due to an irregularity in this process Syndactyly results and fingers fail to divide
normally.
E. Acro-osteolysis
- Refers to lytic changes in the distal phalanges.
- Two patterns of resorption in adults; diffuse and bandlike.
- Diffuse pattern of resorption has a diverse differential diagnosis that includes; collagen
vascular disease; vasculitis; raynaud’s neuropathy; acromegaly.
- Bandlike pattern of resorption can be seen with polyvinyl chloride exposure & hadju-
cheney syndrome.