Congenital Malformation

 Defects in the developmen of body form or

function that are present at the time of birth

Etiological factors :
 Genetic defects

 Genetic revolution

 Environtment

 Combination
Newborn Physical Assessment
Family History

 Any family members with musculoskeletal

problems; genetic component
Birth History

 Weight and height

 Gestational age
 Birth presentation
 Single or multiple birth
 Type of birth: forceps, vaginal extraction,
cesarean section, shoulder presentation
 Asphyxia at birth: apgar score
Brachial Plexus Injury

 Excessive traction of the spinal nerve roots

C5-T3
 Many brachial plexus injuries happen when
the shoulders become impacted during
delivery and the brachial plexus nerves
stretch or tear.
Symptoms of Brachial Plexus injury

 Limp or paralyzed arm

 Lack of muscle control in arm, hand or wrist
 Lack of feeling or sensation in arm or hand
Brachial Plexus Injury

Waiter tip position

Drop hand
Clubfoot

 Talipes equinovarus is a congenital deformity.

 Has four main components:
 Inversion and adduction of the forefoot
 Inversion of the heel and hindfoot
 Equinus (limitation of extension) of ankle and
subtalar joint
 Internal rotation of the leg
Causes

 Unknown
 One of theory say it is result of intrauterine
maldevelopment of the talus that leads to
adduction and plantar flexion of the foot.
Club Foot
Gait Deformities
Genu varum

 Bowing of the legs

 Normal up to 3 years of age
Genu Varum
When is bowlegged considered a
problem?
 Tibial-femoral angle greater than 15 degrees.
 Associated internal tibial torsion
 Intercondylar (knee) distance greater than 4
to 5 inches.
 Joint laxity in the older child.
Figure II intercondylar distance
Blount Disease
Genu Valgum

 “Knock-Knees”
 Physiologic valgum tends to peak at around
24 to 36 months and self corrects at about 7
to 8 years.
Examination

 Tibial-femoral angle less than 15 degrees of

valgus in a child over 7 to 8 years of age.
 Awkward gait
 Intermalleolar (ankle) distance with knees
together greater than 4 to 5 inches.
 Often associated with short stature.
Intermalleolar Distance
Differential Diagnosis

 Rule out other causes of limb deformity.

syndactyl

 Two or more fingers or toes are attached

 Mesenchyme b/w prospective digits in hand
& footplates is removed by cell death, in 1 per
2.000 birth this process fails and result in
fusion between two or more digits
 Presence extra fingers or toes, frequently
lack of muscle connection
Claw toes

 Abnormal claw like shape, happens to four

smaller toes, cause by imbalance of foot
muscles, such as following factors :
 Genes, ill fitting shoes, diabetes, neuropaty
Pes planus

 Idiopathic condition, caused by ligamentous

laxity that presents with a decrease medial
longitudinal arch, a valgus hindfoot and
forefoot abduction with weight bearing
 Treat with stretching and shoe modification