Decreased Upper Extremity Rotation In A 2-year-old Boy

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Decreased Upper Extremity Rotation In A 2-year-old Boy - Page #1

Author: Elizabeth Vasser, MD Co Author #1: Kevin Burroughs, MD Patient Presentation: Two year old male toddler presented to our office with is father, who stated that patient is unable to rotate his left arm to properly catch a football. The father has also noticed that the left arm is a little shorter than the right. History: Patient is a healthy two-year old male, with no chronic medical issues. There were no reported problems during pregnancy, and patient was delivered vaginally without complications. Patient has met all his developmental milestones. He eats with his right hand, but he began throwing a ball with his left. There have been no reports of pain or favoring of either arm. Then, while playing ball last month, his father noticed that he was not rotating his left arm. The father has also noticed some "extra skin" around the left elbow. However, as the child has grown, it has become less prominent. Physical Exam: Right arm: Full range of motion at the shoulder. Full range of motion at the elbow and wrist, including supination/pronation and flexion/extension. Left arm: Full range of motion at the shoulder, symmetric with contra-lateral shoulder. Full flexion and extension at the elbow, with forearm held at rest in approximately 35 degrees of pronation. Full pronation can be achieved, but no additional supination is possible. A small amount of additional skin is notable around the elbow joint. Motion at the wrist appears symmetric with contra-lateral wrist. Patient is neuro-vascularly intact bilaterally. Full 5/5 strength and 5/5 sensation present. No pain elicited on exam. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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