Today, we're going to be talking about common upper extremity musculoskeletal conditions. I have no relevant disclosures. The learning objectives today are diagnosis and treatment of common upper extremity conditions. First, we're going to talk about springle deformity. It is a congenital malformation characterized by an abnormally small high-riding scapula. In most cases, it's going to be unilateral. The etiology is unknown, though it appears to have a familial predisposition. It may be associated with other congenital anomalies, such as Kleipel-Fell syndrome and rib and vertebral malformations. They may also present with scoliosis and torticollis. Complaints usually consist of a cosmetic deformity and limited shoulder motion on the affected side. On exam, scapula is noted to be hypoplastic and a high-riding in association with asymmetry of the base of the neck and shoulders. Shoulder motion is usually severely limited, particularly in abduction. This is due to limited scapular motion because the scapula is often tethered to the cervical spine by a fibrous band. The radiograph confirms the abnormal size and position of the scapula. Here is just a picture. You can see the asymmetry and the much smaller scapula there on the left and how he has decreased abduction with shoulder flexion. Non-surgical is going to involve stretching and range of motion exercises. However, these are rarely successful. So then they'll go on to surgical treatment where they have excision of the prominent superior aspect of the scapula or they're going to release and reduction of the scapula accomplished by positioning it inferiorly on the truss wall. Usually they're going to do this surgery before adolescence as it can result in better cosmetic appearance and restore some of the overall function at the shoulder. Next we'll talk about congenital pseudoarthrosis of the clavicle. This is a rare congenital disorder. It is painless, non-tender bulbous deformity in the region of the mid-clavicle, thought to be due to failure of maturation of the ossification center of the clavicle, generally involves the right side and it can be associated with other congenital anomalies. On examination, the clavicle appears foreshortened with a prominence evident in its mid-position. Palpation reveals hypermobility of the two ends of the clavicle as well as some crepitants. Range of motion at the shoulder is usually normal in these kids. Here on imaging, you can see that you're going to see the bony prominence about midway through the clavicle. This differs from a clavicular fracture at birth. With those, you're going to have tenderness over the deformity. Treatment usually involves no functional impairment, so therefore requires no treatment. Next is radial club hand. This is a congenital absence or hypoplasia of the radial structures of the forearm and hand. Associated muscular structures of the radial nerve are hypoplastic or absent. This is rare. It affects more males than females. Characteristic clinical presentations is one of a small, short, bowed forearm and aplasia or hypoplasia of the thumb. The residual hand is deviated radially. Here's just a picture showing the deformities. The radiograph shows absence of the bones in the affected area. Treatment is best instituted early with passive stretching and corrective casting. Surgical treatment consists of centralization of the hand on the one-bone forearm to maximize function. Next, we're going to talk about ganglion of the wrist. It's a benign cystic mass consisting of accumulation of synovial fluid or gelatin and an outpouching of a tendon sheath or joint capsule. Etiology is unknown, though thought to be related to a herniation of synovial tissue with ball valve effect. Trauma may be reported. On occasion, they are seen on the dorsum of the foot or adjacent to one of the malleoli of the ankle. Examination, there may be present over the dorsal or volar aspects of the wrist, generally towards the radial side. It may be firm or fluctuate. Most are asymptomatic, but occasionally will complain of pain and tenderness. Their size may fluctuate with time and activity. Here's just showing a picture of a ganglion cyst over the wrist. Treatment generally is unnecessary for patients who are asymptomatic, and surgery is not routinely advised because recurrence rate may be as high as 20%. Patient may want them removed for cosmetic reasons. You can do aspiration, injection, or rupture of the cyst. However, this does not eradicate them. As stated, the reoccurrence rate is high. Surgical incision with obliteration of the base of the ganglion is the most successful treatment plan. Next, we'll talk about syndactyly. It's a relatively common congenital anomaly involving failure of the digits of the hand or feet to separate. It's more common and more disabling in the upper extremity. Bilateral involvement is unusual. Positive family history is common, and this may be associated with other congenital anomalies, particularly Apert syndrome and Streeter dysplasia. So it is the most common congenital malformation of the limbs. The incidence is 1 in 2,000 to 2,500 live births. They occur more commonly in males than females, more in Caucasians than African Americans. For ray involvement, 50% include the long ring finger, 30% rings to small finger, 15% index to long finger, and 5% thumb to index finger. Family classification, there is simple, only soft tissue involvement with no bony connections. Complete versus incomplete, a complete syndactyly, the skin extends to the fingertips, whereas with incomplete, the skin does not extend to the fingertips. Complex, side to side fusion of adjacent phalanges, and complicated is accessory phalanges or abnormal bones involved in the fusion. Treatment in mild cases, only the skin is joined, making the reconstructive surgery simple. In more severe cases, the nails, deeper structures, and bone may be conjoined, contributing to deformity and growth abnormalities and making reconstructive treatment more difficult. Next, we'll talk about congenital trigger thumb. This is characterized by a fixed or intermittent flexion deformity of the interphalangeal joint of the thumb that may be present at birth or may develop shortly thereafter. It is thought to be result from tightness of the tendon sheath of the flexor pollicis longus in the region of the metacarpophalangeal joint. Generally, this cannot be reduced. Although it may be passively correctable in milder cases with a snapping sensation felt as the tendon passes through the stenosed pulley mechanism. So here's just a picture of a normal thumb versus a trigger thumb. Treatment, if passively correctable, splinting and extension occasionally results in correction. Otherwise, surgery is required. That is all for this presentation. These are the resources listed. Thank you for your time today.

upper extremity musculoskeletal conditions

springle deformity

congenital pseudoarthrosis of the clavicle

radial club hand

ganglion of the wrist