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. (also incl reference(s))

Congenital Radioulnar Synostosis

Description of Congenital radioulnar synostosis is a rare disorder resulting in the fusion of the radius and ulna
condition from birth. Management is conservative. Operative treatment rarely succeeds. (Radioulnar
synostosis Symptoms & Causes | Boston Children's Hospital, 2020)

(Tsai, 2017)
Relevant When it happened bilaterally, it will become a disabling condition which is possible without
clinical history supination.
Associated Radioulnar synostosis can occur as part of an underlying syndrome or with other
clinical finding, developmental abnormalities, such as:
associated
• other skeletal abnormalities (about one-third of the time)
clinical or
• problems of the heart, kidneys, nervous system or gastrointestinal system
systemic
• certain genetic syndromes, such as Holt-Oram syndrome (also called hand-heart
features
syndrome) and fetal alcohol syndrome

(Radioulnar synostosis Symptoms & Causes | Boston Children's Hospital, 2020)

Additional
information
may be
important as a
chiropractor

Ulnar Minus Variant

Description of “Negative ulnar variance is a condition in which the ulna is relatively shorter than the radius at
condition the carpus. “(Voorhees, Daffner, Nunley and Gilula, 1985)
https://www.ncbi.nlm.nih.gov/pubmed/4001966

Relevant It is likely that when the TFCC (The triangular fibrocartilage complex) is disrupted, there is a
clinical history spreading between the distal radius and ulna, so the tear might be caused by the longer ulnar
or the TFCC cause an ulnar variance.

Associated Negative ulnar variance could be associated with fatigue fractures and avascular necrosis such
clinical finding, as Kienbock’s disease (Souza, 2016).
associated
clinical or
systemic
features
Additional This is an important measurement because the dynamics of the wrist are dependent on the
information ulna and radius translating force through the wrist. Normally, the translation of forces
may be 80/20. 80% translates to the radius and 20% to the ulna. This is one of the reasons we see
important as a more radius fractures than ulna fractures. a mm difference is a big deal. Therefore, anytime we
chiropractor are dealing with mm, there is a lot of room for error. (Ulna Variance and Ulna Shortening,
2020)

Syndactyly
Description of Syndactyly is the condition of congenital deformity and developmental defect of fusion or
incomplete separation of digit soft tissue.
condition
Syndactyly is the abnormal connections between digits such as the webbing of the toes or
hands (middle and ring fingers are the most affected) (Magee, 2014).

Relevant Various chromosomal and metabolic disorder may result in a variety of change in the shape of
clinical history the hand or its creases (Souza, 2016).

Associated Apert’s syndrome: a complex of craniofacial abnormalities caused by premature

clinical finding, craniosynostosis, usually of the coronal suture, leading to turribrachycephaly, associated with
associated syndactyly and polydactyly (extra digits).(Standring, 2016).
clinical or
systemic
features
Additional When doing the upper and lower extremities examination, it should be observe carefully for
information subtle anomalies such as syndactyly of the fingers or toes, as this may indicate the probable of
may be abnormalities of skeletal or organ.
important as a
chiropractor

Acro-osteolysis
Description of Acro-osteolysis refers to resorption of the distal phalanx. The terminal tuft is most commonly
condition affected. It is associated with a heterogeneous group of pathological entities.

When there is linear bone resorption of the midshaft of the distal phalanx with a relatively
spared terminal tuft, the condition is also referred to as band acro-osteolysis and carries a
more limited differential diagnosis. (Weerakkody, 2020).
Relevant Increased parathyroid activity liberates parathormone, which exerts a strong osteoclastic effect
clinical history on the skeleton.

There was a massive effect of osteoclast when the parathormone was released by the
increased parathyroid activity. The acro-osteolysis will commonly found in the middle
phalanges of the second and third digits. (Yochum and Rowe, 1996).
Associated Workers involved in the polymerization of polyvinyl chloride (PVC) may develop a peculiar form
clinical finding, of acro-osteolysis.
associated
clinical or
systemic
features

Additional
information
may be
important as a
chiropractor

Madelung’s Deformity
Description of it is congenital deformity and common happened female bilateral wrist, generally after 10
condition years of age, and the deformity increase unitl the bone growth stop (Yochum and Rowe, 1996)

Relevant Family history with Madelung’s deformity or diaphyseal aclasis (Yochum and Rowe, 1996).
clinical history
Madelung deformity is due to defective development of ulnar third of the epiphysis of the
distal radius, which results in a radial shaft that is bowed with an increased interosseous space,
and dorsal subluxation of the distal ulna (Yochum and Rowe, 1996).

The chance of damaged the medial part of the distal radial epiphysis caused by the history of
trauma and infection (Yochum and Rowe, 1996).

Associated Likely associated with Dyschondroplasia, achondroplasia, Turner’s syndrome,

clinical finding, Mucopolysacchoroidosis, multiple epiphyseal dysplasia (Yochum and Rowe, 1996).
associated
clinical or Typical deformities of bilateral wrist with congenital , post-infective, post-traumatic or due to
diaphyseal aclasis for a long period of time .
 systemic
features

Additional Always using X -rays to confirm the diagnosis (Yochum and Rowe, 1996).
information With the broader wrist, prominent ulnar head is dorsally with the radius angulated ulnarwards
may be and volarly (Yochum and Rowe, 1996).
important as a
chiropractor

References

1. Childrenshospital.org. 2020. Radioulnar Synostosis Symptoms & Causes | Boston Children's Hospital. [online]
Available at: <http://www.childrenshospital.org/conditions-and-treatments/conditions/r/radioulnar-
synostosis/symptoms-and-causes> [Accessed 7 May 2020].

2. Magee, D., 2014. Physical Assessment.

3. Souza, T., 2016. Differential Diagnosis And Management For The Chiropractor.

4. Standring, S., 2016. Gray's Anatomy.

5. Tsai, J., 2017. Congenital radioulnar synostosis. Radiology Case Reports, 12(3), pp.552-554.

6. Voorhees, D., Daffner, R., Nunley, J. and Gilula, L., 1985. Carpal ligamentous disruptions and negative ulnar
variance. Skeletal Radiology, 13(4), pp.257-262.

7. Weerakkody, Y., 2020. Acro-Osteolysis | Radiology Reference Article | Radiopaedia.Org. [online]

Radiopaedia.org. Available at: <https://radiopaedia.org/articles/acro-osteolysis-1> [Accessed 7 May 2020].

8. WristWidget®. 2020. Ulna Variance And Ulna Shortening. [online] Available at:
<https://www.wristwidget.com/blogs/blog-archive/ulnar-variance-important-things-you-should-know>
[Accessed 10 May 2020].

9. Yochum, T. and Rowe, L., 1996. Essentials Of Skeletal Radiology. Baltimore, Ma: Williams & Wilkins.