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))

A. Congenital Radioulnar Synostosis

· Refers to the failure of segmentation of the

adjacent radius and ulna
· Caused by the failure of separation of the
fused cartilaginous precursors of the radius
and ulna during the 7th week of gestation
· Affects supination and pronation
movements of the elbow joint (flexion and
extension of unaffected)
· Does however potentially create excessive
strain on the shoulder and wrist joint

 Over half of cases are bilateral

 Mild deformities can be compensated well through movement of adjacent joints
 To avoid strain activity modification, occupational therapy and ergonomic work places are
recommended

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

https://doi.org/10.1016/j.radcr.2017.03.011
 B. Ulna Minus Variant

· Refers to the relative lengths of the distal

articular surface of the radius and ulna, in this
case the ulnar projects more proximally
compared to the radius
· Can be caused by trauma or mechanical issues
(fracture or surgical shortening), it may also be
congenital (Madelung deformity)
· Associated with Kienbocks disease (avascular
necrosis of lunate) and ulnar impingement
(caused by shortened distal ulna impinging on
distal radius proximal to sigmoid notch of
radius)

 Ulnar variance changes with wrist position (more

positive with maximum forearm pronation and negative
with maximum forearm supination) and increases
significantly during a firm grip

Radiopaedia. (2018). Ulnar Variance. Retrieved from https://radiopaedia.org/articles/ulnar-variance

C. Madelung’s Deformity

· Congenital anomaly of the wrist caused by asymmetric

growth at the distal radial physis secondary to a partial
ulnar side arrest
· Characterised by ulnar and palmer curvature of the
distal radius, positive ulnar variance and proximal
subsidence of the lunate
· In females more than males and typically both wrists

 Stiffness, pain and extensor tendon ruptures have been reported

 Can usually be viewed exteriorly (without x-ray)

Ghatan, A. C., & Hanel, D. P. (2013). Madelung Deformity. Journal of the

American Academy of Orthopaedic Surgeons, 21(6), 372-382.
http://dx.doi.org.ezproxy.cqu.edu.au/10.5435/JAAOS-21-06-372

D. Syndactyly

· Congenital anomaly where there is

fusion of adjacent digits due to failure
to separate of developing phalanges
during organogenesis
 · More common in males (2x)
· Can be bilateral, symmetrical of asymmetrical

 Commonly involves interspaces between

middle and ring finger, ring and little finger
(can also happen between thumb and index
or index and middle)
 Requires surgery for correction

Braun, T., Trost, J., & Pederson, W. (2016). Paediatric Plastic Surgery Procedures. Syndactyly
Release. 30(4), 162-170. DOI: 10.1055/s-0036-1593478

E. Acro-osteolysis

· Slow progressive bone reabsorption

(osteolysis) of the distal phalanges
of the feet and hand
· Can affect the terminal tuft of the
shaft (most common) or the distal
phalanx (transverse or band acro-
osteolysis – second most)
· Cause and development is often
unclear

 Often associated with severe digital

ischemia, digital calcinosis, server sensory
neuropathy, infection, rheumatic disorders,
endocrinopathies, genetic disorders, and
lysosomal storage disorders
 X-ray is best diagnostic tool

Botou, A., Bangeas, A., Alexiou, I., & Sakkas, L.

(2017). Acro-osteolysis. Clinical
Rheumatology, 36(1), 9-14. https://doi-
org.ezproxy.cqu.edu.au/10.1007/s10067-016-3459-7