🦾 Chapter 722 · The Upper Limb

Nelson Textbook of Pediatrics 22nd Edition | Shoulder: Sprengel deformity (congenital elevation of scapula, associated with Klippel-Feil), congenital pseudarthrosis of clavicle (right side, painless). Elbow: Nursemaid's elbow (annular ligament subluxation, reduction with supination), Panner disease (capitellar osteochondrosis, age 5-13, self-limited), OCD capitellum (age 13-16, worse prognosis). Wrist: Madelung deformity (dysostosis, radial/physical bar, Vicker's ligament), gymnast's wrist (distal radial physeal stress). Hand: Polydactyly (most common, Wassel classification for thumb), syndactyly, trigger thumb (not congenital, release A1 pulley), thumb hypoplasia (pollicization if absent CMC joint), camptodactyly (PIP flexion), clinodactyly (radial deviation).

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📋 30 Clinical Scenarios — Upper Limb Disorders

📇 High‑Yield Review Cards

🩺 Clinical Recognition: Upper Limb Disorders

Select a presentation to review diagnostic clues and management per Nelson Ch 722.

📋 Stepwise Management of Upper Limb Disorders

🔑 Key Principles — Nelson Chapter 722
• Sprengel deformity: Congenital elevated scapula (unilateral/bilateral), associated with Klippel-Feil, omovertebral bar. Surgery if severe (>3cm elevation).
• Nursemaid's elbow: Age 1-5 years, longitudinal traction injury. Reduction: supination + flexion. No immobilization.
• Radial longitudinal deficiency: Absent/hypoplastic radius, radial deviation of hand. Associated with VACTERL, TAR, Fanconi anemia (pancytopenia), Holt-Oram (ASD). Surgery: centralization.
• Polydactyly: Most common congenital toe deformity (2/1000 births). Surgical excision at 9-12 months. Do NOT tie off.
• Trigger thumb: Age 1-2 years, inability to extend IP joint, Notta's nodule. Spontaneous resolution <1 year; surgery (A1 pulley release) if >1-2 years.
• Thumb hypoplasia: Pollicization if stable CMC joint absent.

    ⚡ Reflex Prompts — Clinical Decisions

    📖 Summary: The Upper Limb (Nelson 722)