Neonatology Book

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Newborn Orthopedic Exam

Aka: Newborn Orthopedic Exam
  1. See Also
    1. Pediatric Foot Evaluation
  2. Exam: Digits (Fingers and Toes)
    1. Supernumerary Digit
      1. Extra digit without bone most commonly arising from the ulnar aspect of the 5th finger
    2. Polydactyly
      1. Congenital extra-digit (with bone)
      2. Contrast with Supernumerary Digit which does not involve bone
    3. Syndactyly
      1. Congenital persistence of webbing between digits
    4. Clinodactyly
      1. Fifth digit curvature
      2. Associated with inherited, isolated trait, as well as Turner Sydrome, Trisomy 21
  3. Exam: Upper Extremities
    1. Single Palmar Crease
      1. Seen in 3-10% of normal babies
      2. Also seen in Down Syndrome (Trisomy 21)
    2. Shoulder and Neck Exam
      1. Torticollis
      2. Clavicle Fracture from Birth Trauma
    3. Brachial Plexus Injury related palsy
      1. Erb Palsy (C5-C7 spinal nerve root traction injury with waiter's tip deformity)
      2. Klumpke Palsy (C8-T1 spinal nerve root traction injury with full arm paralysis and absent reflexes)
      3. Klumpke Paralysis (Claw Hand deformity)
  4. Exam: Lower Extremities
    1. Bowing of legs is normal variation
    2. Positional deformities of foot
      1. Foot should be easily replaced to normal position
      2. Talipes Equinovarus (Clubfoot)
      3. Metatarsus Adductus (In-Toeing)
        1. Lateral foot border with C-Curve appearance
      4. Calcaneovalgus Deformity
    3. Congenital Hip Dislocation (developmental hip dysplasia)
      1. Tests: Ortolani Test, Barlow Maneuver
      2. Imaging indications (Hip Ultrasound at 6 weeks or Hip XRay at 4 months of age)
        1. Girls born in Breech position (risk is >10% for Congenital Hip Dysplasia)
        2. Consider in boys born in Breech position (risk is >2-3% for Congenital Hip Dysplasia)
        3. Consider in newborns with Family History of Congenital Hip Dysplasia
  5. References
    1. Lewis (2014) Am Fam Physician 90(5): 297-302 [PubMed]

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