I have previously blogged about congenital radial head dislocation at least several times Previous posts .
However, like most upper extremity anomalies, not all patients with a congenital radial head dislocation present alike. Consider first that most of these dislocate so that the radial head moves in the posterior and lateral (outside) direction. A smaller number dislocate in the anterior direction. And anterior dislocations are most likely to block elbow flexion. These dislocations may be accompanied but limited forearm rotation (i.e., palm up and palm down) and, less commonly, pain. But, each child presents differently.
In the recent Oberg Manske Tonkin classification scheme for upper extremity anomalies, congenital radial head dislocation is categorized as a malformation (i.e., problem with limb formation while the baby is in the womb) involving the entire limb but in the radial- ulnar (inside, outside) direction (technically a I.A.2.v). And while our future understanding of these anomalies will undoubtably grow, I believe this grouping is the right place for this condition. I believe the following child shows why.
|Congenital radial head dislocation with a lack of elbow straightening.|
|Congenital radial head dislocation with good but not perfect elbow bending.|
|Congenital radial head dislocation with a very limited ability to supinate (turn palms up).
|Congenital radial head dislocation with near perfect pronation (turning palm down).
|Congenital radial head dislocation x-rays. Both the right and left side look the same. Notice that the radial head is dislocated in the anterior direction.
Congenital radial head dislocation is often thought of as an isolated problem to the elbow. But it is more likely to involve a bigger segment of the limb- the relationship between the radius and the ulna. This case shows that well and, I believe, a new research project we are working on will confirm that theory. We have previously looked at a wrist problem Madelungs study a found that a large number of these children actually have a problem in the whole forearm. Additionally, we have previously shown that surgery at the elbow (i.e., removal of the dislocated radial head) can, in a small % of patients, lead to problems at the wrist. Which, if you believe that Congenital radial head dislocation involves the whole forearm in some patients, makes complete sense. Surgery Outcome Results
Charles A. Goldfarb, MD
My Bio at Washington University