A physiotherapeutic approach to a baby with right disgenesis of thumb and left agenesis of upper extremity: A case report.

Abstract

A boy with bilateral congenital anomalies of the upper extremities with transverse absence of the left arm (agenesis) and absence of right thumb (disgenesis), fixed elbow in extension due to humeroradial synostosis thought that the humerus was intact. His wrist could move passively with 50° flexion, 0° extension, and 70° radial deviation. The other 4 fingers were intact, 4-5 metatarsal bones were in synostosis, and the fifth finger was clinodactyly. He was born by normal delivery. The physiotherapist started sensorimotor training to achieve functional movements of the right upper extremity. The exercises for the trunk muscles were emphasized to prevent the future possible thoracolumbar curve due to the absence of loading of the left arm on trunk muscles. Serial splinting was performed to position the wrist and fingers for functional purposes and abduction and internal rotation of the index finger to perform the opposition position until the pollicization surgery. At 1 and a half, his trunk was straight, and the wrist was partially corrected (15° extension; 35° radial deviation). He was able to play with toys and eat food. The mother rated his performance as 8/10 and 10/10, respectively. Both mother and father were satisfied with his performance in activities of daily living according to his age compared with his peers (9/10; 10/10, respectively). Thus, the physiotherapist's sensorimotor training and the positioning splints may be considered as feasible interventions in this case.