Billy A. Watson and Kerby C. Oberg
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determining skeletal differences, but in the immature skeleton with abundant
cartilage, the full extent of abnormality may not be evident. Magnetic
resonance imaging (MRI) can provide soft tissue and vascular details but also
requires sedation. MRI is more commonly used to plan and optimize an
intervention rather than clarify a diagnosis.
MANAGEMENT
To the growing child, the CULA will be “normal” and the mind will
develop with the body that is present. The perception of the limb as abnormal
will occur over time, but a supportive family and clinical team can be an
enormous help to the child as they navigate this adjustment. Because a number
of professionals may be involved with the care of a child with CULA, clinic
visits may be numerous and overwhelming to the child and family. Some
institutions have implemented a team approach for a variety of congenital
anomaly clinics, including hand clinic, in which pediatricians, geneticists,
surgeons, therapists, and social workers converge to offer a one stop clinic
where a team can assess, discuss and collaborate with the family regarding the
treatment plan.
It is important to evaluate the child’s structural and functional progression
using developmental milestones to fully understand the impact of their CULA.
For example, comparing the X-Ray appearance of secondary ossification
centers and subsequent growth plate closures to standardized norms can
indicate which structures are affected by the CULA and how the natural
progression of their condition may manifest in adult life. Measuring the
milestones of prehension from rudimentary grasp to the incorporation of fine
thumb involvement can suggest how the structural aspects of the CULA has
affected function (Erhardt and Lindley, 2000). These assessments allow
caregivers to monitor the condition’s progression and offer timely therapeutic
options to the patient and family.
Conservative Management
For some disorders, monitoring, splinting and/or physical therapy are the
preferred approach. Trigger fingers are a common CULA that often resolves
over time without intervention (Baek and Lee, 2011). Conservative
management may also be most appropriate for conditions in which outcomes