Cutting edge Orthopedics

10 • CUTTING EDGE - ORTHOPEDICS one simple test that most children will perform (Fig. 10). Extension of the metacarpophalangeal joint must be demonstrated to ensure that the radial nerve/PIN is functioning, while resisted adduction indicates that the ulnar nerve is intact. Alternatively, active abduction/adduction of the index finger can be tested. Finger crossing is a test frequently used to assess the ulnar nerve; however, small children may not yet have the fine motor skills needed to cross their fingers. The Fig. 10: ( a ) The anterior interosseous nerve is tested by assessing flexion of the thumb interphalangeal joint. ( b ) Having the child point the index finger and resist adduction of the digit may be used to assess both the radial and ulnar nerves. Extension of the metacarpophalangeal joint ( asterisk ) is necessary to ensure radial nerve function. Resistance of abduction of the index finger (i.e., digital abduction) indicates that ulnar nerve function is preserved. Contraction of the first dorsal interossei may be observed or palpated ( arrow ) (Courtesy of Stephanie A. Russo, MD). Fig. 9: Locations to assess sensation to light touch for gross examination of ( a ) radial ( red ), ( b ) median ( blue ), and ulnar ( green ) sensory function (Courtesy of Stephanie A. Russo, MD). can be tested in children old enough to under- stand by checking sensation to light touch in the dorsal webspace between the thumb and index finger for the radial nerve, palmar aspect of the distal and middle segments of the index nerve is intact. Alternatively, active abduction/ adduction of the index finger can be tested. Finger crossing is a test frequently used to assess the ulnar nerve; however, small children may not yet have the fine motor skills needed to Fig. 4.9 Locations to assess sensation to light touch for gross examination of ( a ) radial ( red ), ( b ) median ( blue ), and ulnar ( green ) sensory function (Courtesy of Stephanie A. Russo, MD) 44 cross their fingers. The contralateral limb may be used for co parison, if n eded. Repeat exams may be necessary o ensure that a com- plete exam is obtai ed [ 9 ]. Palpation All bony prominences of the limb should be pal- pated. During the assessment, the child’s face should be observed for grimaces, withdrawal, or Radiographic Evaluation Radiographic imaging of he entire upper extremity is often warranted for children with elbow injuries [ 9 , 34 ] unless a reliable clinical exam can sufficiently rule out associated inju- ries. The elbow is best assessed with an antero- posterior (AP) view of the distal humerus (rather than the elbow) and a true lateral view i . 4.10 ( a ) The anterior interosseo s r is tested by assessing flexion of the thumb interphala geal joint. ( b ) Having the child point the index finger and resist dduction of the digit may be used t ass ss both the radial and ulnar nerves. Extension of themetac rpophalangeal joint ( asterisk ) i necessary t ensure radial nerve functio . Resista ce of abduction of the ind x finger (i.e., digital abduction) indi- cates that ulnar n rve functio is preserved. Contraction of the first dors l interossei may b observed or palpated ( arrow ) (Cou tesy of Stephanie A. Russo, MD) S.A. Russo and J.M. Abzug