This will be a look and proceed case
- Likely a young child
- Inspection
- Note the presence of Preaxial polydactyly. My goal is to “determine which is the dominant duplicate”
- [Dominance] On inspection, the ulnar duplicate appears to be bigger.
- “comparing to the contralateral thumb and ipsilateral index finger, it is almost similar in size
- Nails are well formed
- “open close the wrist” - on making a fist, it appears that the ulnar duplicate if the dominant duplicate
- “pick up this key” - i note that the patient is using his ulnar duplicate - suggesting that is the dominant one.
- [Level] WIth regards to the level, it seems to be from the PIPJ
- Look for angular deofrmity
- For each duplicate:
- Check tendons - FPL, EPL
- Check sensation
- Check digital allens test for each duplicate, Cap refill
- Check stability of each joint in each duplicate
- Check Web space for contractures
- Check Kapanji score - can also help with seeing dominance
- Check Function