Physical examination

The physical examination of the young child can be difficult, especially for practitioners who do not routinely treat children. However, a good physical exam is vitally important to the proper evaluation and diagnosis of many pediatric upper extremity conditions. As many of these issues also involve other body parts and organ systems, a complete physical examination, along with a focused upper extremity examination, is important in all new patients to the pediatric hand surgeon’s office. The development of children’s motor, verbal, and social skills proceeds along a predictable path, and these developmental milestones can be used to the examiner’s advantage as the exam is tailored to the age of the child. The structure and flow of the upper extremity examination in children must be flexible, and specific examination techniques, such as the use of a retractable tape measure, can be very helpful. In the specific cases of children with brachial plexus birth palsy and cerebral palsy, specialized examinations have been created to better standardize the evaluation of these difficult and heterogeneous conditions. For brachial plexus birth palsy, these include the Active Movement Scale (AMS) exam, as well as the modified Mallet exam. For cerebral palsy, the video-based Shriners Hospital Upper Extremity Evaluation (SHUEE) provides a comprehensive tool for evaluating a child’s functional use of their upper extremities.