How To Measure Head Circumference Sd

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 Age from birth (years)

Figure 8.31 Ratio of palm width to palm length, both sexes, birth to 16 years. From Snyder et al. (1975), and Malina et al. (1973), by permission.

Thumb Position, Placement, and Range of Movement Thumb Position, Placement, and Range of Movement

Introduction

The position, placement, and range of movement of the thumb may be unusual. Photographs often delineate deviation from the norm better than measurement; however, the two methods presented below have been established to describe unusual thumbs.

The size of the thumb should also be assessed. If the tip of the thumb is below the proximal crease at the base of the index finger when the thumb is held parallel to the hand, then the thumb is either hypoplastic or low set; if the tip of the thumb is above the interphalangeal joint of the index finger, it is too long or digitalized.

Method 1. Thumb Placement Index

Definition Ratio of the distance between

(1) the distance between the proximal flexion crease (A) at the base of the index finger and the distal insertion (B) of the thumb (Fig. 8.32a) and

(2) the distance between the proximal crease (a) at the base of the index finger and the distal flexion crease (b) at the wrist (Fig 8.32b)

Landmarks The first measurement (1) is taken on the lateral aspect of the index finger: Measure from the proximal crease at the base of the index finger to the basal crease of the thumb insertion. The second measurement (2) is taken from the proximal crease at the base of the index finger, on the palmar aspect, to the distal flexion crease at the wrist.

Instruments Tape-measure, calipers, or clear ruler.

Position Maintain the thumb in 90 degrees abduction.

Remarks If the thumb is digitalized, it may not be possible to abduct it to 90 degrees, but the creases will probably still be identifiable.

Alternative Draw around the hand with the thumb held in 90 degrees abduction and measure between the points mentioned.

Figure 8.32(a-b) Measuring thumb placement.

Method 2. Angle of Thumb Attachment

Definition The angles of movement of the thumb (Fig. 8.33).

Landmarks With the hand at rest on a flat surface, palm up, fingers parallel, and thumb extended and abducted away from the palm as far as possible comfortably, draw an imaginary line through the main axis of the index finger and another imaginary line through the main axis of the index finger and another imaginary line through the main axis of the thumb. Measure the angle made by the imaginary lines (Fig 8.33a). Keeping the same hand position with the palm up, pick the thumb up from the flat surface and, keeping the thumb fully extended, rotate the thumb toward the palm, and measure the angle made by the thumb from the flat surface (Fig 8.33b).

If either of the angles is greater than 90 degrees or less than 75 degrees, abnormal thumb joint movement is present.

Instruments A goniometer, or "eyeball estimate" of the angle between the two lines.

Figure 8.33(a-b) Measuring the angles of thumb attachment.

Position Keep hand palm up and flat against a hard surface with fingers parallel. Keep thumb fully extended as it moves through its range of motion.

Remarks These measurements reflect thumb placement and flexibility. Total Lower Limb Length

Definition Total length of the lower limb (including leg and foot).

Landmarks In older children and adults, the total lower limb length is measured from the greater trochanter to the plane of the sole of the foot (floor) (Fig. 8.34). Traditionally, in infants, leg length has been measured

Figure 8.34 Measuring total lower limb length.

Figure 8.34 Measuring total lower limb length.

from the greater trochanter of the femur to the lateral malleolus of the ankle along the lateral aspect of the leg (total lower limb lengths are not available).

Instruments Tape-measure or calipers.

Position Infants may be measured lying supine or prone. Older children and adults are usually measured standing upright with the legs parallel.

Alternative In Children and adults, lower limb length can be calculated from total body length by subtracting upper segment or sitting height, although this is not as accurate as direct measurement.

Remarks By tradition leg length in infants is measured only to the ankle. The newborn graphs reflect that measurement rather than total lower limb length (Fig. 8.35). Values for older children are shown in Figs. 8.36 and 8.37.

In individuals with contractures or genu valgum or varum, the tape has to be worked along the leg to give an accurate estimate of total leg length.

X-ray measurements are more precise to assess bone length.

The highest point of the trochanter may be difficult to find in obese individuals. It then may be helpful to ask the patient to bend forward and thus estimate the trochanter point.

Lower limbs account for approximately one-third of length at birth; by five years, the lower limbs account for one-half of height, and by adulthood, more than one-half the total height.

Pitfalls In infants the sum of the upper and lower leg measurements, as demonstrated in this book do not equal total limb measurement. Leg length is not equivalent to lower segment, which is measured from the pubis to the plane of the sole (i.e., floor).

Gestational age (weeks)

Figure 8.35 Leg length at birth. From Merlob et al. (1984b), by permission.

Gestational age (weeks)

Figure 8.35 Leg length at birth. From Merlob et al. (1984b), by permission.

Pregnancy And Childbirth

Pregnancy And Childbirth

If Pregnancy Is Something That Frightens You, It's Time To Convert Your Fear Into Joy. Ready To Give Birth To A Child? Is The New Status Hitting Your State Of Mind? Are You Still Scared To Undergo All The Pain That Your Best Friend Underwent Just A Few Days Back? Not Convinced With The Answers Given By The Experts?

Get My Free Ebook


Post a comment