However, emotional problems often arise because of it. The latter usually cover a variety of reading skills and deficits, and difficulties with distinct causes rather than a single condition. Some sources, such as the U. National Institutes of Health, define it specifically as a learning disorder.
Multiple exostoses Clinical Presentation The average age at diagnosis is about 6 years old. It is not a painful condition in the childhood.
Pain may be reported in teen years. The main complaint is functional deficit. The functional disability depends on severity of the deformity and whether or not it is bilateral. The severity is determined by position of forearm in pronation supination plane.
A forearm fixed in pronation is severest form of the deformity as patient is not able to compensate for the resulting loss of function by shoulder motion. An abnormal carrying angle of the elbow [angle between arm and forearm axis. With age, as the child approaches teenage symptomatic radial head subluxation may develop.
Inability to supinate forearm is major complaints. The child may have difficulty with such activities as turning a doorknob, buttoning shirts, and handling eating utensils.
The extension of the elbow may be limited.
Patients with unilateral problem have lesser limitations. The involved forearm is thinner than normal and somewhat twisted in appearance. Imaging AP and lateral radiographs are able to diagnose congenital radioulnar synostosis.
Radiographic followup is required even in asymptomatic cases to note for any progressive subluxation of radial head. Treatment Each patients should be individually evaluated to determine the treatment required. Surgical treatment may be considered on the severity of the deformity and if the condition is bilateral.
Patients with neutral rotation, mild pronation or without much functional limitations should not be subjected to surgery. Decision for surgery should base onl functional limitations than on absolute forearm position. Subluxated radial heads are excised at skeletal maturity.
Mobilization Procedures These surgeries aim at achieving and maintaining motion at the synostosis site. Recently, results with the interposition of vascularized fat graft have been encouraging.
Tendon Transfers Tendon transfers are also combined with mobilization procedures. For example flexor carpi ulnaris transfer dorsally around the ulna, and the extensor carpi radialis longus to the volar aspect to achive better supination.
Osteotomy and Derotation It is most preferred and succesful procedure. In bilateral deformities, one side is placed in degrees of pronation and the other, in degrees of supination. Prognosis of Congenital Radioulnar Synostosis Overall, surgical treatment has high failure rates.
The use of postoperative indomethacin or low-dose limited field irradiation within the first 5 days after surgery has been shown to be effective in limiting the recurrence.
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Dyslexia, also known as reading disorder, is characterized by trouble with reading despite normal intelligence. Different people are affected to varying degrees. Problems may include difficulties in spelling words, reading quickly, writing words, "sounding out" words in the head, pronouncing words when reading aloud and understanding what one reads.
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