Comprehensive Rehabilitation and Assistive Device Intervention in an Untreated Quadrilateral Limb Deformity: a case report

Abstract

A 14-year-old boy presented to the OPD of the department of physical medicine and rehabilitation with deformities of all the four limbs. He was having transverse deficiency of the right upper limb and longitudinal deficiency of all other limbs.

On examination the shoulder joint was bilaterally normal in terms of range of motion and power. On the right side the forearm and hand were absent and on the left there was restriction of pronation and supination at the elbow. In the left wrist there was restriction of ulnar and radial deviation and except for the thumb all other digits were absent [Figure 1]. In the lower limbs, hips were normal, knee on right there was a 20-degree extension deficit and the left knee was fixed around 80 degrees of flexion. Legs were short with a length of eight and four inches respectively with two digits on right and one on left [Figure 2]. There were callosities and hyperpigmentation over both knees and foot due to altered gait pattern [Figure 3]. No deficits in strength were noted in the hip and it was not possible to assess in knee and foot due to deformity.