A 6-month-old previously healthy Arabic boy is seen for acute onset of crossed thumbs for 4 hours. According to the mother the infant was otherwise normal. There is no history of trauma, fever, refusal to feed, or any disturbances in bowel and bladder function. The child is the third baby born to a 26-year-old G3P3 mother after an uneventful pregnancy with a birth weight of 3.2 kg. He is a product of nonconsanguineous marriage and lives in a safe family environment. He is exclusively breastfed and is not on any medications. His development is appropriate for his age. Family history is unremarkable.On clinical examination, the infant's vital signs are normal, and his weight, length, and head circumference are at the 75th to 90th percentile. The infant is happy, playful, and lying comfortably in his mother's lap. Except for adduction of both thumbs, there are no other abnormal clinical findings. Both the thumbs are loosely crossed across the palms. The movements of both thumbs are normal, and one can easily elicit adduction and abduction of both the thumbs. Movements at the interphalangeal joints are also normal. There is no local swelling or tenderness. Examination of all the remaining fingers is normal. Both the thumbs go back into a persistent adduction position once clinical examination is completed. All pulses are well felt with a brisk capillary refill of less than 2 seconds. Sensations appear to be normal. There was no evidence of craniotabes, wrist widening, or rachitic rosary. Signs of tetany such as tremulousness or jitteriness, inspiratory stridor,and Chvostek's sign were also absent.
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