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Case of the Week 365

What's the most likely diagnosis?

  • 49 year-old with bilateral arm pain

AP views of both upper extremities

  1. Shoulder dislocations
  2. Thalidomide-induced phocomelia
  3. Holt-Oram Syndrome
  4. Fibrous dysplasia
  5. Radiation osteitis

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2. Thalidomide-induced phocomelia



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Thalidomide-induced Phocomelia

General Considerations

  • From about 1957-1961, Thalidomide found use in Europe, Japan, Australia and Canada as an anti-emetic during pregnancy until it was found to be a teratogen causing birth defects
  • It is estimated that 10,000 babies were born with defects before the drug was banned worldwide
    • It is also estimated that 40% died of birth defects
  • Fetuses were found to be vulnerable to upper limb phocomelia between days 27-30 of gestation and only a single dose of the drug could produce defects

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