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Hand, arm and shoulder

Hand, arm and shoulder

Most children don’t think twice about gripping a pen, throwing a ball or reaching up high. But for a child born with a congenital hand difference, upper limb deficiency or brachial plexus birth palsy, such everyday tasks can pose big challenges. The specialized orthopaedic team at Shriners Hospitals for Children — St. Louis provides the complex, compassionate care every child deserves. The medical team works to advance the lives of children through leading-edge surgical care, therapy and research.

More about the hand, arm and shoulder conditions we treat:

Finger problems

Macrodactyly is an abnormal enlargement of fingers. Surgery may be required to improve the look and function of the fingers.

Polydactyly is being born with extra fingers and/or toes. This deformity occurs during the development of the fetus. Polydactyly is treated with surgery to remove the extra digits.

Trigger finger is a common condition where a finger snaps or locks, causing dysfunction and pain. Trigger finger may be treated with splinting and a home exercise program. If this is not successful, surgery may be required to release the finger so it may be straightened.

Hand problems

Amniotic band syndrome (congenital constriction band syndrome) is a condition that occurs when a fetus becomes entangled in the fibrous, string-like amniotic bands of the amniotic sac, which is the fluid-filled sac that surrounds a fetus in utero during pregnancy. Because the fetus continues to grow and the bands do not, they restrict blood flow and disrupt the fetus’s normal growth and development. The restriction of blood flow can cause congenital deformities to the arms, face, fingers, legs or toes. Treatment of amniotic band syndrome may include surgery, occupational or physical therapy, or the use of a custom prosthesis made in-house.

Klumpke’s paralysis, also known as Erbs Palsy or Brachial Plexus injury, is an injury of the brachial plexus during trauma at birth and causes paralysis of the forearm and hand. Treatment can vary from conservative approaches such as positioning, daily exercises and directed play using the affected arm, to bracing and splinting or surgery.

Radial club hand is a condition that causes a child’s hand to lie at a right angle to the forearm due to an absence of the radius at birth. The muscles of the child’s forearm may be shortened, absent or fused together. In mild cases, serial casting or contracture releases can correct the problem, but in more severe cases, surgery such as surgical releases, ulnar osteotomy or wrist fusion may be necessary.

TAR syndrome is a rare congenital disorder in which the radius is absent in both arms. Other skeletal symptoms can include absent humerus, short or malformed ulna, dislocated hips, tibial torsion, knee deformities, club feet and scoliosis.

Limb length problems

Limb length discrepancy is a difference between the lengths of the arms. Limb length discrepancy of the arms does not usually have an impact on how the arms function and usually requires no treatment, although in some cases, it is warranted. Children with significant differences in arm length may need surgery. Surgical options include epiphysiodesis (slowing the growth in the long arm) and the Ilizarov method (lengthening of the short bone) growth. The Ilizarov method is an external device (metal rings on outside of arm) with small wires that go through the bone. The bone is separated by cutting it and then slowly lengthened. When the desired length is reached, the metal ring and wires are removed and the limb is casted until the bone is fully healed, followed by occupational therapy after cast removal. 

Shoulder problems

Brachial plexus injury (Erb’s Palsy) (see Klumpke’s paralysis) is paralysis of, or injury to, the nerves located in the shoulder area that control the muscles of the arm, that usually occurs during birth. If these nerves are damaged during the birth process, there may be a loss of movement or weakness of the arm. The physician and occupational therapist will perform a thorough assessment to determine the best treatment plan. Treatment options vary depending on the severity of the injury, but usually include range of motion exercises and occupational therapy. Periodic evaluations are important to assess progress. In some cases surgical intervention may be indicated if there is no improvement within three to six months of injury.