Hand and Upper Extremity Program

Some hand and upper extremity injuries can be severe enough to result in amputation. In many cases, surgeons will attempt to reattach the injured limb or part, performing a procedure known as replantation that allows a doctor to reattach a limb using microsurgical techniques. In circumstances that result in permanent loss of limb or a part, there are still often important treatments.

Management of an amputation may include:

• Further reconstructive surgery
• Consultation with hand therapists and prosthetists 

Brachial plexus birth palsy (BPBP) is an injury to an infant’s brachial plexus nerves, which are the nerves that send signals from a child’s spinal cord to the shoulder, arm and hand, that happens during childbirth. It results in paralysis or loss of movement of the arm, shoulder, elbow, wrist, hand or fingers. Brachial plexus injuries unrelated to birth are not common but can be more significant. Paralysis, loss of sensation and other symptoms can be permanent if left untreated.

Burns are common in children who use their hands to explore their environments. In most cases, burns among toddlers and children are due to heat or friction (e.g., treadmill). Treatment is based on the degree of the burn.

Late complications may include:

• Scarring
• Contracture, which may require surgery

There are various deformities of the hand that are identified at birth. Some common ones include:

• Amniotic band syndrome: This condition occurs when a baby is born with multiple band-like wrappings around the arms. The hands and feet may have fingers that are fused together, sometimes congenitally amputated, and sometimes with “rings” around the finger that cause swelling.
• Arthrogryposis: Arthrogryposis is a term used to describe a contracture (permanent shortening) of a joint that is present at birth.
• Hypoplastic thumb: A hypoplastic thumb is usually smaller or weaker than an average thumb. It is often apparent at birth, but in many cases may not be apparent until a child is a toddler or older.
• Congenital finger deformities: Finger joints can be angulated or crooked and are present at birth.
• Macrodactyly: A rare condition, macrodactyly is when a baby’s fingers or toes are abnormally large because of overgrowth of bone and soft tissue.
• Polydactyly: Polydactyly is a common congenital condition in which a child is born with an extra finger or toe. This condition affects about 1 in every 1,000 live births and is often hereditary. The extra digit is usually smaller and made up of soft tissue, though some can have bone and joints and be fully functioning.
• Syndactyly: Syndactyly is a condition in which a child is born with fingers or toes that appear fused together. It may also be referred to as webbed fingers. This condition affects about 1 in every 2,000 to 3,000 live births. It can be hereditary and is occasionally associated with congenital syndromes. Fusing may only affect part of the finger or extend the entire length. Surgical treatment involves separating the fingers and/or toes when a child is about 18 months old. Those with Apert syndrome may also experience syndactyly.
• Split thumb: A split thumb is a common congenital difference in which a child is born with two thumbs or parts of two thumbs. It may also be called duplicate thumb. It is a variation of polydactyly. This is not normally hereditary. Treatment involves surgical reconstruction—normally around 1 year old—to create a single thumb and enhance function.
• Radial longitudinal deficiency (RLD): The radius is a bone in the forearm that extends from the elbow to the wrist. In a child born with an RDL, this bone is either absent or much shorter than it should be. This results in a misshapen forearm or wrist. It can affect other parts of the arm, from the shoulder to the fingers. Children with RDL also frequently have hypoplastic thumb. RDL treatment—often surgical—is designed to create a straight, stable wrist and a functional thumb. This condition is often associated with different congenital syndromes in which other parts of the body are affected as well.

A common pediatric injury to a child’s hand is a fingertip crush. It often happens when a child’s finger is slammed in a car door, stepped on or injured by a large object falling on it. It involves an injury to a child’s nail, nail bed, skin, bone and tendons.

Short-term treatment of a fingertip crush includes:

• Emergency treatment to the fingertip
• Infection prevention
• Immobilization
• Pain control
• Possible surgery to restore appearance and function

A hand fracture is a complete or partial break involving the bones in the fingers, hand and wrist. Most happen when a child falls and lands on his hand, gets his hand caught in a door or is playing sports.

The most important thing to keep in mind with a hand fracture is whether it damages a child’s growth plate or the soft tissue connected to the bone. If so, it may affect how your child’s pediatric hand and upper extremity physician treats his hand fracture.

We treat the following types of fractures:

• Finger fracture
• Hand fracture
• Carpal bone fracture: a fracture to one of the eight small bones in the wrist
• Scaphoid fracture: one of the carpal bones most frequently fractured

A ganglion cyst is a small cyst (fluid-filled sac) located next to a joint or tendon. It is most often found near the wrist joint or finger. It may cause pain if it is putting pressure against a tendon or joint. In most cases, these lesions are benign (not cancerous) but require medical evaluation to determine if it is a cyst. Treatment includes observation, drainage or removal of the cyst.

Nerves are the body’s electrical wiring system. Motor nerves send signals from the brain to tell the body to move. Sensory nerves carry signals about sensations, such as pain and temperature, to the brain.

Nerve damage in the arms and hands may prevent movement and function. It can be a result of a cut, fracture or crush injuries.

Signs your child may have nerve damage include:

• Numbness
• Weakness
• Feeling of pins and needles

Nerve injuries can require surgical reconstruction and/or therapy.

Kids and teens may injure their fingers, hands, wrists, arms, elbows or shoulders playing sports. Our hand and upper extremity team treats the following sports-related injuries:

• Fingertip crush injuries
• Finger, hand and wrist fractures
• Growth plate injuries
• Tendon lacerations or injuries
• Nerve injuries
• Sprains and strains
• Stress fractures
• Overuse injuries
• Ligament injuries

A tendon is tissue that connects our muscle to bone. When muscles work, their tendons pull on the bones, making joints move. Tendon injuries to the fingers, hands and upper arms are common. A laceration, or cut, to the tendon can greatly affect your child’s function.

Your child may have a tendon laceration if he:

• Cannot bend one or more joints following an injury or laceration.
• Feels pain when bending a finger.
• Has an open wound and cannot comfortably move the joint.

Tendon lacerations usually require urgent surgery. Physical therapy may also be necessary to help your child regain use of the affected tendon.

A trigger thumb or finger catches or locks in a flexed position. Usually painless, it is often mistaken for a dislocated joint or a tendon injury.

It is understood to be an acquired—not congenital—difference. It will sometimes get better without treatment. Surgery may be required to return mobility to the affected digit.