Pediatric Hand and Upper Extremity Program

Emergent and chronic amputation is the loss of a limb, hand or finger. Some hand and upper-extremity injuries can be severe enough to require amputation. In most cases, attempts at urgent reconstruction are made. Treatment for an acute amputation may include microsurgical replantation (reattachment using a surgical microscope). An artificial limb may help your child regain function if the amputation cannot be reattached.

Management of amputations may include:

• Further reconstructive surgery
• Consultation with therapists and prosthetists

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

Learn more about brachial plexus birth palsy and injuries

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

• Scarring
• Contracture, which may require surgery

• Amniotic band syndrome
• Hypoplastic thumb: a hypoplastic thumb is usually smaller or weaker than an average thumb. 
• Congenital finger deformities
• Macrodactyly
  
• Polydactyly: polydactyly is a common congenital (at birth) condition in which a person is born with an extra finger or toe. This condition affects about one in every 1,000 live births and is often passed down in families. Usually only one hand or foot is affected. The extra digit can be located anywhere on the hand or foot. It is usually smaller and made up of soft tissue, though some can have bone and joints and be fully functioning.
• Syndactyly and Apert’s syndrome: syndactyly is a condition in which a person is born with fingers and/or toes that appear fused together. This condition affects about one in every 2,000 to 3,000 live births. It can be passed down in families and is occasionally associated with congenital (at birth) syndromes. The fusing may only affect part of the finger or extend the entire length. Surgical treatment involves separating the fingers and/or toes, most often around 18 months of age.
• Split thumb: a split thumb is a common congenital (at birth) difference where a child is born with two thumbs or parts of two thumbs. It is a variation of polydactyly. This is not normally passed through the family. Treatment involves surgical reconstruction—normally around age 1—to create a single thumb and enhance function.
• Radial longitudinal deficiency: the radius is a bone in the forearm that extends from the elbow to the wrist. In a child born with a radial longitudinal deficiency (RDL), this bone is either absent or much shorter than it should be. This results in a misshapen forearm or wrist. It can affect any part of the arm—from the shoulder to the fingers. Children with RDL also frequently have hypoplastic thumb. Radial Longitudinal Deficiency treatment—often surgical—is designed to create a straight, stable wrist and functional thumb. This condition is often associated with different congenital (at birth) syndromes where other parts of the body are affected as well.

A fingertip crush injury is common. It involves injury to the nail, nail bed, skin, bone and tendons.

Acute management includes:

• Fingertip Crush
• Infection prevention
• Immobilization
• Pain control
• Surgery may be required restore appearance and function

• Finger
• Hand
• Carpal bones (the eight small bones in the wrist)
• Scaphoid (small bone at the base of the thumb)

A ganglion 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. A ganglion may cause pain if it is putting pressure against a tendon or joint. In most cases, these lesions are benign (not cancer) but require medical evaluation. Evaluation is needed to determine if it is a cyst.

Treatment includes observation 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. Nerve damage can be the result of a cut, fracture or crush injuries.

Signs your child may have nerve damage include:

• Numbness
• Weakness
• Pins and needles feeling

Nerve injuries can involve surgical reconstruction and/or therapy.

• 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
• Feels pain when bending a finger
• Has an open wound and cannot comfortably move the joint

Tendon lacerations usually require surgery. Physical therapy also may 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, they are often mistaken for a dislocated joint or a tendon injury.

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