What We Treat

Children with limb differences are all unique, which means their treatment should be individualized to meet the needs of each child and family. An upper limb difference can be classified as:

  • Failure of formation
  • Abnormal formation
  • Too many bones and fingers
  • Too few bones and fingers

The Limb Deficiency Program offers comprehensive evaluation, state-of-the-art prosthetic and orthotic devices, and therapy to meet the ongoing functional demands of growing, active children with congenital or acquired upper extremity limb differences.

Our program can treat many of the various types of upper limb differences, including:

Transverse deficiencies

  • Above the elbow
  • Below the elbow

Longitudinal deficiencies of the forearm

  • Radial deficiency
  • Ulna deficiency 

Deficiencies of the hand

  • Cleft hand
  • Cleft hand, atypical symbrachydactyly
  • Syndactyly 

Deficiencies of the fingers

  • Clinodactyly
  • Klirner

Amniotic band

  • Hand and finger amniotic bands

Services We Offer

Children are treated in a multidisciplinary program specializing in the diagnosis and treatment of children with upper limb differences.

Our specialists include:

Our services include surgery and specialty prosthetic upper limb devices for children of all ages.

Surgical options

Limb lengthening 

Limb lengthening is a treatment for major limb length discrepancies (often greater than two inches). In general, lengthening can be done with either an external fixator, or with an internal fixator.

While your child is undergoing lengthening treatment, the doctor will typically see you on a weekly basis to ensure the limbs are lengthening properly. In addition, physical therapy is very important during the lengthening process, as it can help prevent stiffness once the limb becomes longer.

Limb lengthening is a very specialized surgical skill, and only surgeons who are trained in limb lengthening should perform the operation. If the bone is lengthened too fast, it may not heal, and the surrounding muscles, nerves, and joints may be at risk for permanent damage. If the bone is lengthened too slow, it may heal too quickly, and the bone may not be able to reach its desired length.

There are two types of devices that are used in limb lengthening surgery:

It is important to have a thorough discussion with your surgeon about limb lengthening and which device is best suited for your child’s condition.

Learn more about limb lengthening

Other surgical options:

  • Lengthen or shorten fingers and smaller bones
  • Straighten bones and fingers
  • Amputation
  • Reposition bones and fingers
  • Transfer fingers and toes
  • Targeted muscle innervation
  • Orthotic devices—Custom fit braces and splints

Prosthetic devices

Upper limb prostheses are designed to meet the functional demands and needs of children with limb loss. There is no right or wrong decision when it comes to whether to wear a prosthesis. Understanding the types of prostheses available for the level of limb loss helps the child and family make the decision that is right for them. Options for prostheses include: non-articulating functional prostheses; body-powered prostheses; myoelectric prostheses; and activity-specific prostheses.

  • Non-articulating functional—These prostheses are generally worn to give children equal arm lengths and to help with simple tasks such as propping, support, balance, and trunk and upper arm strengthening as well as the appearance of the arm. Simple grasp may be an option depending on the type of hand made with the prosthesis.
  • Silicone restorations—These prostheses are highly cosmetic, real-life stylized non-articulating functional prostheses. Silicone prostheses require specialized fabrication that takes extra time for the customization.
  • Body-powered—Body-powered prostheses provide grasp and release function that operates a terminal device by a cable and harness. Tension on the cable either opens or closes the terminal device: prosthetic hand; prehensor; or hook.
  • Myoelectric —A myoelectric prosthesis is an active, electrically powered prosthetic device that allows children to open and close a prosthetic hand for grasp and release functions. Small electrodes are built into the socket, which detects signals from the muscles under the electrodes. The signal from the muscle helps control the speed and the degree of opening. This technology helps increase independence while providing a more natural appearance than many conventional prostheses. As children grow, the ability and appearance of the hand becomes more important to them. This technology is well-suited for teens though adulthood. Using specially designed computer software, patients can program grip patterns and select other hand features, in many cases using gesture control —an advanced option that allows the wearer to change hand patterns with a simple gesture. We offer two types of myoelectric prosthesis: one for full-hand deficiency and one for partial-hand deficiency.
  • Microprocessor - For our older patients, advanced innovative prosthetic devices are available that provide independent movement of each finger and stronger, faster grasp and release functions. These include the I-Limb, Michelangelo, BeBionics and various other advanced options. The Children’s Limb Deficiency Program was one of the first providers in Atlanta to offer advanced microprocessor upper extremity prosthetic technology. 
  • Sports, recreation, and activity-specific prostheses— These prostheses are designed to help children perform a specific task or sport. They help children participate in activities that require two hands for grasp and movement.

Targeted muscle reinnervation

Our hand and upper extremity orthopaedic surgical specialists currently offer targeted muscle reinnervation. The Children’s Limb Deficiency Program team is prepared to support the prosthetic and rehabilitation needs of the patients who have had TMR as part of surgical reconstruction.

Our Unique Approach

Whether or not your child is having surgery or being fitted with a custom brace or prosthesis, it is important to establish a close relationship with their physician and members of the care team.

All of our team members are trained and experienced in working with children with limb differences and their families. Our certified orthotists have formal education in biomechanics and material sciences, which is required in designing custom devices. We work closely with patients and their families to make sure they have the training and support they need to be independent and confident, now and into the future.

Meet the upper limb difference team

Some physicians and affiliated healthcare professionals on the Children's Healthcare of Atlanta team are independent providers and are not our employees.

Children’s provides additional services and programs for children with limb deficiencies and deformities: 

  • Rehabilitation: The rehabilitation team at Children’s is trained and experienced in working with children who are undergoing limb-lengthening and limb-salvaging procedures.
  • Adaptive Sports Program: Our team partners with sports medicine and rehabilitation to help children and teens find sports they enjoy and can play safely. We can design and assist with the technology needed for adaptive sports.
  • Prosthetic training: Training is provided by therapists trained and experienced in working with children during stages of prosthetic fitting.

Helpful Resources

External resources

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