UW Health Specialists Offer Pediatric Upper Extremity Care

Contact Information
(608) 263-6420
Extending a Hand
MADISON - Cerebral palsy, stroke or head trauma are just a few of the reasons a child might lose the ability to grasp and release a toy, flex a wrist in a tumbling game, peel a sticker for a work of art, or extend a hand to greet a friend or loved one.

Despite a wide range of research and clinical care opportunities for children with neurological disorders, less attention is paid to the specific need of children - to restore and regain function in their upper extremities, and give them back the hands they need to explore their world.

"Our center has all the resources to offer this kind of specialized care," says Kenneth Noonan, MD, a UW Health pediatric orthopedic surgeon. "It fills a much-needed role."

Motor disorders like cerebral palsy, hemiplegia or hemiparesis as well as a traumatic injury to the brain can lead to such upper extremity problems as contractures of the elbows or wrists, thumb-in-palm deformity, or swan neck deformities in the fingers or thumbs.

Treatment options include physical and occupational therapies, medications, splinting, surgery or a combination of the above. Non-operative approaches are preferred for children under the age of eight, in an effort to interfere as little as possible with normal growth and development.

"Occupational and physical therapy can have a very positive effect on younger children," Dr. Noonan says. "We've also had good results with short-term medications that deaden the nerves in the affected limb, such as injections of Botox."

For older children and teens, surgical options such as tendon releases or transfers can transform muscles that deform to muscles that support an arm or hand. A tendon release in the hand may allow a clenched fist to open or position a thumb into a more passive position, allowing the hand overall to become more functional. In certain cases, bone fusions in the wrist or finger joints may be used to stabilize a badly deformed area.

"Surgery is almost always followed by some fairly intense occupational therapy," Dr. Noonan says. "Good outcomes result from both physician and patients committed to this 'marriage' of surgery and therapy."
Dr. Noonan and his colleagues from UW Health orthopedics, rehabilitation and surgery have collaboratively begun to offer a clinic focused on pediatric upper extremity care. The goal, Dr. Noonan says, is to not only improve their patients' ability to use their hands, but their attitudes about their hands as well.

"Helping kids feel better about their hands is just as important. They feel like 'Finding Nemo,' it's a bad fin," Dr. Noonan says. "The social and psychological benefits of being able to use and control their hands are every bit as important as the physical ones."

To refer a patient to the UW Health pediatric orthopedic upper extremity clinic at the American Family Children's Hospital, call (608) 263-1344.
Date published: 4/28/2008