Pediatric Hand Surgery

Our surgeons are expert in treating the wide variety of hand deformities that are present at birth. Children may have two or more fingers that are connected (webbed or fused) by soft tissue, and in some cases, with shared bones. They may be missing fingers or have extra ones, have a poorly formed thumb or none at all. A child may be without a hand or have a shortened forearm.

There are a multitude of congenital hand deformities, but some examples include:

• Radial hypoplasia
• Thumb hypoplasia
• Syndactyly
• Cleft hand
• Constriction Ring Syndrome (CRS) or Amniotic Band Syndrome

These are just some of the conditions our specialist surgeons can address to give a child the best possible use of their hand or arm.

Vascular malformations are abnormal clusters of blood vessel tissues that form during fetal development. Although present at birth, they may not become evident until later in childhood. Treatment of these malformations is based on type, symptoms, and effect on function.

Malformations frequently grow slowly, and there are many treatment options. Hasbro Children’s Hospital also has a Vascular Anomalies Clinic that our hand specialists are actively involved in, enabling multiple specialist evaluations and treatment planning.

In trigger thumb, the flexor tendon that controls thumb movement becomes stiff or locked in position because it is too thick to glide easily through the opening in the flexor sheath. The term “trigger thumb” comes from the snapping sensation the digit makes when it straightens. The tendon can become so thick that it gets stuck in a flexed or extended position. This called locking.

Trigger thumb is not usually present at birth but develops between ages 1 and 3 due to unknown causes.

“Watchful waiting” is one response to trigger thumb, as the problem may eventually resolve on its own. Stretching and splinting are non-invasive approaches to the problem. A simple surgery will be considered if neither of those strategies is successful.

Spasticity

Children can have severe extremity spasticity (contracted muscles) from cerebral palsy or from a stroke. Our team of hand surgeons and therapists can help develop a treatment plan for patients with this condition.

Brachial plexus injuries (birth-related nerve damage)

Injuries to the brachial plexus, a network of nerves between the neck and shoulders, cause pain, numbness, and weakness from the shoulder to the hand. These nerves control muscle function and feeling in the chest, shoulder, arms, and hands.

Injuries to the brachial plexus happen in as many as three out of 1,000 births, when a difficult delivery causes the nerves to be torn, stretched, or compressed. The type of injury and its location determines the effects and whether surgery or physical therapy is the best course of treatment.

• Various injuries to the upper extremity (the upper arm, forearm, and hand) that may require the skills of our surgeons include wrist and hand fractures; tendon, ligament, or nerve injuries; frostbite; and burns.
• Children may sustain accidental traumas to the extremities (upper or lower) requiring soft tissue reconstruction in the form of skin grafts or flaps. Our hand specialists are trained to help address these injuries.

​​​​​​Hand surgeons work with specialists in dermatology, oncology, pediatric surgery, and radiation oncology to optimize patient outcomes in cases involving benign or malignant tumors.