Common Upper Extremity Deformities:
• Internal Rotation of the Shoulder
• Extension of Flexion Contractures of the Elbow
• Flexion Contractures of the Wrists
• Thumb in Palm
• Extension or Flexion Contractures of Individual Fingers
Courses of Treatment:
O/T should begin as soon as possible to increase passive range of motion. This can be done through a clinic or at home with your local Early Intervention. Either way you should be taught stretches to do at home with your child. Here are some common stretches to try. Always speak to your O/T or Child's Doctor before starting any kind of new routine.
A therapist should evaluate and identify those joints that need stretching, and then teach the caregiver how to do it correctly. Then the caregiver practices under supervision to make sure proper technique is used. Issues such as previous surgeries, medication, bone density, etc., must be considered. These ROM exercises could be made available to the OT or PT to use, individualized for each person.
Splinting for wrists should be started as early as possible to take advantage of the infant's flexibility.
There are many types:
Benik - Soft neoprene splints with a metal bar that can be manipulated to give different amounts of stretch. Learn more: http://www.benik.com.
Joe Cool Splint - Thumb abduction splints are made of soft, flexible neoprene and have an adjustable hook and loop closure system. They do not have a latex component, and they can be hand washed in cold water (line dry). Learn more: http://www.joecoolco.com/.
Bamboo Splint - is a dynamic elbow splint for children with special needs that encourage extension of the elbow at more favorable angles in order to learn gross and fine motor skills as well as prevent undesired oral/facial interaction. Learn more: http://www.bamboobrace.com/company/.
Dyansplint - stretches joints that are lacking range of motion. Learn more: http://www.dynasplint.com/.
Custom Made Splints - These are fabricated by an O/T or Orthotists. They are usually made with the same material as AFO's and can be custom made to your child's hands. They are secured most often with velcro straps.
Often with children who have little passive elbow flexion, surgery is recommended. Doctors often recommend an elbow release (tricepsplasty) surgery between 8 months and a year but may be delayed to assure that the child is up and walking before changing the power of straight elbows. This is a surgery done by releasing the tight fibrous structures in the elbow that constrict movement. After that if is child still does not develop any active flexion or enough functional passive flexion doctors may recommend a muscle transfer to give elbow flexion (bending). This depends on the quality of the donor muscles as well. Common muscles used are the pecs (pectoralis major) and a muscle from the back, Latissimus dorsi. Most doctors will not perform this surgery on children under 4 or 5, because the child needs to participate in the therapy following the surgery to re-train the muscle motion, wear splints to protect the transfer, etc. Every doctor is different in how aggressively they treat upper extremity problems. Some doctors do not believe this surgery is effective at all and may not offer this as an option to their patients. There are also several hand surgeries that can be performed. For children with a serious flexion contracture in their wrists a small triangular wedge of bone (wedge osteotomy) can be removed to bring the wrist to a more neutral resting position. There are also surgeries for thumb-in-palm, if extremely severe, and various finger surgeries.