Hand and Orthopedic Upper Extremity Program

The Hand and Orthopedic Upper Extremity Program at Boston Children’s Hospital provides comprehensive care for infants, children, adolescents, and young adults with a wide range of injuries of the hand, wrist, arm, elbow, and shoulder. Whether your child has a congenital condition, sports injury, trauma, or a complex issue that requires a variety of specialists, we have the expertise and resources to tailor care to your child’s needs.

We care for more than 6,600 patients and perform more than 1,500 surgeries each year. All of the surgeons on our hand and orthopedic upper extremity team have dual fellowships in pediatric orthopedics and hand surgery, augmented by many years of experience.

Just as importantly, we specialize in treating children at various ages and stages of development. On a physical level, we focus on our patients’ healthy growth throughout childhood and adolescence. Every time we make a treatment decision, we take each patient’s age, stage of growth, and the potential impact on their future growth into account. On an emotional level, we strive to help patients accept themselves as they are in order to foster confidence and independence.

Our team includes:

• hand and upper extremity surgeons, more than in any other pediatric program in the country
• nurse practitioners and physician assistants experienced in caring for children with hand and upper extremity issues
• physical and occupational therapists skilled in promoting recovery and function of the hand and upper limb
• a psychologist with an understanding of our patients’ emotional issues
• social workers who connect families with additional resources and support

We are unique for our depth of expertise and the wide range of conditions we treat. Our program is the first — and remains one of the only pediatric programs in the U.S. to combine expertise in hand and upper limb conditions.

In addition:

• Our Brachial Plexus Program, established in 1989, was one of the first centers in the United States, and we continue to perform a large number of shoulder and nerve reconstructions on children and young adults born with brachial plexus injuries.
• Our Congenital Upper Limb Differences (CoULD) Registry, the first of its kind, is now a multi-center registry that measures patient outcomes over time. The registry’s purpose is to better understand upper extremity function and emotional well-being of children with upper limb differences.

Whether a child has a straightforward injury or a complex condition that requires multiple specialists, our goal is the same: to provide the care, expertise, and support our patients need to live the fullest, most independent lives they can. To this end, we also work to connect parents with other families whose children are living with similar conditions.

We treat the full spectrum of hand and upper extremity conditions, including:

• arthrogryposis
• hand and upper limb issues related to cerebral palsy
• polydactyly, syndactyly, clinodactyly, and trigger thumb
• neurofibromatosis
• traumatic injuries, including TFCC injuries and pseudoarthrosis
• fractures, including Monteggia fractures and nonunion fractures
• osteochondromatosis and other tumors, both benign and malignant, that affect upper extremities

Our clinical specialties include:

• non-surgical and surgical treatment of congenital hand differences such as polydactyly and syndactyly
• advanced techniques of fracture and micro-surgical care for complex fractures and soft tissue (skin, nerve, tendons, muscles, ligaments, and blood vessel) injuries to the hand and upper extremity, including peripheral nerve injury and brachial plexus birth injury
• muscle, bone, or nerve transfers and post-traumatic reconstruction of complex injuries in collaboration with the Department of Plastic and Oral Surgery
• care for hands and upper limbs affected by benign or malignant tumors in collaboration with the Bone and Soft Tissue Tumor Program
• comprehensive care for acute and chronic sports injuries, in collaboration with our colleagues in the Sports Medicine Division
• emergency and urgent care for a wide array of complex fractures and soft tissue injuries as a member of Boston Children's Level I Trauma Center
• consultation and surgical care for children and young adults with neuromuscular disorders such as cerebral palsy (CP) and arthrogryposis in conjunction with the Departments of Neurology, Neurosurgery, and Physical Therapy and Occupational Therapy
• consultation for parents expecting babies with confirmed or suspected hand or upper limb differences, in collaboration with the Maternal Fetal Care Center

Much of the knowledge and many of the innovations used around the country were developed at Boston Children’s by specialists in the Hand and Orthopedic Upper Extremity Program. For instance:

• Our surgeons wrote the landmark textbook that surgeons around the world refer to when caring for patients with hand and upper extremity deformity, Pediatric and Upper Limb Surgery.
• Our surgeons wrote the textbook Boston Children’s Illustrated Tips and Tricks in Pediatric Orthopaedic Fracture Surgery (Lippincott). Through text, illustrations, and video of a number of complex pediatric fracture surgeries, the textbook provides a valuable resource for surgeons and residents.

Our Orthopedic Clinical Effectiveness Research Center publishes an average of 200 papers in peer-reviewed journals each year. We have also established national registries that enable researchers around the globe to conduct multi-center studies of patient care and outcomes in order to further advance the field of hand and upper extremity care. One such registry, the Congenital Upper Limb Difference (CoULD) Registry, includes preoperative children from 0 to 18 years of age with congenital upper extremity differences.

We are good at what we do. Our program combines unmatched expertise in hand and upper extremity care with a support structure of renowned experts and resources. Together, we treat thousands of patients each year for a broad range of hand and upper extremity issues.

In short, we provide world-class expertise with psychosocial support from a broad range of professionals all focused on a shared goal: achieving the highest possible level of function, independence, and self-confidence for each of our patients.

Our experts have created a series of downloadable guides that cover different types of hand and upper limb conditions, symptoms, diagnosis, and treatments.

• amniotic band syndrome (also known as constriction band syndrome)
• arthrygryposis
• camptodactyly
• cleft hand
• clinodactyly
• enchondroma
• hand therapy
• macrodactyly
• Madelung’s deformity
• osteochondroma
• polydactyly
• radial longitudinal deficiency
• symbrachydactyly
• syndactyly
• thumb duplication
• thumb hypoplasia and aplasia
• ulnar longitudinal deficiency