Improving the care of children through education, advocacy, and research
Little Arms is the educational arm of a consortium of surgeons specializing in Pediatric Hand Surgery. Our surgeons are Internationally recognized experts in the care of the Pediatric Upper Limb, from the neck to the fingertips. They have served in leadership positions throughout the field of hand surgery and travel internationally to learn from others and to share their knowledge.
Children are not just small adults. As they transition from newborns to adolescents, their entire skeleton changes, matures, and adapts to its environment. Congenital differences, injuries, and developmental conditions can impact their musculoskeletal system in ways that are often unique to each individual. Children deserve the best care we can give them.
Get in touch with us to ask questions about your child’s condition, to clarify information on this site, or to verify that the care your child is going to receive is supported by the latest information and research.
Contact
➤ LOCATIONs
Shriners Hospital of Philadelphia
3551 North Broad St., Philadelphia PA, 19140
The Hospital for Special Surgery
535 E 70th St
New York, NY 10021
☎ CONTACT
rolonj@hss.edu
(212) 774-2642
Areas of Practice
NEUROLOGIC CONDITIONS
brachial plexus injury
The Brachial Plexus is a set of nerves that give sensation and provide muscle control for the entire arm. Four cervical (neck, C5-8) and one thoracic (chest, T1) nerve roots emerge from the spinal cord and combine to form the upper trunk (C5-6), the middle trunk (C7), and the lower trunk (C8-T1). These nerve roots can be injured at birth during a difficult delivery where the baby gets stuck (shoulder dystocia), or from any injury where the head and the shoulder are forced in opposite directions. Stretch injuries can be mild (neuropraxia), moderate (axonotmesis), or severe (neurotmesis or avulsion). Mild stretch injuries, which are the most common, resolve within 2-3 months of injury with no lasting consequences. In football, these injuries are called “stingers” or “burners.” Moderate injuries typically begin to recover within 5-6 months. More severe injuries are unlikely to recover without surgery. The most important thing to know about Brachial Plexus injuries is that if surgery is required to fix the nerves, it should be performed within 3-9 months, depending on the type of injury, to get the best results.
peripheral Nerve injury
Nerve injuries distal, or below, the Brachial Plexus are referred to as peripheral nerve injuries. These include ulnar, median, and radial nerve injuries.
spinal cord injury
There are over 300,000 people in the United States alone that are living with a Spinal Cord Injury. Surgical options exist to not only improve the function of the hands and arms, but also to decrease the dependance on a ventilator.
TRANSVERSE AND ACUTE FLACCID MYELITIS
Viral and Autoimmune insults can injure the spinal cord, resulting in either Transverse Myelitis or Acute Flaccid Myelitis.
cerebral palsy
Cerebral Palsy can affect any part of the brain, and most often results from either lack of oxygen or a stroke in the perinatal period.
CONGENITAL DIFFERENCES
syndactyly
Some children are born with two or more fingers that did not separate. This is called syndactyly and is the most common upper limb congenital difference.
polydactyly
Extra fingers can be on the thumb side (pre-axial), the center of the hand (central or sympolydactyly), or on the small finger side (post-axial).
radial (thumb) deficiency
A child born with a small or absent thumb or a missing or short radius bone requires an extensive workup for co-existing conditions such as Holt-Oram syndrome, Thrombocytopenia Absent Radius (TAR), Falconi Anemia, and VACTERL Association.
Ulnar (small/ring finger) deficiency
Ulnar deficiencies include everything from complete aplasia of the arm to phocomelia to just a small pinky finger. Other associated conditions include proximal femoral focal deficiency (PFFD), fibular hemimelia, and scoliosis.
amnionic bands/symbrachydactyly
Loss of fingertips at birth can be caused by a variety of developmental and environmental factors.
arthrogryposis
Children born with contractures in at least one joint in 2 limbs are considered to have Arthrogryposis. There are over 300 subtypes, with the most common being Amyoplasia.
SKELETAL TRAUMA
sports injuries
The arms and hands are often injured in sports. As children’s sports participation has become more intense, the level of potential injuries have become more severe.
fractures
Children are not little adults. The growing skeleton, when fractured, has a greater ability to fix itself than in an adult. However, the consequences of a bad outcome from a fracture can be lifelong and life-altering.
ligament injuries
Ligament injuries in children are less common than fractures.
post-traumatic reconstruction
Bad outcomes after injuries may be remediated using a combination of bone, ligament, and tendon realignment.
dislocations
Joint dislocations in a child demand the same level of urgency as in an adult.
“To someone with nothing, a little is a lot.”
Let's Chat.
Use the form below to contact us regarding your child’s upper limb. Please be as detailed as possible. Include your child’s symptoms and diagnosis if known. You may also email or call us directly.