Skip to navigation

Shriners Hospitals for Children — Philadelphia

3551 N. Broad St. Philadelphia, PA 19140

Philadelphia, PA

215-430-4000

Call today

215-430-4000

About the conditions we treat

Acute fractures are common orthopaedic injuries that occur in kids. Falls during play and injuries while playing sports are common. These fractures primarily involve the arms and legs. Most pediatric fractures can be treated with casting with or without closed reduction. Occasionally, surgery is required to realign the broken bones.

Amniotic band syndrome (congenital constriction band syndrome) is a condition that occurs when a fetus becomes entangled in the fibrous, string-like amniotic bands from the fluid-filled sac that surrounds the baby during pregnancy. Because the baby continues to grow and the bands do not, they restrict blood flow and disrupt normal growth and development. The restriction of blood flow can cause congenital deformities to the arms, face, fingers, legs or toes. Treatment of amniotic band syndrome may include surgery, occupational or physical therapy, or the use of a custom prosthesis made in-house.

Amputation can be secondary to a failure of the limb to develop during pregnancy or following trauma (e.g. lawnmower accident). An infant born with an amputation requires evaluation by a physician with expertise in pediatric amputation to ensure the best management options are provided, (i.e. therapy, prosthesis, family support and education). In contrast, a child who sustains a traumatic amputation requires emergent care and immediate management. This urgent care usually occurs at a trauma hospital with surgery directed at limb salvage (e.g. replantation). Successful salvage requires extensive rehabilitation. Unsuccessful salvage requires amputation management as detailed above.

Anterior cruciate ligament/ACL tear is an increasingly common sports injury that may lead to instability and pain in the knee. Treatment is often through surgical reconstruction, with a variety of management options based on the age of the patient, followed by rehabilitation.

Arthrogryposis is a rare congenital disorder characterized by multiple joint contractures (stiff joints), which can include weakness and fibrosis. Treatment may include physical and occupational therapy, splints or casts. Surgery may be necessary to improve joint function.

Leaders in arthrogryposis evaluation and treatment
We provide worldwide expertise in the evaluation and treatment of children with arthrogryposis. Our therapists, orthotics department and physicians are exceptional in the non-operative and operative management of these children. The goals of management include improving range of motion, achieving ambulation and promoting independence in life’s daily activities. The upper and lower extremity teams work in concert to achieve these goals and coordinate care to maximize the child’s potential.

Benign tumors of the bone are various types of tumors that can grow within the bone or sprout from the inside to the outside of the bone. Tumors within the bone are frequently benign cysts filled with fluid or composed of cartilage (a.k.a. enchondroma). These tumors grow and can expand the bone, making the bone more susceptible to break or fracture. In fact, a fracture may be the first sign that there is a tumor within the bone. Tumors that sprout from the bone are usually an exostosis (bone covered by cartilage). These benign tumors can be an isolated growth (solitary) or many growths in multiple areas (multiple hereditary exostosis).

Blount’s disease/bow legs (tibia vara) is a rare growth disorder of the tibia (shin bone) that causes the lower leg to angle inward, resembling a bowleg. Treatment for Blount’s disease may include bracing or surgery.

Bone lesions (non-cancerous) are abnormal growths or tumors found in the bone. Surgery may be a necessary form of treatment if the tumor enlarges or affects function.

Brachial plexus injury (Erb’s Palsy) is paralysis or injury to the nerves located in the neck/shoulder area that control the muscles of the arm that usually occurs during birth. If these nerves are damaged during the birth process, there may be a loss of movement or weakness of the arm. The physician and occupational therapist will perform a thorough assessment to determine the best treatment plan. Treatment options vary depending on the severity of the injury. Severe injuries or torn nerves require microsurgery to reconnect the nerves within the first year of life. Less severe injuries require range of motion exercises and occupational therapy. Periodic evaluations are important to assess progress. Insufficient recovery requires secondary surgery that may include joint release, tendon transfer or osteotomy.

Leaders in brachial plexus evaluation and treatment
We provide worldwide expertise in the evaluation and treatment of children with brachial plexus injuries. Our therapists, occupational therapy department and physicians are exceptional in the non-operative and operative management of these children. The initial goals of management are range of motion and exercises. The goal is to maintain supple joint and limb motion allowing time for the injured nerve to recover. This therapy is necessary while the child is still growing. In children who fail to recover movement, microsurgery is necessary to reconnect the nerves and the surgical team is facile in this operation. Ongoing expert evaluation is necessary for the best care options.

Bunions are an abnormal enlargement of the joint of the great toe. Bunions may be treated by taping or splinting of the foot, padded shoe inserts, anti-inflammatory medication or cortisone injection. Surgery may be necessary if conservative treatment does not work.

Cerebral palsy (CP) (static encephalopathy) is a condition affecting muscle tone, movement and coordination. It is the most common disability that occurs before, during or immediately after the birth of children and is related to an event which caused lack of oxygen to the brain and a neurological impact. Shriners Hospitals for Children is considered a leader in treating the orthopaedic effects of cerebral palsy and it is the most commonly treated condition at the Philadelphia Shriners Hospital.

There are three main types of CP:

Within each main type, there are several more specific diagnoses indicating a more specific area of neurological impairment, such as spastic hemiplegia, spastic diplegia, etc.

Children with cerebral palsy can exhibit a wide range of symptoms, from mild to severe. Some typical indicators of cerebral palsy may include:

Treatment options for cerebral palsy include:

Charcot-Marie-Tooth is a group of disorders that affect the peripheral nerves that carry messages between the brain and muscles throughout the body. There is loss of muscle in the legs, feet, arms and hands. Treatment includes physical and occupational therapy, braces and splints. Surgery may be necessary for severe foot and hand deformities.

Cleft hand (central deficiency) is a condition where the central portions of the hand and/or feet fail to develop in utero. The hands and/or feet are missing a variable number of digits. The classic type is missing central digits with preservation of the border digits and a deep-seated cleft in between. Hence, the hands have thumbs and small fingers and the feet have great and small toes. However, there are variations with more or less digits absent. Cleft hand can be hereditary and occur in families or can occur spontaneously without other family members being affected.

Clubfoot/talipes equinovarus is a condition present at birth where the foot points downward while the toes and bottom of foot point inward. We use the Ponseti method for treating clubfoot. This consists of serial casting, which starts as soon after birth as possible. Most babies will have a minor surgical procedure called a tenotomy, followed by bracing with a foot abduction orthosis. Physical therapy may be ordered. Once corrected, older children are carefully followed and braced as needed. Rarely is there a recurrence of the clubfoot as the child grows.

Congenital hand deformities is a global term that implies failure of the limb to develop normally during pregnancy. Specific congenital hand anomalies include syndactyly, polydactyly, duplicated thumb, hypoplastic or absent thumb, cleft hand (central deficiency), radial deficiency, ulnar deficiency and macrodactyly. Treatment options include observation, bracing, therapy and possibly surgery to improve function.

Developmental dysplasia of the hip (DDH) is a condition of the hip joint where the child is born with or develops an abnormal hip. The normal hip is a ball and socket joint where the ball (femoral head) is located on the top of the thigh bone (femur) and sits in a round socket (acetabulum) that is a part of the pelvis. DDH is a spectrum of disease ranging from slight under-covering of the ball by the socket to a hip that is completely dislocated. In the newborn period, treatment may involve a Pavlik harness to promote development of the hip joint. In older children, spica casting or surgery may be necessary to keep the ball in the socket and promote normal development of the hip. Newborns are susceptible to DDH by tight swaddling techniques. It is recommended that when a newborn is swaddled, the upper body can be wrapped tightly but the legs should be free to allow proper hip flexion and abduction. Tight swaddling where the hips and knees are straight not allowing movement has been shown to increase the risk for DDH.

Distal hereditary motor neuropathies (dHMN) usually cause weakness in the legs more than arms and are very slowly progressive. The feet are often affected. This is an inherited condition that can develop during infancy up to age 40 and is managed with bracing, therapy and surgery if indicated.

Down’s syndrome, also known as Trisomy 21 (an extra chromosome 21), is a condition that can cause abnormal motion of the bones of the neck (cervical spine). Too much abnormal motion in the cervical spine can cause pressure on the spinal cord. Treatment for this disorder requires regular clinical exams and X-rays. Surgery may be necessary if there is too much motion of the cervical spine (laxity) and/or if there is pressure on the spinal cord.

Duplicated thumb is a condition where the thumb fails to develop normally during pregnancy. The thumb forms with two parts and is also called a “split thumb.” Duplicated thumb is common and typically requires surgery at about one year of age. The goal of surgery is to combine the best parts of each thumb to reconstruct the best thumb possible with regards to size, alignment and movement.

Dwarfism (achondroplasia) is a bone growth disorder resulting in short stature. Options for treatment may be hormone therapy or surgery.

Flat feet/pes planus is a very common condition that usually does not interfere with a child’s comfort or ability to walk. If the flat foot persists and the child is complaining of pain, shoe orthotics/inserts, braces or pain medication may be beneficial. Surgery is rarely needed.

Fracture (complete or partial) is a broken bone. Treatment may include casting or surgery. Physical or occupational therapy may be necessary following the cast removal or surgery. Learn more about the fracture clinic.

Genu valgum (knock knees) is a common condition in young children, which they usually outgrow. Treatment is usually observation and sometimes X-rays. Pictures of the child’s legs may be taken several months apart to see their progression. If necessary, a child may undergo a surgical procedure called guided growth, where plates and screws are secured to the growth plate; or a surgical procedure called an osteotomy, which is a complex procedure that involves cutting the bone, adding or removing a wedge of bone and realigning the bone.

Genu varum (bowed legs) is a common condition in young children. In the first year of life bowed legs are normal. Treatment is usually observation. Pictures of the child’s legs may be taken several months apart to observe the straightening process. Most children outgrow this condition. If necessary, a child may undergo a surgical procedure called guided growth where plates and screws are secured to the growth plate; or a surgical procedure called an osteotomy, which is a complex procedure that involves cutting the bone, adding or removing a wedge of bone and realigning the bone.

High arched feet (pes cavus) is a condition where the arch of the foot does not flatten with weight bearing. Treatment for pes cavus is corrective shoes with arch supports or insoles. Surgery may be necessary for severe cases only.

Hypoplastic thumb is a condition whereby the thumb fails to develop normally during pregnancy. Hypoplastic means small or underdeveloped. The degree of smallness is variable and ranges from slightly small to completely absent. A slightly smaller thumb may require no treatment, or tendon transfer surgery to enhance thumb motion. The tendon transfer surgery moves a tendon from another digit to the thumb to promote movement. Very small or absent thumbs require a surgery called pollicization where the index finger is made into a thumb. This surgery is complicated and requires surgical expertise of a pediatric hand surgeon to obtain the best outcome.

In-toeing (pigeon toes) and out-toeing are common developmental concerns in children. The problem can develop solely in the foot or can be from a slight rotation of the hip or the lower leg bone. Most children outgrow this without any treatment, therefore special shoes, braces or exercises are not needed. Casting or surgical procedure is necessary for severe cases only.

Juvenile rheumatoid arthritis (includes juvenile idiopathic arthritis) is an autoimmune disease that causes inflammation of the joints. Treatment may include medication and physical and occupational therapy. Surgery may be necessary for very severe cases only.

Knee pain is a very common finding, particularly in active children and youth. X-rays may be needed to determine the cause. Treatment is based on the specific diagnosis.

Kyphosis is an abnormally rounded back. Treatment may include physical therapy. Surgery may be necessary for a severe curve or if the spinal cord is being pinched.

Legg-Calvé-Perthes is a condition where blood no longer reaches the ball part of the hip, causing the bone to stop growing and flatten. Eventually blood flow is restored, dissolving the flattened part of the bone and replacing it with new bone. There is no known cause of this disorder. Treatment consists of observation, X-rays and keeping the newly growing bone centered in the hip socket. This helps the bone grow back in a properly round and smooth shape. Physical therapy (stretching) exercises may be prescribed to help keep the range of motion in the hip joint. Assistive equipment for walking, such as crutches, may be necessary. Occasionally, the child may need to be placed in casts or traction to keep the hip in the proper position while healing. Surgery is sometimes required, typically after the age of 7, to shape the hip joint and relieve pain.

Limb deficiency is a condition where a child is missing all or part of a limb. Limb deficiencies may be congenital or acquired and may take place in lower or upper limbs.

A multidisciplinary team of surgeons, nurses, prosthetists and therapists evaluate and work with each child to create a solution that maximizes their individual function. Treatment for both congenital and acquired limb deficiency may include custom prosthesis (artificial limb), splints or braces. Physical or occupational therapy may be needed. Surgery may be necessary to improve function and appearance of the residual limb.

Limb length discrepancy is a difference between the lengths of the arms or legs. Limb length discrepancy of the arms does not usually have an impact on how the arms function and usually requires no treatment. Children with limb length discrepancy of the legs may be treated using a shoe lift or shoe insert. Children with significant differences in leg length may need surgery. Surgical options include epiphysiodesis (slowing the growth in the long leg), Ilizarov method (lengthening of the short bone) or a new technique using lengthening rods. Epiphysiodesis is a surgery to stop the growth at the epiphysis (end of the bone). It is performed on the longer leg, which allows the shorter leg to catch up in growth. The Ilizarov method is an external device (metal rings on outside of arm or leg) with small wires that go through the bone. The bone is separated by cutting it and then slowly lengthened. When the desired length is reached, the metal ring and wires are removed and the limb is casted until the bone is fully healed, followed by physical therapy after cast removal.

Lordosis is an exaggerated swayed back. Treatment may include physical therapy or bracing. Surgery may be necessary for severe cases.

Lupus is a chronic autoimmune disease where the immune system attacks the tissues and organs. Lupus is treated with medication.

Macrodactyly is an abnormal enlargement of fingers. Surgery may be required to improve the look and function of the fingers.

Meniscus injury - The menisci are semi-circular cushions inside the knee joint that are important for the long-term health of the knee. A meniscal tear may require surgical repair, followed by rehabilitation.

Metatarsal adductus is when the toes and forefoot point towards the midline. This may often be treated with stretching or casting, sometimes followed by bracing. Surgery is occasionally (but rarely) needed.

Missing thumb or fingers is a condition whereby the digits fail to develop normally during pregnancy. The number of digits missing is variable. A missing thumb is known as a hypoplastic thumb and the treatment is detailed under that category. A missing finger can be completely absent or manifest as a residual soft tissue nubbin. The treatment of missing fingers depends upon the number of fingers missing and the presence or absence of a thumb. In some cases, no treatment is necessary as the child is able to function well with his or her compliment of fingers. In other cases, reconstruction is necessary by adding bone to the residual soft tissue nubbin. In extreme cases, microsurgical transfer of a toe to the hand to act as a finger may be necessary.

Muscular dystrophy is a genetic and progressive disease that causes muscle fibers to weaken and break. Common treatments include physical therapy, medication and bracing of the limbs. Mobility aids, such as a cane, walker or wheelchair, may be needed. A ventilator may be needed for breathing assistance. Surgery may be necessary for contractures or scoliosis.

Osgood-Schlatter disease is an overuse injury in the knee area of growing adolescents. There are several treatment options for Osgood-Schlatter disease including rest, ice, pain medication, physical therapy or a knee strap.

Osteochondritis dissecans is a condition in which there is a damaged area of cartilage and underlying bone within a joint, most commonly the knee or elbow. This may be treated with surgery or with bracing and rehab alone, depending on the nature of the lesion.

Osteogenesis imperfecta (brittle bone disease) is a genetic defect that impairs the body’s ability to make strong bones. Treatment may include medication, casting or bracing. Surgery may be necessary for fractures that do not heal, recurrent fractures of the same bone or for scoliosis.

Osteomyelitis is a bone infection. This condition requires immediate treatment. Typically, the infected bone is removed and intravenous antibiotics are administered for a prolonged time. Once the infection is gone, the bony deficit requires reconstruction. Small deficits may heal or require bone grafting. Large deficits require more extensive surgery to bridge the defect.

Out-toeing – Some children may turn their feet out at rest or when they walk. There are many potential causes for this, which will be evaluated. In many cases, no treatment is needed; however, depending on the underlying cause, treatment with surgery or physical therapy may be required.

Patellar instability is a condition in which the patella (or kneecap) does not track smoothly in its joint. This may be treated with focused physical therapy and bracing or surgery in some cases.

Polydactyly is being born with extra fingers and/or toes. This deformity occurs during pregnancy. Polydactyly is treated with surgery to remove the extra digits.

Radial deficiency is a condition where the radial (radius bone) side of the forearm fails to develop normally during pregnancy. The extent of involvement is variable. Mild cases have mild shortening of the radius and a normal hand. Severe cases have complete absence of the radius and a missing thumb. In these cases, the hand/wrist is unsupported and sits perpendicular to the forearm. Treatment may require centralizing the wrist on the end of the remaining ulna (forearm bone) to make the forearm straight. Additional thumb reconstruction via pollicization (surgery that makes the index finger into a thumb) is often necessary.

Rickets is a metabolic bone disease that causes weak bones, bowed legs and other bone deformities. Treatment for rickets may include vitamin D and calcium supplements or bracing. Surgery may be required for severe cases only.

Scheuermann’s disease is a more severe form of kyphosis or abnormal rounding of the back. Treatment may include physical therapy or bracing. Surgery may be necessary for a severe curve or if the spinal cord is being pinched.

Scleroderma is a condition that includes chronic hardening and tightening of the skin and connective tissue. Treatment may include medication and physical or occupational therapy. Surgery may be necessary for complications caused by scleroderma.

Scoliosis is a progressive condition causing the spine to curve. Treatment may include bracing with custom orthoses made in-house. Surgery may be necessary for severe cases. See Scoliosis and spine care page.

Leaders in scoliosis evaluation and innovative treatment
We provide worldwide expertise in the evaluation and treatment of children with scoliosis. Our therapists, orthotics department and physicians are exceptional in the non-operative and operative management of these children. Non-operative treatment utilizing physical therapy and bracing is helpful in most children. Progressive deformity requires surgery to prevent severe spine curvature. Our surgeons offer fusion and fusionless options dependent upon your child’s age, curve and the status of his/her spine.

Slipped capital femoral epiphysis is a condition when the upper end of the femur slips backwards in the hip socket, causing hip pain. Surgery is necessary to prevent further slipping.

Solitary and multiple hereditary exostoses are tumors that sprout from the bone; usually bone covered by cartilage. These benign tumors can be an isolated growth (solitary) or many growths in multiple areas (multiple hereditary exostosis). Multiple hereditary exostosis requires a team of experts and the bone tumors can grow anyway in the upper extremity, lower extremity and even the spine. Exostoses are removed if they are causing pain, deformity or neurologic problems. Surveillance is necessary into adulthood and there is a small chance that benign exostosis can degenerate into a cancerous lesion (chondrosarcoma) that requires removal.

Spina bifida (myelodysplasia) is a congenital defect of the spine where the spinal cord and its coverings (meninges) are exposed through a gap in the backbone. The initial care to address the exposed spinal cord and hydrocephalus is provided by a neurosurgeon. Orthopaedic evaluation and treatment for children with spina bifida begins after the neurosurgical intervention. Orthopaedic treatment for spina bifida includes physical therapy and occupational therapy, motion/gait analysis, ambulatory aids and/or orthoses (braces) to improve independence. Some children with spina bifida benefit from a custom wheelchair and seating assessment to improve mobility and prevent pressure areas. At Shriners Hospitals for Children — Philadelphia, we practice a multidisciplinary team approach including rehabilitation care, assistive technology, wheelchair and seating clinic, motion analysis center, neurology, neurosurgery, orthopaedics, orthotics (bracing), urology and nutrition services. Care is customized according to each child’s needs.

Spinal cord injury is damage to the spinal cord usually related to trauma, such as motor vehicle accident, sporting injuries or violence. The injury can occur at the cervical (neck) level, the thoracic (chest) level or the lumbar (lower back) level. The injury disrupts the signals that travel from the brain to the spinal cord and prevents them from reaching their downstream targets. The injury can be a complete blockade or incomplete barrier that allows some signals to traverse the injured segment. Cervical spinal cord injury affects the arms and legs (tetraplegia). Thoracic and lumbar spinal cord injury spares the arms and affects the legs (paraplegia). The initial injury requires immediate management to prevent any additional injury to the spinal cord. Surgery is often required to stabilize the bony/ligamentous injury to the spinal column. Many medical issues also require management, as the injury to the spinal cord affects many other homeostatic systems such as blood pressure. We provide worldwide expertise in the evaluation and treatment of children with spinal cord injury. Once the spine is stabilized, extensive rehabilitation is necessary that requires a multidisciplinary team, including rehabilitation specialists, spine surgeons, therapists, urologists, phycologists, nurses and social work. The team works together and with the patient/family to ensure that the optimum care is rendered. Although not required, we also perform ongoing clinical research to carefully assess our outcomes following treatment. We also are devoted to basic science research in the effort to find the cure for spinal cord injury. We offer non-operative and operative management. Therefore, children with spinal cord injury are best cared for at an institution that specializes in the care and treatment of spinal cord injury.

Spinal instability is an abnormal motion between the bones of the spine (vertebra) from a disorder/syndrome or a trauma. Too much abnormal motion of one vertebra on another can cause pressure on the spinal cord and nerves. Treatment for this disorder requires regular clinical exams, X-rays and possible bracing. Surgery may be necessary if there is too much motion of the spine and/or if there is pressure on the spinal cord and nerves.

Spinal muscular atrophy is a group of disorders of the motor cells in the spinal cord and lower brainstem, which leads to muscle weakness and atrophy. This condition is typically inherited. Treatment for spinal muscular atrophy may include physical therapy, respiratory care, splints, spinal orthoses or surgery.

Spondylolisthesis is the slipping forward of a vertebra over a lower segment, which causes back pain. Treatment for spondylolisthesis may include medication, steroid injections, physical therapy or bracing. Surgery may be necessary to prevent further slipping.

Spondylosis is a defect or crack in the back part of the vertebra, which causes back pain. Spondylosis can occur in the cervical (neck) or lumbar (low back) spine areas. Treatment for spondylosis may include medication, steroid injections, physical therapy or bracing. Surgery may be necessary to prevent further slipping.

Sports injuries include strains, sprains or overuse injuries to the bones or ligaments, tendons or muscles from athletic activity. Recommended treatment for sports injuries includes RICE: rest, ice, compression, elevation; medication; bracing, casts or splinting; and physical or occupational therapy.

Syndactyly is a condition in which the fingers/toes were not completely separated (webbed) during development. Some forms of syndactyly are inherited while some forms occur sporadically. Treatment of syndactyly varies by child; therefore each child will be evaluated by a team of hand and foot specialists to decide a treatment plan. Sometimes the hand functions well without surgery and sometimes surgery is required to separate the fingers and deepen the space between the fingers.

Synostosis is a condition whereby the joint between two bones fails to form normally during pregnancy and the bones are fused together. Any joint in the body can be affected, including the spine, arms or legs. The child is born with a stiff joint and absence of skin creases across the affected joint. Synostosis can involve one or more joints in the body. Surgical treatment is difficult and efforts to make a joint have been disappointing. Physical and occupational therapy is helpful in facilitating walking and activities of daily living.

Tarsal coalition is an abnormal connection of the two bones at the back of the foot, causing foot pain. There are several treatment options for tarsal coalition, including rest, shoe inserts/arch supports, boots or casts, or steroid injections. Surgery may be necessary to improve function and reduce pain.

Tethered spinal cord is a neurological disorder caused by tissue attachments that limit the movement of the spinal cord in the spinal column. This condition is often seen in conjunction with spina bifida. Treatment for this condition is surgery.

Toe walking is a condition where a child walks on his/her toes without putting weight on the heel or any other part of the foot. It is common in toddlers and typically children outgrow it. If toe walking persists beyond age three, it is suspicious for an underlying neuromuscular problem. If treatment is necessary, a child may undergo physical therapy, bracing, splinting, serial casting or surgery.

Torticollis is a condition where an infant’s neck does not turn equally to both sides. The cause of congenital muscular torticollis is unclear, although a specific muscle (sternocledomastoid) is tight. The initial treatment is therapy, such as gentle stretching to release tightness, strengthening exercises to improve muscular balance and handling to stimulate movement toward the affected side (e.g. placing toys on the affected side to promote turning of the neck). About five to 10 percent of cases fail to respond to stretching and require surgical release of the muscle. Non-congenital muscular torticollis occurs in older children and has numerous underlying causes including cervical vertebrae abnormalities, adenitis, tonsillitis, rheumatism, enlarged cervical glands, retropharyngeal abscess or cerebellar tumors. An extensive work-up is required including X-rays and MRI.

Transverse myelitis (TM) is a neurological disorder caused by inflammation across the spinal cord. Damage from inflammation can interrupt communications between the nerves in the spinal cord and the body. Symptoms of TM include a loss of spinal cord function over several hours to several weeks and in severe cases results in paralysis, bowel dysfunction and bladder dysfunction. Some children with TM have permanent impairments that affect daily activities and mobility. The segment of the spinal cord that is damaged by TM determines which areas of the body are affected. At Shriners Hospitals for Children — Philadelphia, our multidisciplinary team provides children with acute inpatient rehabilitation and outpatient medical and rehabilitation care. Our team members specialize in rehabilitation care, orthopaedics (spine, hand and lower extremity), urology, intensive care, wound care and custom orthotics (braces). Additional services include aquatherapy, locomotor training, tendon transfers followed by intensive rehabilitation, custom wheelchair, and seating clinic and social services.

Trigger thumb/finger is a common condition where a thumb or finger snaps or locks, causing pain and impaired function. Trigger thumb or finger may be treated with splinting and a home exercise program. If this treatment is unsuccessful, surgery may be required to release the digits so it may be straightened.

Ulnar deficiency is a condition where the ulnar (ulna bone) side of the forearm fails to develop normally during pregnancy. The extent of involvement is variable. Mild cases have mild shortening of the ulna and a normal hand. More involved cases have increased shortening and/or missing ulnar digits (ring and small fingers). Severe cases have complete absence of the ulna and the radius is fused to the humerus bone (synostosis). Treatment of the ulnar deficiency is challenging, especially when missing fingers and lack of joint movement are present, but the goal is to promote the best function possible.

Vertical talus is a congenital foot disorder where the foot points upward, creating a rocker bottom. There are several treatment options for vertical talus, including casting, physical therapy and stretching or surgery.