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About the conditions we treat

About the conditions we treat

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.

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 world-class 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.

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 world-class expertise in the evaluation and treatment of children with brachial plexus injuries. Our therapists 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 proficient in this operation. Ongoing expert evaluation is necessary for the best care options.

Brachycephaly is a condition in which the back of the head becomes flattened, causing the head to widen, and occasionally the forehead bulges out. Treatments may involve use of a helmet, headband or therapy.

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.

Cavovarus foot refers to a foot that has both cavus (high arch) and varus of the heel (a heel that is turned inward.) It leads to stress on the lateral foot, often ankle instability or peroneal pathology and occasionally even fractures to the lateral bones of the foot and ankle. Treatment often involves physical therapy, orthotic devices and sometimes surgery.

Cavus foot is a condition in which the foot has a very high arch causing an excessive amount of weight to be placed on the ball and heel of the foot when walking or standing. Treatment includes orthotic devices, shoe modifications, bracing and sometimes surgery.

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 a leader in treating the orthopaedic effects of cerebral palsy.

There are three main types of CP:

  • Ataxic causes a disturbance in balance and depth perception

  • Athetoid leads to involuntary and uncontrolled movements

  • Spastic, the most common type of cerebral palsy, causes stiffness and movement difficulties

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:

  • Abnormal muscle tone

  • Poorly coordinated movements

  • Persisting infant reflexes still present at an age when they should disappear

  • Involuntary movements

  • Tight or spastic muscles

  • Excessive drooling or difficulties speaking, sucking or swallowing

  • Difficulty engaging in precise motions, like writing or buttoning a shirt

Treatment options for cerebral palsy include

  • Therapy – the most important part of any therapy program is the daily stretching exercises that the therapists have set up. Therapy is provided after surgery or to meet specific goals.
      • Occupational therapy may improve the development of the small muscles of the body, such as the face, feet, fingers, hands and toes, in order to improve daily living skills and other activities.
      • Physical therapists work with the muscles of the abdomen, arms and legs to improve a variety of skills, including balance, walking, standing, using the stairs and transferring.
    • Orthotics (braces) are used to:
      • Help muscle growth keep up with bone growth
      • Prevent foot and knee damage
      • Help support weak muscles
      • Protect the muscles after surgery
    • Medications may be prescribed to control or prevent seizures and/or to reduce spasticity, which can impact movement and motor skills.

    • Mobility aids such as crutches, a walker or a wheelchair may be necessary.

    • Serial casting is used to help stretch muscles that have gotten so tight that exercises and bracing do not help. When the muscle is stretched enough, the cast is removed and your child must wear a brace.

    • Surgery may be required to reduce spasticity in legs and improve muscle development.

    • Orthopaedic surgery may be required to take care of bone deformities caused by contractures.

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.

Clavicle fracture is a break in the collarbone, one of the main bones in the shoulder. Treatment includes ice, arm support such as a sling or wrap, and physical therapy. Surgery may also be necessary for more severe fractures.

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.

Congenital radial head dislocation is an unusual congenital abnormality of the elbow. Although it is present at birth, it is rarely discovered until children get a bit older. It can occur alone or more commonly, may be associated with other conditions or syndromes. Treatment most often include analgesics and possibly surgery.

Developmental dysplasia of the hip (DDH), also referred to as congenital hip dislocation, 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 typically progress very slowly. 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.

Dolichocephaly is a condition in which one has an abnormally long head. It is often due to the positioning of the developing baby during pregnancy, abnormal sleeping position or neck tightness.

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 (skeletal dysplasia) is a genetic condition usually caused by a defect in a specific gene, known as a genetic mutation. 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.

Foot Pain can refer to pain in the heel, the ball of the foot, or toes.

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 our fracture care.

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.

Infant shoulder dystocia is a birth related shoulder trauma that occurs during delivery when an infant’s shoulders become lodged in the mother’s pelvis, often because the baby is proportionately too big for the birth canal. Other causes include the baby being born face first, pulled out by the face causing undue stress on the neck, or born feet first, also creating undue stress on the shoulder and neck area.

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 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.

Macrodactyly is an abnormal enlargement of fingers or toes. 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 missing 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.

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.

Osteochondroma & hereditary multiple exostosis are conditions in which benign (noncancerous) bone tumors develop. Osteochondroma generally occurs as a single lesion and it is not a heritable disease. When two or more osteochondroma are present, this condition is call hereditary multiple exostoses.

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.

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.

Plagiocephaly is a flattening of one side of a baby’s head. Treatment may include use of a helmet or headband and/or therapy.

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 (radial club hand) 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.

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 world-class 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.

Shoulder dislocation is a condition in which the humeral head (ball) comes out of the glenoid (socket). The shoulder is the most common dislocated joint in the body. The initial treatment is “reduction,” which means putting the ball back into the socket. After the shoulder is put back into place, it is often immobilized in a sling, followed by physical therapy. In some cases, surgery is required to repair damaged ligaments.

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. Orthopaedic evaluation and treatment for children with spina bifida begins after 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 — Erie, we practice a multidisciplinary team approach including rehabilitation care, assistive technology, wheelchair and seating clinic, motion analysis center, orthopaedics, orthotics (bracing), urology and nutrition services. Care is customized according to each child’s needs.

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 (webbed fingers/toes) 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.

TAR syndrome is characterized by the absence of a bone called the radius in each forearm, short stature and a shortage of blood cell fragments involved in clotting (thrombocytopenia). The ulna is also sometimes underdeveloped or missing in one or both arms. Sometimes other skeletal abnormalities affect the upper arms, legs or hip sockets.

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.

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.

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 (ulnar club hand) 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.