At Shriners Hospitals for Children, the health and safety of our patients, families, volunteers and staff is our top priority. With the evolving situation regarding COVID-19, we are closely monitoring updates from local health departments and the Centers for Disease Control and Prevention (CDC), and are actively following their recommendations.

If your child has an upcoming appointment, please contact your local Shriners Hospitals for Children location.

Shriners Hospitals for Children — Honolulu visitor information.

Skip to navigation

Hand, arm and shoulder

Hand, arm and shoulder

Upper extremity conditions

Upper extremity fractures

Upper extremity fractures are a common injury in children. Common causes for upper extremity fractures are falls, sports injuries, as well as motor vehicle accidents. The fracture may occur anywhere along the shoulder, arm, elbow, wrist or hand. The emergency room is the usual initial contact for the patient, where the extremity will be stabilized. Following the initial treatment, our orthopaedic surgeons will follow the child closely to monitor healing, pain management and function. Because each fracture is unique, the need for surgery will vary with each individual. Post injury therapy is extremely important to achieve optimal function.

Brachial plexus injury (Erb’s Palsy)

The brachial plexus is a bundle of nerves located in the shoulder area. If these nerves are injured 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. It usually includes range of motion exercises and massage therapy. Periodic evaluations are important to assess progress. Surgical intervention may be indicated in some cases.

Hand and finger deformities

There are many types of congenital hand and finger deformities that are treated by an orthopaedic surgeon who specializes in hand surgery. Some examples of deformities we treat are:

Club hand

A club hand (radial club hand; radial dysplasia) is a congenital condition in which the radius bone in the forearm is either malformed or absent. In some cases, the thumb can be small or absent. Treatment usually begins in infancy and often includes occupational therapy, as well as surgery.


Polydactyly is a condition in which a person is born with extra fingers and/or toes. This deformity occurs during the development of the fetus. Polydactyly is treated with surgery to remove the extra digits. Children with polydactyly can be expected to live relatively normal lives if they are born without other associated anomalies or syndromes.

Trigger finger

Trigger finger is a common condition where a finger snaps or locks, causing dysfunction and pain. Trigger finger may be treated with splinting and an exercise program done at home. If this is not successful, surgery may be required to release the finger so it may be straightened.


Syndactly is a condition in which the fingers/toes were not completely separated during development. Some forms of syndactyly are inherited, while some forms occur without any known cause. Sometimes, the hand functions well without surgery. At other times, surgery is required to separate the fingers and deepen the space between the fingers.

Cleft hand

A cleft hand is a congenital condition in which one or more fingers are absent; however, the small finger is always present. Cosmetics and functionality are the major concerns with a cleft hand. Some children may have very mild limitations, while others may have significant issues. Treatment often includes occupational therapy, as well as surgical intervention.

Congenital limb deficiencies and amputations

Congenital limb deficiencies and amputations can be caused by a variety of conditions such as: fibular deficiency, tibia deficiency, amniotic band syndrome and congenital amputation. A child may be born with a condition where the limb has a complete amputation or the child is born without a functional lower part of the arm/leg. A multidisciplinary team of surgeons, nurses, prosthetists and therapists evaluate and work with each child to create a solution that maximizes their individual function.