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Conditions treated

Conditions treated

Conditions treated

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

Amniotic band syndrome (congenital constriction band syndrome) is a condition that occurs when a fetus becomes entangled in the fibrous, string-like amniotic bands of the amniotic sac, which is the fluid-filled sac that surrounds a fetus in utero during pregnancy. Because the fetus continues to grow and the bands do not, they restrict blood flow and disrupt the fetus’s 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.

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.

Blount’s disease (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 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, but usually include range of motion exercises and occupational therapy. Periodic evaluations are important to assess progress. In some cases surgical intervention may be indicated if there is no improvement within 3-6 months of injury.

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 doesn’t work.

Cerebral palsy (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 a lack of oxygen to the brain. 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 Twin Cities hospital.

There are three main types of cerebral palsy:

  • Ataxic – This type causes a disturbance in balance and depth perception.
  • Athetoid – This type leads to involuntary and uncontrolled movements.
  • Spastic – The most common type of cerebral palsy, which 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) – 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: 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 contractures in bone deformity.

Charcot-Marie-Tooth is a group of disorders that affect the peripheral nerves that carry messages between the brain and muscles throughout the body. Treatment may include physical and occupational therapy, braces or splints. Surgery may be necessary for severe foot deformities.

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 clinically observed and braced as needed. Rarely is there a recurrence of the clubfoot as the child grows.

Dermatomyositis is a rare autoimmune disorder that inflames healthy muscle tissue causing weakbness. Common treatment may include physical therapy, speech therapy, medication, and surgery.

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 (PDF – Be Careful When You Wrap Your Baby - DDHSwaddle.pdf). 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.

Ehlers-Danlos syndrome is a group of inherited disorders that weakens connective tissues. Treatment may include medication and physical therapy. Although it is rarely necessary, surgery may be included in treatment of Ehlers-Danlos syndrome.

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.

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.

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 idiopathic arthritis (includes juvenile rheumatoid 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.

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-Calve-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 of 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.

  • Congenital limb deficiency is when a portion or the entire upper or lower limb does not form or does not form properly during pregnancy.
  • Acquired limb deficiency is a traumatic loss of a limb due to an accident, e.g. farm machinery, lawnmower.

A multi-disciplinary 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.

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, scoliosis, or heart problems.

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.

Osteogenesis imperfecta 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.

Patellar (knee) instability is a condition where the kneecap is unstable and can move out of place (dislocates). Treatments include physical therapy or immobilization (cast). Surgery may be necessary in order to stabilize knee.

Pes cavus (high arched feet) in 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.

Pes planus (flat feet) 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.

Polydactyly is being 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.

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. Severe cases may require surgery.

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. Severe cases may require surgery.

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

Spina bifida (myelodysplasia) is a congenital defect of the spine where the spinal cord and its 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, crutches, and/or custom orthoses (braces) made in-house. At Shriners Hospitals for Children — Twin Cities we practice a multidisciplinary team approach including assistive technology and rehabilitation care, neurology, orthopedics, orthotics (bracing), and urology services. All services are conveniently provided during the specialty clinic held on the 2nd and 4th Friday of each month so that families can see all specialists in one visit without leaving the building.

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.

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.

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.

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.

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

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, boot or cast, 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 (link back to spina bifida on website). 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.

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

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.

   
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