Saturday, October 26, 2019

Hand Camp 2019- St. Louis Shriners Hospital

I realize that I post about Hand Camp nearly every year.  Our St. Louis Shriners Hand Camp is really something special.  But I do so for good reason- it is just so impactful for kids, families, staff, and me!  Being outside the hospital setting allows a different kind of conversation and allows a different perspective for everyone.  Kids and families being with other kids and families with similar challenges is simply something that the hospital environment cannot reproduce.  Plus the activities at Hand Camp as shown below are fun, build confidence in the kids, and provide a similar sense of confidence for parents.  The parents come to really understand that their child truly will not have limits.  The group sessions allow honest conversation amongst parents and allows parents to ask our teen counselors questions- who better to provide a honest perspective than a teen or young adult who is living with similar challenges?

There a handful of Hand Camps throughout the US, some bigger than others but most with similar philosophies.  Most of these are hospital based and typically free for participants and families (ours certainly is).  Some are run through organizations:

Camp No Limits

Hands to Love


Here are a few pictures and videos to inspire us!

Hand Camp nature hut with guinea pig.

Shriners Hand Camp team.

Hand Camp.  Dream Team.

Shriners Hand Camp climbing wall

Inspirational video of the climbing wall.

Charles A. Goldfarb, MD              
My Bio at Washington University     

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Sunday, October 20, 2019

Nerve Injury after Trauma

The blog is mostly about kids born with differences in the arms (and occasionally legs).  However, my practice also includes kids with sports injuries and other traumas.  I will occasionally post interesting findings on these topics as well.  This is a child with a nerve that is not working correctly after an elbow fracture.  Specifically, this child sustained a fracture of the humerus (supracondylar humerus fracture) as shown here.

This patient was treated with a closed reduction (bones put back in place without making a skin incision) and pins were placed to keep the bones stable as healing started. 

Supracondylar humerus fracture after fixation

It is important to understand the patient's physical examination prior to surgery- this patient had a median nerve palsy.  That is, the median nerve was stretched and not functioning perfectly.  There were signs of the muscles/ tendons not working and signs the feeling in the fingers was not normal. 

This is not expected to improve during surgery and typically the nerve recovers over months after the surgery.  We typically watch and wait as the nerve recovers. 

This patient is now 8 weeks after surgery.  The bone is healed.  Elbow motion is almost normal.  BUT, the median nerve is not working perfectly- specifically, the FPL and FDP to index fingers are not strong as she demonstrates in this amazing video.

Also, this picture helps with an understanding of the change in feeling- see the skin changes on the index finger.  The other helpful finding on examination is the lack of sweat on the index finger- without the nerve working well, the finger is dry.

Skin changes with median nerve palsy

To be clear- this patient has a median nerve palsy (bruising).  This injury affect muscle and feeling.  Sometimes, there can be a AIN (anterior interosseous nerve) palsy which only affects the muscles (specifically, the FPL, the FDP to index and middle, and the pronator quadratus).  Patients with an AIN palsy have normal feeling.  Or, if the whole median nerve is affected, there are changes to the muscle and to the nerve that affect feeling. Anatomically, the AIN is part of the median nerve at the elbow and then, typically around 5 cam past the joint, the median nerve branches the AIN as a separate nerve.  The AIN is susceptible to injury because it sits in the back of the nerve, closest to the bone and, in this case, closest to the fracture.

At this point, we will watch and expect the nerve to get better over the next few months.  Very rarely, the nerve will not perfectly recover and further assessment with nerve studies can be helpful to understand the nerve's recovery.

Charles A. Goldfarb, MD              
My Bio at Washington University     

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Saturday, October 12, 2019

Activity Specific Prosthetics

This is a brief post on activity- specific prosthetics.  There has been much controversy on the timing and appropriate use of prosthetics in kids.  I have previously blogged about this several times as can be seen HERE.  I really appreciate activity specific prosthetics.  The child is engaged in the process based on a demonstrated interest and the specially designed and fitted prosthetic makes a difference.  This idea, compared to the 'old- fashioned' idea that every kid is fitted with a general prosthetic at 6 months of age, just makes so much more sense!

This is a great example of a really helpful tennis specific prosthetic.  It allows an ability to more easily play tennis including serving.
Activity specific prosthetic.  This one is designed for tennis to allow serving.  

Here are a few other activity specific prosthetics.  I took these pictures in the lab and the prosthetic is not typical (harness included) but demonstrate the point- easily changeable prosthetics that have a specific function.  These are durable, functional, and appreciated by kids and families.

Voluntary closing prosthetic.  

Activity specific prosthetic.  Associated with harness (not typical).  This one can be used for weight lifting, etc.

Activity specific prosthetic.  This one is designed for riding a bicycle.  

Activity specific prosthetic.  This one is designed for... yes- lacrosse. 

Activity specific prosthetic.  This one is designed for volleyball. 

Activity specific prosthetic.  This one is designed for volleyball (other view)

I will close by saying- search the internet.  There is a great deal of information and pictures out there on what is possible.  Many companies will work with you for sports and activities.

Charles A. Goldfarb, MD              
My Bio at Washington University     

Please CLICK HERE to support our research.  
Designate my name.  Thank you!