Paediatric
Hypoplastic limb
Upper limb · development
What it is
This term covers upper limbs that are underdeveloped at birth. Longitudinal deficiencies affect one side of the forearm — the radius or the ulna is short or absent, and the wrist deviates toward that side. Transverse deficiencies stop the limb at a given level, most often below the elbow.
Radial longitudinal deficiency is frequently accompanied by abnormalities of the heart, the kidneys or the blood. Screening is therefore arranged as a matter of course, with the other specialties involved.
Symptoms
There is a difference in length, shape or alignment, a wrist that deviates, missing or reduced fingers, and reduced reach.
It should be said that these children are generally very capable with what they have. Function is often better than appearance suggests, and it is function — not the X-ray — that guides decisions.
Non-operative treatment
Early therapy, stretching and splinting begin in the first weeks. Prosthetic assessment is offered where relevant, bearing in mind that many children with a transverse deficiency choose not to wear a prosthesis and manage very well without one.
That choice belongs to the child and the family, and it can change with age.
Surgical treatment
What is offered depends on the type of deficiency: soft-tissue release and serial casting for a deviated wrist, centralisation or radialisation, gradual bone lengthening, thumb reconstruction or pollicisation, and correction of associated elbow stiffness.
Timing is planned around growth and, above all, around what the child is trying to do at that point in life. An operation that improves an X-ray but takes away a function the child already had is not progress.
Recovery expectations
Follow-up extends through growth, with a period of therapy after each stage.
Goals are stated as concrete tasks — feeding, dressing, two-handed play, carrying a school bag — rather than degrees of movement. Those are the markers used to judge the result.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.