Pediatric Upper Extremity Function

Arms are useful appendages for how they are meant to be used. Often with neurological concerns, the arms are used for other activities such as body support and movement. This is not the intended use but serves the child to improve mobility. Protecting the arms and their function is critical to lifelong health.

The upper extremity includes everything from the shoulders to the fingertips. That is, all bones, muscles, joints, nerves, and blood vessels.

Bones should be kept healthy through weight-bearing and functional use. The arms are made to do some lifting but generally not body weight. A healthy diet is important, but also sunlight encourages vitamin D absorption. This helps not only to form bones but also to maintain the strength of bones already formed.

Education about wheelchair propulsion should begin early. If a manual chair is used, start with the arm straight down to propel the wheel. A natural tendency is to reach back, which puts stress on the shoulder leading to complications immediately or even later in life.

Muscles can be strengthened to allow the increased ability to support body weight when transferring and walking with assistive devices. Occasionally, the use of weights, elastic bands, and even electrical stimulation can increase muscular strength. Contractions or tone (spasticity) of muscles is painful and limit motion. Treatment for tone can be used to relax the spasming muscle.

Joints must be supple and able to go through the entire range of motion. A joint that is even slightly out of range can lead to pain and restricted movement, which hinders functions. Joints can be restored to function depending on the causative issue. Splints can assist with joint or muscle contracture as the splint is adjusted until the issue resolves. Surgery may be needed for more involved concerns.

Nerves can be impaired, which affects function. The lack of messages being sent to and from the brain or through the spinal cord does not allow communication within the body for movement or sensation. Sometimes, these functions can be taken over by other nerves or through the use of adaptive equipment.

Nerves can also have an impingement which is an internal part of the body pressing on a nerve that interrupts message transmission. This can appear as a decrease in strength, dropping things, tingling, numbness, and electrical shocks within the body. Any change noted by the child or caregiver should be reported as nerve entrapment may appear without noticeable symptoms with paralysis. Surgical release of the entrapped nerve allows it to return to function over time, with the recovery time being one inch per month.

Blood vessels supply the oxygen and nutrients needed by all the cells in the arms and body. Sometimes, a blood clot can form in the arms, which disrupts blood flow. This can occur from an injury, a simple bump leading to a clot, or constriction from ‘hooking’ the arm around the back of a wheelchair, crossing legs, or equipment that is constricting. Blood clots can dislodge traveling to the heart, lungs, or brain with significant complications.