Hand, Arm and Shoulder


A girl working on a craft project

The Hand and Orthopaedic Upper Extremity Program at Shriners Hospitals for Children – Northern California provides children with hand, arm or shoulder deficiency expert care. Our Pediatric Surgery team evaluates and treats hand or upper limb abnormalities that are present at birth (congenital) or occur after birth (acquired).

Our Brachial Plexus Injury Team treats babies and children who suffered birth injuries to nerves in their arms and hands. Most children don’t think twice about gripping a pen, throwing a ball, or reaching up high. But for a child born with a congenital hand difference, upper limb deficiency or brachial plexus birth palsy, such everyday tasks can pose big challenges.

Hand sunrise Logo - each hand has different amount/arrangement of digits

The expert pediatric orthopaedic team at Shriners Hospitals for Children – Northern California provides the complex, compassionate care every child deserves. The medical team works to advance the lives of children through leading-edge surgical care, therapy and research.

Make an appointment

If your child has a condition that can be treated by Shriners Hospitals for Children – Northern California, please call our Referral Center to schedule an appointment, call (916) 453-2191 or via email at referrals.ncal@shrinenet.org​. A Referral Coordinator will partner with you to gather the necessary information to allow our physician leadership to evaluate the best path for your child. All care is provided regardless of the family’s ability to pay.

Congenital Hand Differences

Congenital Hand Differences (CHD) refers to all physical differences of one or both hands, arms or shoulders that are present at birth. CHD may be caused by difficulties with hand formation or growth, but the reason for these difficulties is often not known. Acquired hand differences are hand differences that are caused by injury or disease after birth. Children who acquire differences may have challenges similar to children with CHD. We invite you to explore the resources and supports in this site developed for you when it comes to raising your child with a CHD.

Shriners Success Stories

Picture of Tal Oppenheimer


Meet Tal and Sarah

Our Medical Team and Orthopaedic Research

The Medical Team

Michelle James, M.D.
Pediatric Hand Surgeon
Chief of Orthopaedic Surgery

Lisa L. Lattanza, M.D.
Consultant Pediatric Elbow Surgeon

H. Relton McCarroll, M.D.
Consultant Pediatric Hand Surgeon

Claire Manske, M.D.
Pediatric Orthopaedic Hand Surgeon

Janice Conroy, R.N.
Case Manager
Co-Director, Camp Winning Hands

Orthopaedic Research

Led by Dr. Michelle James, the orthopaedic clinical research program is comprised of a multi-disciplinary team of physicians, therapists, bio-mechanical engineers and clinical research professionals, focusing on research pertaining to children’s hand and arm function. Current research projects include:

  • Motion analysis studies of children’s thumbs, elbows and shoulders.
  • Development and evaluation of a smartphone application to test hand function in preschoolers.
  • Studies of hand function in several conditions including Cerebral Palsy and Symbrachydactyly.
  • Development of pediatric elbow function evaluation tool.
  • Long term follow-up studies of children with Brachial Plexus Birth Palsy.

Pediatric Hand Study Group Logo

Visit here to learn more about the Pediatric Hand Study Group.

Conditions Treated

Hand and Arm Differences: Malformations, Deformities, Deficiencies

  • Adactyly
  • Amniotic band syndrome / constriction bands
  • Cleft hand / central deficiency / ectrodactyly
  • Congenital amputation (transverse deficiency)
  • Congenital radial head dislocation
  • Polydactyly
  • Proximal radio-ulnar synostosis
  • Radius deficiency
  • Symbrachydactyly
  • Syndactyly
  • Thumb deficiency (small or missing thumb)
  • Ulnar deficiency
  • Webbed fingers

Hand and Arm Injuries

  • Fracture (broken bone) follow-up
  • Nerve injuries
  • Tendon injuries
  • Post-traumatic deformities

Neuromuscular Conditions (Palsies)

Post Claire Manske, M.D.

Six-hospital study identifies better brachial plexus birth injury surgery

Impactful research changes clinical practice, according to pediatric orthopedic surgeon Mary Claire Manske, M.D. And that’s just what she has done with a paper on brachial plexus birth injury.

In the paper published in the Journal of Bone and Joint Surgery last year, Dr. Manske compared two surgical approaches used in infants for repairing the suprascapular nerve and restoring external shoulder rotation.