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Congenital Upper Limb Differences and Overuse Injuries

Amber Henson
by Amber Henson
Jul 16, 2024

Recently, we received an email from someone with a congenital limb difference. They’re in their 30s and have never used a prosthesis because they’ve adapted to living life with one arm. But they emailed us because they were considering a prosthesis — in fact, when they sent the email, they were in a doctor’s office, waiting to have their sound arm evaluated for overuse injuries.

We love how people with congenital limb differences can be so innovative when it comes to living life with one hand. We see it all the time in our centers, where our clinical team, especially our occupational therapists, spend time with patients, asking them to perform various daily tasks with and without their new prosthesis. People have found some great workarounds, like holding jars in the crook of their elbow on their affected side and opening them with their sound hand.

What we don’t love is how these innovations can also lead to long-term musculoskeletal imbalance and overuse injuries. Because the world is built for people with two arms, people with a limb difference often succumb to overuse of their sound side. This is why we recommend that children with an upper limb difference are fit while they’re young. Children are excellent at adapting and being able to understand how using a prosthesis as a tool early in life will help them avoid injury to the other arm and balance out both sides of the body.

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Why doesn’t every doctor and prosthetist recommend that young children be fit with a device early? Some may believe that if children are meeting their physical milestones, why try to complicate that? Many other care providers are not as well educated on the long-standing benefits of prosthetic use, especially for patients with congenital limb differences. Since upper limb differences account for only 10% of all limb differences, it’s not a widely researched topic. But we’ve found from our years of experience that if a child can be introduced to what a prosthesis can do for them and get used to how it feels, then they are more likely to utilize a prosthesis later in life.

In the video below, you can learn about Autumn, who is eight years old and has a below elbow congenital limb difference on her left side. In the video, her mom talks about why they make the two-and-a-half-hour drive for Autumn’s prosthetic care: “We’ve learned that the importance of prosthetics, specifically for upper limb, is so that Autumn doesn’t overuse the muscles in her shoulder. We want her to continue to be healthy and have balanced muscle control.”

What about later in life, like the person in his 30s who emailed us — can a prosthesis still help? Absolutely. Adults can learn to utilize a prosthesis and have an even better understanding of their functional needs and how a prosthesis may be useful to them. You can read about several of our adult patients with congenital limb differences who began using a prosthesis later in life in our article, Adults with Congenital Limb Differences. The reasons for their decisions are varied. Some had a major life change that highlighted the need for a prosthesis, like having a baby. Others saw that the technology was better now than when they were a kid. Others, like Max Okun (pictured at the top of this article), who has an upper limb difference on his left side, had been experiencing chronic back pain. His first solution was to go to the gym and try to strengthen his back so the pain would lessen. But without his left elbow and forearm, his shoulder was doing all the work, which actually caused the back pain to increase. The answer for Max was to find a specialist who could create an activity-specific device to allow him to return to the gym, continue strengthening his back and ultimately decrease his pain.

Max Feature

Our prosthetists and technicians have fit many people with congenital limb differences who have never worn a prosthesis before. Our clinical therapy specialists also work with these individuals to help strengthen their residual limbs and teach them how to use their prostheses in ergonomic ways. In addition to a prosthesis, adaptive tools can be helpful and our therapists will educate patients about their benefits. Our Justification, Authorization and Billing Team has experience with helping our patients advocate for themselves when insurance companies ask: ”Why does this patient need a prosthesis now after going without since birth?” The simple answer is: “Because now is when they’ve decided they need one.”

If you or someone you know is interested in either preventing overuse injuries or pursing a prosthesis to help those damaged areas heal, please contact us. If you would like to comment on this article, please do so below.

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