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Arthrogryposis (Congenital Joint Contracture)
As one of the largest pediatric orthopedic groups in the country, Gillette Children’s Specialty Healthcare offers comprehensive evaluations, diagnosis and treatment plans for infants and children who have arthrogryposis. Our in-depth knowledge and expertise within a family-centered environment helps patients maintain joint mobility and improve joint function.
Why Choose Gillette?
- Gillette is one of the nation’s Best Children’s Hospitals in pediatric orthopedics.
- Our skilled surgeons and nurse practitioners are experts in both the diagnosis and treatment of arthrogryposis.
- Because arthrogryposis often occurs as part of a spectrum of disorders, we offer a coordinated approach to care so patients see a team of specialists during a single visit at one location.
- Our goal is to help patients treat joint issues early and, when possible, without surgery, so they can participate in a full, active life.
- We believe that clinical research and outcomes-based medicine promote the highest standards of care.
Arthrogryposis multiplex congenita is a Greek term for “curved joint.” Children diagnosed with arthrogryposis are born with a limited range of joint motion. The condition often causes joint stiffness and muscle weakness.
Types of Arthrogryposis
There are four types of arthrogryposis:
- Amyoplasia: This is the most common type of arthrogryposis. It affects both arms and legs. Patients often lack muscular development and range of motion in the joints. Joints also might be deformed.
- Distal arthrogryposis: This type affects only a few joints, usually in the hands and feet. A child’s range of motion might be slightly limited.
- Classic arthrogryposis: This type affects the hands, wrists, elbows, shoulders, hips, feet and knees to varying degrees. In some of the most severe cases, nearly every joint in the body is affected, including the jaw and the back. Muscle weakness frequently accompanies joint contractures (stiffness that prevents full extension of the joint), further limiting movement.
- Syndromic arthrogryposis: This type of arthrogryposis affects internal organs as well as the muscles and joints. It can cause breathing problems, feeding problems, speech disorders and sometimes developmental delays.
Arthrogryposis Causes, Incidence and Risk Factors
Anything that prevents normal joint movement before birth can result in joint contractures. When a joint isn’t moved while a baby is in the uterus, extra connective tissue grows and fixes the joint in one position. Lack of joint movement also means that tendons connected to the joint aren’t stretched to their normal length. Short tendons make normal joint movement difficult.
Factors that can limit joint movement before birth include:
- Lack of room in the uterus for normal movement
- Malformation of the central nervous system and spinal cord
- Abnormal development of the muscles, tendons, bones or joints
- Heredity (the condition is passed from parent to child)
Arthrogryposis occurs in about one of every 3,000 births. It affects males and females equally.
The risk factors for arthrogryposis are:
- A family history of arthrogryposis
- A family history of a congenital neuromuscular condition
- Prenatal illness that restricts movement
Arthrogryposis Symptoms and Effects
The most common symptoms of arthrogryposis are:
- Two or more joints appear malformed
- Bones above or below the affected joints are misshapen, curved or bowed
- Joints do not move smoothly, are restricted or don’t function properly
Arthrogryposis can delay a child’s attainment of typical motor milestones. In many cases, however, children can learn to move despite abnormal joint development. In severe cases, arthrogryposis can affect the spine and cause problems with the heart, lungs or other internal organs. Long-term joint misalignment sometimes leads to early or severe osteoarthritis.
Arthrogryposis Diagnosis and Treatment
A diagnosis of arthrogryposis requires the following three characteristics:
- Congenital—a child has the condition at birth
- Non-progressive—the condition does not worsen as a child ages
- Multiple joint contractures—the motion of two or more joints is limited
If health care providers suspect arthrogryposis, they’ll perform a physical exam. An X-ray or ultrasound can help diagnose the condition.
Early diagnosis is important in managing arthrogryposis appropriately. Physical therapy can help improve muscle strength and increase range of motion of the affected joints for most types of arthrogryposis. Removable splints can help enhance the effectiveness of stretching exercises. Sometimes ankle surgery can improve the foot position; in addition, casts or braces might help patients walk and bear weight correctly. Though performed infrequently, surgery on the knees, hips, elbows and wrists might help patients achieve a greater range of motion. In some cases, tendon transfers can improve muscle function.
The most common treatments for arthrogryposis are:
- Open reduction: Orthopedists perform open reduction surgery to return a dislocated or misshapen joint to its proper place. Orthopedists most often use this procedure on older children or children whose joints do not move back using a closed reduction (a procedure to set joints without surgery).
- Tenotomy: Sometimes children require a surgery, called tenotomy, to release tight tendons.
- Osteotomy: Orthopedists may need to cut or realign the bones above or below the affected joint using a procedure called an osteotomy.
- Cast and braces: Children who’ve had a reduction or osteotomy might need to wear a cast after the orthopedists returns the bones to their proper place. While wearing a cast, children might need to be carried or use a wheelchair. Later, an orthotist replaces the cast with a brace to further correct joint damage. Children might need to wear the brace at all times, or only when sleeping or moving.
Our Arthrogryposis Services
Early detection and management of arthrogryposis can help prevent additional problems as a child grows. By providing a variety of experts in pediatric medicine and orthopedics, we make it easier for patients, families and health care providers to create a treatment plan that meets the patient’s needs. Our multidisciplinary team approach often lets us provide specialized health care during one visit at one location.
A patient who has arthrogryposis often sees experts in the following specialties and services:
- Assistive technology
- Occupational therapy
- Physical therapy
- Rehabilitation medicine
- Rehabilitation therapies
Gillette patients can also receive services for conditions associated with arthrogryposis such as clubfoot, neuromuscular conditions, limb-length discrepancies and limb differences, early arthritis or pain.
For information about the comprehensive services we provide at Gillette, search Conditions and Care.
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