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Arthrogryposis is a condition that affects joints of a body due to neuro-musculo-skeletal problems. It is a congenital disorder and also a non progressive condition. This condition is also known as arthrogryposis multiplex congenita. It is a rare disorder that manifests in form of joint contractures. The disease can affect muscles causing weaknesses in muscle tissues. It can also consist of fibrosis. There are different types of arthrogryposis multiplex congenita such as amyoplasia. The different forms of AMC may have different symptoms and causes. In some forms of arthrogryposis, few joints may be deformed with nearly full range of joint movement but in others, many joints may be affected including the knees, feet, shoulders, wrists, elbows, and hands. Some severe types of the condition may involve other joints like the back and jaw. 

Causes of arthrogryposis

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The exact cause of this disorder is not clearly understood but there are different schools of thought that try to explain why arthrogryposis occurs in people. The condition may not be hereditary or genetic and some of the possible causes include obstruction of the intrauterine movement in pregnancy. If there is inadequate room for movement of the fetus, it may result to contractures, immobility or poor mobility of joints as well as stiffness.

A number of things can create an inadequate space in the uterus such as abnormal shape of the uterus and less than sufficient amniotic fluid. These aspects can prevent the movement of joints of the fetus before birth resulting to the joint contractures and the subsequent arthrogryposis condition. If the fetus joints are immobile for a long period, they tend to develop excess connective tissue causing the fastening of the joints.

Moreover, there are also theories which associate early viral infections at the time of baby development to arthrogryposis. Some other theories suggest that the condition is caused by failure of the central nervous system and the muscular system. Fetal hyperthermia is also linked with this condition. Hyperthermia can be set off by fever that protracts for a long period raising the body temperatures, which in turn affect the fetus. Soaking the body of a pregnant mother in hot tubs for prolonged period could increase body temperature and spark the fetal heating or hyperthermia thus leading to arthrogryposis.

When the nervous system is impaired such as the case of spina bifida, this may result to arthrogryposis. Similarly, if the nervous system is impaired due to brain defects, this could trigger arthrogryposis. Neuro-muscular disorders like multiple sclerosis could also prevent the movement of joints leading to the condition. Other possible causes of arthrogryposis are toxic substance that may cause injuries to the fetus such as phenytoin, alcohol, and drug substances.

What are the symptoms of arthrogryposis?

Different symptoms may be seen in babies with this condition but the most common ones are restricted mobility of joints or joint immobility, which is accompanied by muscle weakness. The condition may affect the arms and legs seriously but the joints of wrists and ankle appear to be the most afflicted. The muscles of a child appear very weak and weary. In addition, the muscles are emaciated and at times, they may be missing.

Another symptom may be a displaced hip joint. Besides these symptoms, some children may have deformed faces. Others may have spinal cord anomalies. Children born with this condition also tend to develop cardiac and respiratory complications. The genital tract of the affected babies may be abnormal. Moreover, skin impairment may also occur thus resulting to a malfunctioning skin.

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Treatment and management of arthrogryposis

Different approaches may be required in treatment of arthrogryposis condition and this is because of the many different symptoms that may manifest when a child suffers from one of the many forms of the condition. A multidisciplinary approach can assist in treatment where surgery may be performed, occupation therapy, and physiotherapy may be applied to help in joint mobility.

Surgical interventions can help in rectifying joint deformities. Customized orthopedic surgery can help in treating the afflicted joints. Osteotomy can be applied in cases of severely affected joints. In addition, some symptoms that are linked with this condition can also be managed through surgical operations such as the hip joint displacement, club foot, and hernia.  The surgery procedures can help improve the quality of life of the baby.

Physical therapy consists of casting, splinting, stretching and other joint mobility enhancement techniques. These techniques help in enhancing the range of movement in joints affected due to arthrogryposis. When utilized properly, physiotherapy can help not only strengthen and reinforce joints but also strengthen muscles. The therapy improves the overall flexibility of joints making a child more mobile.

Another method used in treatment and management of arthrogryposis is occupational therapy. This kind of therapy helps train the child in fine motor skills. It also helps in training a child on activities of daily living or ADL.  Occupational therapy can also address the psycho-social and psychological effects that a child suffers after having deformities of joints. This helps create a better wellbeing and can enable the child cope with the deformities.

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