Arthrogryposis Multiplex Congenita: Early Mobilization, Splinting and Functional Care
In short
Arthrogryposis causes non-progressive congenital joint contractures. Learn gentle passive mobilization protocols, serial splinting, and functional transfer training.
In this guide (4 sections)
Understanding Arthrogryposis Multiplex Congenita (AMC)
Arthrogryposis Multiplex Congenita (AMC) is a descriptive term for the presence of non-progressive congenital contractures affecting multiple joints in two or more body areas at birth.
The most prevalent form is Amyoplasia (classic arthrogryposis), characterized by symmetrical limb involvement with cylinder-like limbs, absent skin flexion creases, intact sensation, and normal intelligence. The primary underlying mechanism is fetal akinesia (decreased fetal movement in utero).
Classic Deformity Patterns and Management Goals
Upper limbs typically present with shoulder adduction and internal rotation, extended elbows, flexed wrists, and ulnar deviation. Lower limbs frequently feature clubfeet, knee flexion or hyperextension contractures, and dislocated hips.
| Body Region | Classic Deformity Presentation | Primary Functional Risk | Rehabilitation Goal | |
|---|---|---|---|---|
| Shoulders and Elbows | Shoulders adducted/internally rotated; elbows extended and rigid. | Unable to bring hands to mouth for self-feeding. | Gain passive and active elbow flexion to at least 90 degrees. | |
| Wrists and Hands | Wrists flexed and ulnarly deviated; fingers flexed with thumb-in-palm. | Impaired grasp, release, and keyboard/pen access. | Serial night splints in functional extension; palmar web space preservation. | |
| Hips and Knees | Knee flexion or severe hyperextension; teratologic hip dislocation. | Inability to achieve upright standing and walking. | Establish plantigrade foot and knee extension for standing frame positioning. | |
| Feet | Rigid, severe equinovarus clubfoot. | Impaired weight-bearing base. | Ponseti casting and surgical release to achieve flat weight-bearing. |
Early Physiotherapy and Positioning Protocols
Physiotherapy must commence in the first days of life, capitalizing on early neonatal soft tissue plasticity.
- Frequent Low-Load Stretching: Gentle passive range of motion performed 3 to 5 times daily, holding stretches for 30 to 60 seconds with every diaper change.
- Serial Thermoplastic Splinting: Custom resting splints for wrists and knees remoulded every 2 to 3 weeks to capture newly gained joint excursion.
- Adaptive Standing Frames: Introduce upright standing by 10 to 12 months in a prone stander to encourage weight-bearing through long bones and promote head-trunk control.
Frequently Asked Questions
Is Arthrogryposis a progressive disease?
No. The underlying pathology is strictly non-progressive. However, contractures can recur during rapid adolescent growth spurts if stretching and night splinting are discontinued.
Why should aggressive or forceful stretching be avoided?
Forceful passive stretching can cause epiphyseal fractures, subchondral bone damage, or heterotopic ossification in fragile, rigid neonatal joints.
Can children with AMC achieve independent walking?
Yes. Up to 85 percent of children with Amyoplasia achieve functional community or household ambulation, often using lightweight orthoses (KAFOs or AFOs) and assistive walkers.
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