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Arthrogryposis Multiplex Congenital (AMC) is a condition characterized by deformity and stiffness of the joints, in which the baby is unable to move or change position and is identified soon after birth.
The occurrence of arthrogryposis is mainly associated with conditions that interfere with the baby's movement during pregnancy, such as a decrease in the amount of amniotic fluid, genetic alterations or diseases related to the mother, such as multiple sclerosis, for example.
The treatment for arthrogryposis must be guided by the doctor and aims to reduce joint stiffness and/or correct the deformity, favoring the baby's movement, and physiotherapy or surgery sessions may be indicated in some cases.
Symptoms of Arthrogryposis
The main symptom of arthrogryposis is stiffness, flexion or extension of a joint. Changes linked to arthrogryposis are related to the affected joint, and can be verified:
- Shoulders turned inward;
- Folded fists and fingers;
- Displacement of the hip;
- Clubfoot, turned inward;
- Scoliosis, in which the spine is shaped like an S or C;
- Knees and/or elbows extended;
- Limitation of movement;
- Muscle weakness;
- Muscle atrophy, in some cases;
- In some cases, the central nervous system may also be compromised, however intelligence is preserved.
Although the symptoms of arthrogryposis are not progressive, the cause that leads to this condition can be, so the baby may show other changes over time.Therefore, it is important that the cause is identified early so that the most appropriate treatment can be initiated, preventing changes that may compromise the person's quality of life.
How the diagnosis is made
The diagnosis of arthrogryposis is usually made soon after birth, through a physical evaluation, in which it is observed that the baby has difficulties moving a certain joint and/or changing its position.
During pregnancy, it is possible to suggest the occurrence of this condition due to the evaluation of some conditions related to pregnancy and the woman, such as amount of amniotic fluid, diseases or genetic alterations.
In addition, after birth, genetic and imaging tests can be performed to assess the baby's bone and joint he alth, as well as to investigate the associated cause and, in this way, it is possible to carry out a more specific treatment and suitable.
Arthrogryposis can happen as a result of several situations, however it is usually associated with conditions that directly interfere with the baby's movement during pregnancy, the main ones being:
- Decreased amount of amniotic fluid;
- Multiple pregnancy;
- Uterine malformation;
- Infections, such as Zika virus infection;
- Genetic diseases related to the fetus, such as neuropathies, muscular dystrophy, spinal muscular atrophy, trisomy 18, for example;
- Maternal diseases, such as multiple sclerosis and changes in uterine vascularization, for example.
In addition, the use of drugs and alcohol abuse during pregnancy, as well as the use of medication without medical advice, can result in the development of arthrogryposis.
How the treatment is done
Treatment for arthrogryposis may vary according to the observed alteration. In most cases, manipulation by the doctor is indicated and the use of plaster on the joints, in the first months of life, which allows improvement of the changes. However, in some cases, surgery may be necessary to promote correct bone development and joint movement.
It is also interesting to have physiotherapy sessions, as it is possible to prevent muscle atrophy, in addition to promoting muscle strengthening, joint lubrication and improved movement.
Surgery for arthrogryposis
Orthopedic surgery may be indicated for the correction of congenital clubfoot, severe knee flexion, shoulder dislocation, hip dislocation or other situations in which it may be possible to improve joint malleability, such as capsules, ligaments and muscles with fibrosis.In addition, in case of scoliosis, it may be indicated to place a device to fix the spine to the sacrum, when the scoliosis angle is greater than 40º.
A child with arthrogryposis may undergo more than 1 surgery in a lifetime, and physiotherapy sessions are always recommended before and after surgery, with at least 30 pre- and postoperative sessions.
Physiotherapy for arthrogryposis
Physiotherapy should be performed especially before and shortly after surgery, but it can also be indicated in other periods of life, and can be performed from birth until when recommended by the doctor.
Preferably, physiotherapy should be performed 2 times a week, with sessions of about 1 hour, but in addition, it is necessary for parents or caregivers to do passive and stimulation exercises at home, which have been guided by the physical therapist during the consultation. Each baby or child must be evaluated personally, because there is no protocol that fits all cases of arthrogryposis.