Arthrogryposis is a syndrome associated with severe stiffness of the upper extremity. Wrist and finger flexion is the predominant pattern of upper extremity deformity. Goals are to maximize passive and active motion using therapeutic modalities with or without surgery. This report discusses 17 children with arthrogryposis treated primarily with early (infantile) passive range of motion and serial casting. Each patient underwent therapy including stretching, serial casting, and orthosis fabrication. Gentle sequential casting addressed the wrist and digit contractures with a cast applied from the forearm to the fingertips. Padding was added to prevent skin maceration and no skin problems occurred. A retrospective chart review and WeeFIM score was completed to assess results.
The average number of casting sessions per extremity was four. Distal arthrogryposis responded better than global arthrogryposis. Nine of the 12 patients with global arthrogryposis had recurrence of deformity. Compliance with long-term splinting remained less than optimal and was only accomplished in 60%. The families and patients complained that continuous use of an orthosis interfered with activities of daily living. The average final passive wrist extension in both the distal and global groups was between 7 and 9 degrees. Total correction averaged 33 degrees. WeeFIM scores showed varying degrees of independence.
The mainstay of early treatment in arthrogryposis is therapy to maximize passive motion. Early surgical intervention has been reported, although the results are inconsistent. The concept of frequent passive mobilization of the stiff joints must be stresses to the family. Failure to respond may require a low load and prolonged stress, such as serial casting.
Journal of Pediatric Orthopaedics