Paediatric
Arthrogryposis
Upper limb · congenital stiffness
What it is
Arthrogryposis covers a group of conditions, present at birth, in which several joints are stiff and fixed in position. It follows from the baby moving very little during pregnancy: the muscles around the affected joints are weak and partly replaced by fibrous tissue.
In the upper limb the pattern is often recognisable: shoulders turned inward, elbows straight and stiff, wrists bent toward the palm, thumbs held in the palm. Sensation is usually normal, and in the most common form intellectual development is unaffected.
Symptoms
Joints are stiff from birth. An elbow that will not bend prevents the child from bringing a hand to the mouth; a flexed wrist and a thumb held in the palm make grasping difficult.
Children develop remarkable compensations very early. Assessment therefore focuses less on degrees of movement than on concrete tasks: feeding independently, dressing, holding a pencil, moving about.
Non-operative treatment
Stretching and splinting, begun in the first weeks of life and kept up consistently, are the foundation of treatment. Occupational therapy, serial casting and adapted equipment do the rest.
This phase is not a wait before surgery: many children reach good independence through therapy alone. The work parents do at home, guided by the team, counts as much as the sessions in clinic.
Surgical treatment
Surgery answers specific functional goals set with the family. One common principle in the upper limb: one elbow that bends to bring the hand to the mouth, and one that stays straight for hygiene and transfers — both arms do not need the same result.
Options include posterior release of the elbow with lengthening of the triceps, tendon transfers to restore active elbow bending, realignment of the wrist by osteotomy or tendon transfer, and release of the thumb held in the palm.
Recovery expectations
Recovery is long. Splinting and therapy continue for months and often years: surgery is one step in the programme, not its endpoint.
Gains are measured in tasks regained rather than in degrees. Follow-up continues throughout growth, because what a child needs changes with age and with school.
These pages give general information for patients and referring physicians. They do not replace an individual assessment: the treatment plan is decided in consultation, based on your examination and your goals.