Arthrogryposis multiplex congenita involving the upper extremity can be associated with significant contractures of major joints. Treatment options to maximize upper extremity motion and function include passive joint stretching, serial casting, or surgical intervention. This study reviewed all patients at Carrie Tingley Hospital with arthrogrypotic wrist flexion contractures treated with passive stretching, serial casting, and custom wrist orthotics to determine the effect on wrist position and function. Seventeen infant patients with distal and classic arthrogryposis used this regimen. Average follow-up was 6 years. The greatest gain in wrist motion occurred after the first casting session for both groups. Patients with distal arthrogryposis had the largest improvement in passive wrist motion, were more functionally independent at final follow-up, and had no recurrence of deformity. Patients with classic arthrogryposis had rigid wrist flexion contractures and a 75% incidence of deformity recurrence after casting. At final follow-up, these patients remained functionally dependent, requiring >50% assistance with activities of daily living, and had less improvement in wrist motion. The authors recommend early casting of infant wrist deformities for both forms of arthrogryposis. If the wrist deformity recurs, repeat serial casting is unlikely to improve wrist extension. Other treatment options may be considered in the older child.
Study conducted at Carrie Tingley Hospital, Albuquerque, New Mexico, U.S.A.
From the *Department of Orthopaedics & Rehabilitation, University of New Mexico School of Medicine, Albuquerque; and †Carrie Tingley Hospital, University of New Mexico Health Sciences Center, and the Department of Orthopaedics and Pediatrics, University of New Mexico School of Medicine, Albuquerque, New Mexico, U.S.A.
Address correspondence and reprint requests to Dr. James C. Drennan, Carrie Tingley Hospital, 1127 University Boulevard, NE, Albuquerque, NM 87102, U.S.A.