Em , Judith G. A amioplasia tipo A exibe grave comprometimento dos quatro membros, aspecto facial arredondado narinas antevertidas, filtro nasal alto e micrognatia. No tipo B nota-se grave acometimento global dos membros superiores com o tronco e os membros inferiores normais. O tipo C exibe grave comprometimento dos membros inferiores, com o tronco e os membros superiores normais.
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Treatment[ edit ] The treatment of arthrogryposis includes occupational therapy , physical therapy , splinting and surgery. Since arthrogryposis includes many different types, the treatment varies between patients depending on the symptoms.
These surgeries are explained below. Passive enhancement[ edit ] There are a number of passive devices for enhancing limb movement, intended to be worn to aid movement and encourage muscular development. For example, the Wilmington Robotic Exoskeleton is a potential assistive device built on a back brace, shadowing the upper arm and forearm. It can be difficult to fit and heavy and awkward to wear. The garment looks like normal clothing but contains bundled steel wires under the arms, which help to push the arms toward a lifted position while allowing the wearer to move freely from that position.
On the dorsal side, at the level of the mid carpus , a wedge osteotomy is made. Sufficient bone is resected to at least be able to put the wrist in a neutral position. If the wrist is also ulnarly deviated, more bone can be taken from the radial side to correct this abnormality.
This position is held into place with two cross K-wires. In addition, a tendon transfer of the extensor carpi ulnaris to the extensor carpi radialis brevis may be performed to correct ulnar deviation or wrist extension weakness, or both. This tendon transfer is only used if the extensor carpi ulnaris appears to be functional enough. There is often an appearance of increased skin at the base of the index finger that is part of the deformity.
This tissue can be used to resurface the thumb-index web after a comprehensive release of all the tight structures to allow for a larger range of motion of the thumb. This technique is called the index rotation flap. The flap is taken from the radial side of the index finger. It is proximally based at the distal edge of the thumb-index web. The flap is made as wide as possible, but still small enough to close with the excessive skin on the palmar side of the index finger.
The flap is rotated around the tightest part of the thumb to the metacarpophalangeal joint of the thumb, allowing for a larger range of motion. Foot surgery may also be indicated to assist brace and orthosis fitting and hence promote supported standing.
The most common foot deformity in arthrogryposis is club feet or talipes equinovarus. In the early years of life the serial casting according to the Ponseti method usually yields good results. The Ponseti method can also be used as a first line treatment in older and more resistant cases. It is usually be accompanied by soft tissue surgery in the form of release of contracted tendon and capsular structures.
In older patients near skeletal maturity joint fusion or arthrodesis may be indicated as well. Similarly, congenital vertical talus is classically managed by serial casting according to the reversed Ponseti method. Resistant or recurrent cases may be offered an extensive soft tissue release.
However this is fraught with risk of foot stiffness and pain on the long term. Talectomy or excision of the talus to give room for creation of plantigrade foot has been practiced.
Naviculectomy or midtarsal resection arthroplasty represents a less invasive option with satisfactory short term results. The joint contractures that are present will not get worse than they are at the time of birth.
There is no way to completely resolve or cure AMC. But with proper treatment, most children make significant improvements in their range of motion and ability to move their limbs which enables them to do activities of daily life, and live relatively normal lives. Therapeutic interventions that are cornerstone in the treatment of AMC include: stretching and range of motion exercises, physical, occupational, and speech therapy, splinting and serial casting.
Surgical intervention may also improve joint mobility and function. Some authors say the overall prevalence is one in  and others say it is one in among European live births.
Abstract Objective: Review the literature and report a case of arthrogryposis multiplex congenital, emphasizing the importance of physiotherapy for children with AMC since there are few reports concerning the subject in the literature. Case Report: A seven year old black male infant was diagnosed to have arthrogryposis multiplex congenita with scoliosis, presenting with thorax and upper and lower limb severe deformities. He had normal intelligence and visual and hearing alterations were not observed. He received a physiotherapy treatment plan for one year and gains in the amplitude and functionality of his movements were observed. Comments: Physiotherapy enables patients with AMC to restore part of the musculoskeletal system mobility and flexibility. Keywords: Arthrogryposis Multiplex Congenital. Em 29 de agosto de o paciente foi institucionalizado.
O que é Artrogripose Múltipla Congênita (AMC)