TREATMENT OF ARTHROGRYPOSIS

The basic aim of treatment for arthrogryposis is to provide the best possible quality of life for the patient; to facilitate movement in the surroundings, to enable the patient to function independently in daily life, and at later stages of treatment to take an active part in social life due to being able to function without the constant assistance of others. To achieve this, it is necessary from the earliest stages to begin therapeutic procedures aiming to increase the flexibility of the joints and increase movement range by strengthening the muscles which still function and by correcting the deformations which interfere with everyday life.

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SURGICAL TREATMENT OF UPPER LIMBS

The upper limbs should be understood as a functional whole whose purpose (as is the purpose of treatment) is to ensure the ability of the patient to take care of themselves and to use communication devices (telephone, computer, pen) or transportation supports (crutches, walker, wheelchair, vehicle). As in the case of the lower limbs, it is crucial to begin conservative treatment of contractures of the upper limbs at the newborn stage and in early infancy. 

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TREATMENT OF LOWER LIMBS

The lower limbs of children suffering from AMC are usually affected by intense spasms and,  apart from a regular programme of rehabilitation and the use of orthoses, often require surgical intervention, sometimes multiple interventions. Most often, surgical intervention is required in cases of dislocation of the hips, contractures of the knees, and deformations of the feet. The primary aim of treatment of lower limbs is to restore the child's ability to maintain an upright position and the ability to walk.

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TREATMENT OF FOOT DEFORMATION IN ARTHROGRYPOSIS

Often, among as many as 98% of children suffering from amyoplasia and 70% of children with arthrogryposis generally speaking, the patient suffers from talipes equinovarus, commonly known as clubfoot. Considerably less commonly, congenital vertical talus, commonly known as rocker bottom foot, is also seen, more commonly so in cases of distal arthrogryposis. Occasionally, isolated clubfoot is encountered (among about 1% of sufferers), as are metatarsus adductus, commonly known as pigeon toe, equinovalgus and calcaneovalgus. The aim of treatment of foot deformations is to restore the child's ability to maintain an upright position and the ability to walk without pain.

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TREATMENT OF SPINAL DEFORMATION

As curvature of the spine is common among patients suffering from arthrogryposis, it is necessary to regularly monitor the state of the patient's spine right from the beginning of treatment. In cases of moderate deformation, rehabilitation therapy should be undertaken; with some patients, a therapeutic custom-fitted back brace is useful, occasionally with the use of a general anaesthetic in the target position or with the use of a stretching table.  The early appearance of curvature of the spine, hip dysplasia, and lumbar hyperlordosis (excessive forward bending of the spine) is a factor which presents a risk due to the sometimes rapid progression of these conditions, and is an indication for the application of surgical treatment, including in the case of small children, with whom a so-called growing rod is used to maintain the correct position of the spine while simultaneously allowing it to grow. It is considerably more difficult to correct curvature of the spine in children suffering from AMC than in other cases, such as idiopathic curvatures, and thus more kinds of complications may arise.

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REHABILITATION IN ARTHROGRYPOSIS

Rehabilitation, including orthopaedic surgery and individual orthopaedic supply,  is an integral part of a comprehensive treatment plan for children with arthrogryposis. The main aim of rehabilitation, in conjunction with surgical treatment, is to a large degree to assist the sufferer in achieving independent mobility. Surgical treatment creates conditions for the proper functioning of joint mechanics and proprioception, or the sense of one's own body position and movements. By using these processes in rehabilitation, physiotherapists train the patient in new motion tasks or aid in restoring proper functionality (including walking, conducting manual operations etc.).

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