What is arthrogryposis?


A child with contractures that bend their fingers, hand and wrist.

Arthrogryposis (arth-ro-grip-OH-sis) means a child is born with contractures. This means some of their joints don’t move much and may even be stuck in 1 position. Often the muscles around these joints are thin, weak, stiff or missing. Extra tissue may have formed around the joints, holding them in place.  

Most contractures happen in the arms and the legs. They can also happen in the jaw and the spine. 

Arthrogryposis can happen on its own, or it may be linked with other conditions. For example, it can be a feature of . Children with arthrogryposis sometimes have other health problems, such as problems with their nervous system, muscles, heart, kidneys or other organs, or differences in how their limbs, skull or face formed. 

This condition is also called arthrogryposis multiplex congenita. “Arthrogryposis” means the joints are curved or crooked. “Multiplex” means it affects more than 1 joint. “Congenita” means the condition is present at birth. 

  • What to expect

    Each child with arthrogryposis is different. In some children, the condition is mild. It affects only a few joints, and these joints have almost as much movement as is typical. In other children, the condition is more serious. It affects more joints and restricts their movement more. In extreme cases, arthrogryposis affects nearly every joint. 

    Arthrogryposis does not get worse over time. For most children, treatment can lead to big improvements in how they can move and what they can do. 

    Most children with arthrogryposis have typical thinking and language skills. Most have a normal life span. Most lead independent, fulfilling lives as adults. However, some need lifelong help with daily activities. Some walk, and others use a wheelchair.

  • What causes arthrogryposis

    The main cause of arthrogryposis is fetal akinesia. This means the baby does not move around inside the womb as much as is typical. Starting in early pregnancy, moving helps a baby’s joints, muscles and develop. If a baby doesn’t move much, these parts may not develop well. Extra tissue may form in the joints, making movement harder. 

    There are many reasons why fetal akinesia might happen, including: 

    • Nerve signals don’t reach the baby’s muscles because of problems with the baby’s . 
    • There isn’t enough room inside the womb for the baby to move. This may happen if the womb is not the typical shape or if leaks out of the womb (oligohydramnios). 
    • The baby’s muscles don’t form in the typical way and are weak, or their tendons, bones or joints don’t form typically. 

    Fetal akinesia usually has nothing to do with what the parents did or did not do before or during pregnancy. 

    About 1 baby in 3,000 is born with arthrogryposis. 

    Most families who have a child with arthrogryposis are not at greater risk for having another child with it. In about 1 in 3 children with this condition, doctors do find a cause. The families of these children may be at greater risk. Your child’s doctor can explain what this means for your family. 

Why choose Seattle Children’s for arthrogryposis treatment?

Seattle Children’s arthrogryposis team has extensive experience treating arthrogryposis in children. We work as a team to evaluate your child’s abilities and recommend a plan to help your child become as active as possible. We use the latest methods to increase your child’s range of motion, muscle strength and skills. 

If your newborn is critically ill with nervous system problems related to arthrogryposis, we provide specialized care in our Neuro NICU — the only neonatal program in Washington, Wyoming, Alaska, Montana and Idaho. 

  • The experts you need are here
    • The arthrogryposis team includes doctors, surgeons, , , therapists, and other experts from Rehabilitation Medicine, Orthopedics, Genetics, Occupational Therapy, Physical Therapy, Nutrition, Social Work and Child Life. 
    • We can successfully treat arthrogryposis in many children with physical and occupational therapy, sometimes along with splints and casts. We have the largest team of and in the Pacific Northwest who specialize in the care of babies, children, teens and young adults. We also have onsite orthotists to build and fit splints and casts for our young patients.  
    • If your child needs surgery, our pediatric orthopedic surgeons know how to plan the order of their surgeries to get the best results for your child. Many of the surgeons have expanded fellowship training in areas such as foot and ankle conditions, hip problems, upper extremity surgery, limb deformity, neuromuscular diseases and spine problems. 
    • The doctors at Seattle Children’s who give your child are board certified in pediatric anesthesiology. This means they have extra years of training in how to give anesthesia to children safely. They know how to handle special issues, such as how to a child who has problems with their jaw or airway. 
    • Arthrogryposis and the conditions it may be linked with can affect more than a child’s muscles and joints. That’s why we connect you and your family with any expert your child may need across Seattle Children’s. For example, specialists in may be involved in your child’s care. 
  • Care from before birth through young adulthood
    • For some families, our work begins even before their baby is born. If a prenatal (before birth) suggests that your developing baby may have arthrogryposis, we work with Seattle Children’s Fetal Care and Treatment Center. Together, our experts provide diagnostic and counseling services to you and your family. 
    • We specialize in caring for kids. This means our experts have the knowledge, training and skills to treat the youngest patients through young adults. We have treated many children of all ages with arthrogryposis. At Seattle Children’s, your child’s team has special training in the medical, surgical, emotional and social needs of young people. 
    • Babies, children and teens are still developing, so they may need different care than adults do, like treatment that takes their into account. When we evaluate your child’s condition, design their treatment and provide their care, we carefully consider their growth. We think about how growth may affect your child’s joints and movement over time. We also consider how their arthrogryposis may affect the rest of their development and health. 
    • As your child grows, we adapt their treatment to meet their changing needs. Along the way, we consider all aspects of what your child and family need to thrive — from learning practical skills for daily life to coping with feelings.  
    • If your child needs imaging that uses radiation, we use the lowest amount possible (PDF) to make the best image. We have a low-dose radiation X-ray machine, called the EOS. It makes safer full-body images. We also have the largest group of  pediatric radiologists in the Northwest.
  • Support for you and your family
    • The team at Seattle Children’s helps connect you with other families of children with arthrogryposis if you want. We also have a yearly arthrogryposis get-together for families.
    • We know it can be stressful to have a child with arthrogryposis and to find the treatment they need. Everyone at Seattle Children’s works to make your experience here as easy as we can on your whole family.
    • Your child’s team does more than plan and provide care for your child. We also make sure you and your child understand your child’s condition and treatment options.
    • Seattle Children’s supports your family with a range of resources. OurChild Life specialists, Family Resource Center and Guest Services are here to help
  • Research to improve care
    • Seattle Children’s takes part in the CoULD Registry for upper limb differences. A registry is a place where researchers keep information about people who have a certain condition so they can learn more about it. CoULD connects researchers from children’s hospitals around the country to study treatments and improve life for kids born with arms and hands that aren’t typical.  
    • Learn more about current orthopedics research at Seattle Children’s. 

What are the symptoms of arthrogryposis?

Children with arthrogryposis are born with joints that have limited movement or are stuck in 1 position (contractures). They may also have:

  • Thin, weak (atrophied), stiff or missing muscles
  • Stiff joints due to extra tissue (fibrosis or fibrous ankylosis)
  • Differences in the skin around their joints, such as webbing

There’s a wide range of how children are affected, from mild (few contractures with nearly normal movement) to serious (many contractures with little or no movement).

Arthrogryposis may be a feature of other, more complex conditions. Your child may have other problems in these areas:

  • Nervous system
  • Muscles
  • Heart
  • Kidneys or other organs
  • How their limbs, skull or face formed

How is arthrogryposis diagnosed?

If the doctor thinks your child has arthrogryposis, they will examine your child carefully. During the exam, the doctor looks for details about how your child formed and how their joints are affected. The doctor also checks for problems with other body systems to tell whether your child has a more complex condition.

  • Diagnostic tests

    To get more information, your child may need 1 or more tests, such as these: 

    • X-ray to check their bones and joints
    • Ultrasound to check their (CNS) and organs 
    • CT (computed tomography) scan to check their bones
    • MRI (magnetic resonance imaging) scan to check their CNS or muscles
    • Muscle biopsy to see if their muscle fibers are typical
    • Skin biopsy or blood tests to check their for anything that is not typical 
    • (EMG/NCV) studies to tell if a problem with their nervous system or muscles is the cause and to tell how quickly signals travel along their nerves  

    Genetic tests can tell your doctor more about some forms of arthrogryposis, so your child’s team may suggest these tests, too.

  • Diagnosis before birth

    Sometimes doctors can diagnose arthrogryposis based on what they see during an ultrasound before a baby is born (prenatally). If this happens, talk with your healthcare team about what they can tell from the ultrasound and what it may mean for you and your baby. Our team at Seattle Children’s is here to provide prenatal consultations to talk with you about your baby’s condition.

How is arthrogryposis treated?  

The main goal of treatment for arthrogryposis is to help your child’s joints move as well as possible. This means improving their flexibility, their strength and the way their bones line up. For your child’s lower body, the focus is on working with their feet and legs so they may be able to stand and walk. For their upper body, the focus is on working with their hands and arms so they may be able to do more things on their own. 

Along with this, your child’s healthcare team — and your family — will do activities to build your child’s skills. No matter how much or how little your child’s joints move, most likely they will be able to do a lot for themselves, if they are taught how.

Nonsurgical Treatment for Arthrogryposis

Physical therapy and occupational therapy are the main treatments for arthrogryposis. Your child’s therapy will be tailored to their needs and abilities. Therapy starts right after birth. Parents and caregivers play an important role by doing daily therapy at home. 

As your child grows, their muscles, tendons and other around their joints might not lengthen at the same rate. This can cause contractures to come back. Most likely your child will need ongoing therapy to deal with issues like this as they grow. 

  • Physical therapy

    Physical therapists (PTs) use stretches and exercises to increase your child’s range of motion and muscle strength so they can move better. 

    PTs also work with your child to improve their gross motor skills. This includes finding ways for your child to roll, sit, crawl, stand, walk and play. 

    If a wheelchair, walker or other device might help your child be more mobile, PTs suggest these devices and teach your child how to use them. 

  • Occupational therapy

    Occupational therapists (OTs) teach your child skills to take care of themselves (such as how to eat and how to get dressed) and ways to move around (such as how to get out of a chair and how to use crutches). 

    They also work with your child to develop fine motor skills, such as writing. 

    Many tools (adaptive devices) may help your child do things on their own. OTs suggest these tools and teach your child how to use them. OTs also make customized splints and adaptive devices. 

  • Splints and casts

    Splints and casts are rigid supports that go around a joint to hold it in place. PTs and OTs use splints and casts as part of therapy. These supports can help line up your child’s bones so your child can move better. Splints and casts also help keep joints stretched, and they can improve or prevent contractures. 

    Your child may need different splints or casts at different times. Some splints are worn only at night. Often children go through a series of splints or casts that are changed as their range of motion changes. Your child’s team will teach you how to work with splints and casts during daily activities, such as doing your child’s therapy exercises at home or getting your child dressed. 

    Our OTs make splints and casts for the arms and hands. Our orthotists make them for the legs and feet.

  • Other types of care

    Arthrogryposis affects each child in different ways, so your child may need other types of care, too. For example, some children need speech therapy. This could help them learn to speak more clearly if their muscles used for speech are weak or if the feeling inside their mouth is not typical. Some children need a gastrostomy tube or a tracheotomy if jaw, mouth or throat problems make it hard for them to eat or breathe. Some families work with a dietitian to make sure their child gets good nutrition. Your child’s team will put together a complete plan based on your child’s needs.

Surgery for Arthrogryposis 

Your child’s team may also recommend surgery. In most cases, surgery is done after a child improves as much as possible with physical and occupational therapy. Often it’s done when the child is older. But it may be done at any age based on what your child needs. 

Children with arthrogryposis need an expert team for surgery. Their surgeons must know how to plan the order of their surgeries to get the best results. Their must know how to handle special issues, such as how to a child who has problems with their jaw or airway.  

Types of surgery for arthrogryposis include: 

  • Surgery to cut into or through bone (osteotomy) to improve how joints line up. Surgeons may shorten or lengthen a bone or change its position. 
  • Surgery to lengthen or release muscles or tendons that prevent a joint from moving well. 
  • Surgery to cut through a (capsulotomy) if the capsule restricts movement. 
  • Surgery for scoliosis, clubfoot or hip dysplasia. 

Your child’s team will talk with you about the benefits and risks of surgery and what results to expect.

Contact Us

Contact Orthopedics and Sports Medicine at 206-987-2109 for an appointment, a second opinion or more information.

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