Charles Goldfarb, MD, the author of this blog, is an orthopedic hand surgeon at Washington University in St. Louis specializing in congenital hand and upper extremity disorders. He practices at St Louis Childrens Hospital and Shriners Hospital for Children in St Louis, Missouri. This blog was created to demystify abnormalities of the hand and wrist that children may experience from the time of birth. We encourage comments and feedback.
Tuesday, November 11, 2014
Arthrogryposis: Arm position and elbow flexion
Kids with arthrogryposis are smart and are able to figure out how to accomplish many of life's tasks despite their functional limitations. We, as surgeons, can sometimes help children with arthrogryposis by releasing and/ or repositioning tight joints. We cannot make the arms or hands normal but little changes can make for big improvements.
It is always amazing for me to watch kids with arthrogryposis figure out the best way to accomplish a task. Furthermore, different kids almost always figure out the same way to do these maneuvers. These tricks are not taught but are highly effective ways to get the job done. Below is one example. Watch this child with arthrogryposis:
1) use his back to swing his arm into flexion and prop it onto the table
2) then use the table to further flex the elbow
3) Finally he bends his neck forward to allow his hand to reach his mouth
And he makes it look so easy! I thank his family for allowing me to post this video.
Many children have stiff elbows. Surgery to release the stiff elbow and allow elbow flexion (even without a muscle to power the elbow flexion) can make a big functional difference in a child's life. One of the most impactful scientific articles on arthrogryposis treatment was on this Topic. Straight elbows are tough as you simply cannot get your hand to your mouth!
The other interesting thing about this child with arthrogryposis is the fact that his arm is internally rotated. Look at his right arm especially- the hand is pointed backwards because the shoulder is rotated in. While he can adjust to this position somewhat, it can make grabbing and functioning a bit harder. See our previous Post on this topic. If you look again at the video above, when he swings his arm up onto the table, the hand is pointing backwards and he has to shift it around so that he can use it on the table.