Sunday, September 22, 2019

Distal arthrogryposis, before and after

Distal arthrogryposis is very different from AMC or other forms of arthrogryposis.  By definition, distal arthrogryposis includes joint tightness (contractures) in the hands and feet.  Here is an excellent Link from NIH.  I have also previous posted on distal arthrogryposis, those links can be found HERE.

I wanted to share some early results on a 5 year old patient with distal arthrogryposis.  This patient had surgery 3 months ago on his right hand and is planned for surgery on the left.  There were two goals with surgery- free the tight thumb while placing it in a better position for function AND releasing the tight middle finger (camptodactyly).  This patient is helpful as an example because the surgically treated right hand previously looked almost exactly like the left hand looks today. 
Distal arthrogryposis, right hand, after surgery.  Note the position of the thumb and middle finger.

Distal arthrogryposis, left hand, before surgery.  Note the tight thumb and middle finger.

These two videos emphasize the same points on distal arthrogryposis of the right hand after surgery and the left hand before surgery.  I apologize for my video skills (trying to multitask) but the improved positioning on the right is striking while recognizing that the hand still has limitations.




The family is very pleased and have noticed functional improvements already. Surgery included
1) Flap to deepen thumb- index web space with release of contracture
2) Stabilization of thumb MCP joint
3) Release of tight PIP joint of middle finger
4) Flap to release tight PIP joint

Charles A. Goldfarb, MD              
My Bio at Washington University     
email: congenitalhand@wustl.edu

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