Occupational/Physical Therapy

• The initial evaluation and treatment for a child is performed by an experienced therapist. In some cases it may be possible to correct arthrogryposis to some degree with therapy alone.
• For example, newborns are often most affected at birth with contractures that might include hyper-extended knees, flexed hips, or clubfeet. Therapists can often achieve significant correction in the first six months of life followed by work on activities of daily living activities and walking.
• Therapy may include mobilization, casting, and splinting that would be ongoing in addition to any other treatments.

Casting / Splinting

• Casting and splinting is the primary treatment for wrists, hands, and clubfeet and is often the only treatment needed. It can be performed by me and/or therapists and may be utilized at all ages.

Psychosocial and Emotional Therapy

• Any physical disability can have an impact on body image and all children who have multiple surgical procedures require a strong support system in order to thrive. Having your family work with experienced psychologists, social workers and child life specialists is essential for an overall happy child.

Surgical Treatment

Soft Tissue Release

• Contractures are caused by shortened or abnormally tight soft tissue which prevents limbs from moving as they should. In soft tissue releases, contractures are relaxed by cutting the tight muscle, tendon, or ligament which allows the limb or extremity to move more freely.
• On some surgical procedures, we partner with a highly skilled (wound) plastic surgeon. We have been thrilled with the outstanding results of working in tandem on cases such as severe knee contractures with and without webbing (pterygium).

Tendon Transfer

• A tendon is a tough type of tissue which connects muscles to bones, keeps limbs in position, and plays an important role in the movement of body parts. Tendons may be moved from one part of the body to another to correct the positioning and/or enable movement of a limb.

Osteotomy

• Curved bones in many arthrogrypotic children can be corrected through casting but surgery may be required in cases that are complex or involve older children. An osteotomy is a surgical procedure where a curved or deformed bone is broken and reset. Internal pins or plates and screws are utilized and at times external frames called “fixators” are used to hold/guide the bone into the correct position and proper alignment.

Frames & Devices (Fixators)

• External frames (ex: Taylor Spatial Frame, Ilizarov Frame, etc.) consist of adjustable stainless-steel discs and rods that are affixed to bone and held in place by pins and struts. The tension of the wires can be adjusted to allow force to be distributed through the top and bottom discs of the frame. This relieves stress from the osteotomy site while the bone re-aligns and tissues in the limb are slowly stretched.

Growth Modulation

• Growth plates (physeal plates) are bits of cartilage that are present in children and adolescents. The plates are located at the ends of the long bones (ex: femur, tibia, etc) and create new bone tissue which determines the length of mature bones. Growth modulation is a minimally invasive procedure that temporarily alters the growth plate to allow bones to be straightened. We often use small metal plates which are shaped like an ‘8’ (8 plates) to gradually guide new bone growth during modulation.

Arthrogryposis is varied and challenging for the patient, family and care giver. Parents might feel discouraged and the situation may seem hopeless, but after treating many patients Dr. Feldman knows that we should never give up. While outcomes may vary and goals might change, Dr. Feldman's arthrogrypotic patients have been amongst the most personally rewarding patients to treat, as he has been able to see them grow over time and reach new functional milestones with treatment.