Arthrogryposis Multiplex Congenita (AMC) Flashcards

1
Q

AMC is NON-Progressive

A

NON-progressive****

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2
Q

What is AMC?

A

NON-progressive NMSK syndrome present @ birth

Characterized by severe jt contractures, mm weakness, fibrosis

Artwork 1700’s, addressed 1950’s

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3
Q

AMC Defined

A

Defined by presence of contractures in 2 or more body areas***

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4
Q

AMC Incidence/Etiology

A
  • Etiology unclear
  • Insult occurs First Trimester
  • MMs form normally→ replaced by fibrous fatty tissue during fetal dev.
  • Basic mechanism→ DECd fetal mvmt in-utero
    • 6 Primary reasons for lack of mvmt***
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5
Q

6 Causes of Decd Fetal Mvmt:

A
  1. Maternal illness
  2. Fetal Crowding→ twins, etc.
  3. Neuro defs
  4. Vascular compromise
  5. Connective tissue/skeletal defects
  6. MM defects
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6
Q

Dx of AMC

A
  • No definitive prenatal test or preventative measures*
  • Blood work, CVS, amniocentesis typ inconclusive
  • High-lvl US is MD suspects
  • Post-natally→ mm biopsy, blood work, clinical findings can R/O other dx
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7
Q

Dx of AMC

Dr. Polumbo said this about In-Utero

KNOW IT!!!

A

Lt-mod exercise

Deep Breathing

NO Caffeine

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8
Q

AMC Clinical Manifestations

A
  • Great variation, BUT gen. include:
    • Severe jt contractures, lack of mm dev. (Amyoplasia***)
  • Typ impacted body parts: in order MOST→LEAST
    • Foot (78-95%)
    • Hip (60-82%)
    • Wrist (43-81%)
    • Knee
    • Elbow
    • Shoulder
  • 2 Common Variations***
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9
Q

Two Main Types AMC:

A

Jackknifed vs. FrogLike

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10
Q

2 Main Types of AMC:

JACKKNIFED

*bold= also found in Froglike

A
  • Flexed/dislocated hips
  • Extd knees
  • Clubfeet* (equinovarus)
  • IR shoulders*
  • Flexed elbows
  • Flexed and ulnarly deviated wrists*
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11
Q

2 Main Types AMC:

FROGLIKE

bold*= also found in JACKKNIFED

A
  • ABD and ER hips
  • Flexed knees
  • Clubfeet* (equinovarus)
  • IR shoulders*
  • Extd Elbows
  • Flexed and Ulnarly deviated wrists*
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12
Q

JACKKNIFED vs. FROGLIKE

Only Differences

A
  • Jackknifed:
    • Flexed/disloc’d hips
    • Extd knees
    • Flexed elbows
  • FrogLike:
    • ABD/ER hips
    • Flexed knees
    • Extd elbows
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13
Q

JACKKNIFE VS FROGLIKE

Similarities:

A

Clubfeet* (equinovarus)

IR Shoulders*

Flexed and Ulnarly deviated wrists*

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14
Q

Medical Mgmt AMC:

Well-timed Sx mgmt

A
  • Well-timed Sx mgmt→ Limbs and Spine*
    • Foot sx gen. prolonged until child pulling sit→stand OR interested in standing
    • *Hip Dislocations:
      • U/L→ typ CORRECT
      • B/L→ typ DELAYED
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15
Q

Hip Dislocations and AMC and fix or leave alone

A
  • U/L→ typ CORRECT: bc prevent pelvic obliquity
  • B/L→ typ DELAY: bc if no pain or asymm→ better to keep moving and avoid sx
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16
Q

PT Exam in Infancy AMC:

A
  • Exam immediately following birth!
  • PROM: re-assess monthly
  • Strength→ observe mvmts and palpate mm contracts
  • Motor milestones→ delayed or skipped
    • Scooting is OK bc look @ jackknife or froglike→ very diff to get into crawling pos.
17
Q

PT Exam in Infancy AMC

Formal assessments used but reflect poorly bc strength and ROM limits preclude achievement of many motor milestones*

Some used:

A

AIMS, Bayley, PDMS-2, PEDI, WeeFIM

18
Q

PT Goals Infancy AMC

A
  • Max. strength and ROM
  • Enhance gen. sensorimotor dev.
  • Fam/parent edu.
  • Pos’ing for optimal functioning***
    • splints, casting, bracing
19
Q

Interventions Strategies Infancy

JackKnife positioning (see pics)

A
  • Stretch hip flexors and pos’ing in prone
    • able to sit IND by 15mos (normal is 6mos)
  • Scoot/rolling = primary means of mobility→ should be encouraged
  • Typ stand when placed
  • Usually attempt amb.
    • AFTER club foot sx w/ orthotics
20
Q

Intervention Strategies Infancy

FrogLegged Type

A
  • More pos’ing options, BUT do not tolerate prone well due to extended elbows
  • Towel roll/boppy pillow under chest→ assists w/ comfort
  • Pos’ing for hips in neutral align.
    • Towel roll on Lat aspects of LEs or velcro strap to maint. pos.
  • Tend to be slower to achieve rolling, but faster in attaining sitting/scooting
    • pos’s more eff/functional vs quadruped
21
Q

Intervention Strategies for Infancy AMC

Therapy focus on…

A
  • Therapy focus: Functional Skills
    • Rolling, sitting, hitching on butt, standing, ambulation
    • Goal→ maximize part. w/ peers
22
Q

Intervention Strategies Infancy

Strengthening:

A

Transitional mvmts and play

S/L can be functional

*Aquatic tx often recommended

23
Q

Intervention Strategies Infancy

Standing

A
  • Encouraged thru standing frames and orthotics
    • 6mos*** → should tolerate 2hrs

*Floor→stand and sit→stand emerge when amb begins

24
Q

Stretching and Splinting

“Young children respond most readily to conserative tx using serial splinting, freq stretching, proper pos’ing”→ Donohue

A
  • Parents/caregivers edu’d stretching Day 1
  • Stretching→ incorp into daily routine
  • Prolonged stretch→ serial splints or orthoses to hold in lengthened yet comfy pos.
25
Q

PT Exam Preschool-Adolescence

A
  • ROM closely monitored
  • Functional mm strength→ det’s bracing needed
    • test in total Arc of motion
  • Functional mobility/gait, balance, endurance
26
Q

PT Goals/Interventions Preschool-Adolescence

A
  • Reduce disability, stretching/night pos’ing contd
  • Enhance IND amb/mobility w/ minimal bracing/devices
    • Orthotics: least amt best but likely to start w/ more and gradual dec
    • AD choice
      • least restrictive best, environ changes to accommodate
27
Q

Intervention Strategies Preschool-Adolescence

Social/ADLs

A
  • Encourage social skill attainment
    • encourage part. w/ non-disabled peers→ confidence/social skills/cog
  • Team approach to IND w/ ADLs
    • adapted equip, toileting, dressing
28
Q

PT Considerations in Adolescence

What happens and what negative results they can have during this time

A
  • Time when child gains IND and parental monitor of contractures DECs==> Poor outcomes
  • Sx interventions for mgmt often postponed due to social schedule and HEP compliance plummets==> Further deformity
  • May need to introduce alt. mobility methods==> Decd confidence/self-worth
29
Q

Transition to Adulthood

A
  • Maint. ROM needed
    • orthoses contd for night pos’ing
    • stretching not as imperative 2* mature skeleton
  • Functional limits→ prev defs not addressed
  • Pain→ yrs of jt stress/damage
  • Job type/living situation bc these indivs are bright and cog. intact
30
Q

Take-Home Message AMC:

A
  • AMC is NON-progressive MSK disorder that impacts ROM, alignment, strength and functional mobility
  • Thru correct medical/therapeutic intervention deficits can be mediated and 2* impairments limited