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Arthrogryposis multiplex congenita


Other Names for this Disease

  • AMC
  • Amyoplasia congenita
  • Arthrogryposis
  • Arthromyodysplasia congenita
  • Congenital amyoplasia
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.

Your Question

My daughter was born with GuĂ©rin-Stern syndrome, now more commonly known as arthrogryposis multiplex congenita or arthrogryposis. I would like information about this condition, as well as resources for group discussions, medical research, and specialists in the field.

Our Answer

We have identified the following information that we hope you find helpful. If you still have questions, please contact us.

What is arthrogryposis multiplex congenita?

Arthrogryposis multiplex congenita (AMC) refers to the development of multiple joint contractures affecting two or more areas of the body prior to birth. A contracture occurs when a joint becomes permanently fixed in a bent or straightened position, which can impact the function and range of motion of the joint and may lead to muscle atrophy. AMC is not a specific diagnosis, but rather a physical symptom that can be associated with many different medical conditions. It is suspected that AMC is related to decreased fetal movement during development which can have a variety of different causes, including environmental factors (i.e. maternal illness, limited space), single gene changes (autosomal dominant, autosomal recessive, X-linked), chromosomal abnormalities and various syndromes. Treatment varies based on the signs and symptoms found in each person, but may include physical therapy, removable splints, exercise, and/or surgery.[1][2]
Last updated: 1/12/2015

What are the signs and symptoms of arthrogryposis multiplex congenita?

Arthrogryposis multiplex congenita (AMC) refers to the development of multiple joint contractures affecting two or more areas of the body prior to birth. A contracture occurs when a joint becomes permanently fixed in a bent or straightened position, which can impact the function and range of motion of the joint.[2][1] In some cases, only a few joints are affected and the range of motion may be nearly normal. In people who are severely affected, every joint in the body can be involved, including the jaw and back.[3] Muscles of affected limbs may be atrophied or underdeveloped. Soft tissue webbing may develop over the affected joint.[2][1]

AMC is not a specific diagnosis, but rather a physical symptom that can be found in many different medical conditions. The signs and symptoms associated with AMC can, therefore, vary greatly in range and severity depending on the underlying condition.[2][1]
Last updated: 1/12/2015

What causes arthrogryposis multiplex congenita?

The exact cause of arthrogryposis multiplex congenita (AMC) is not fully understood. AMC is thought to be related to decreased fetal movement during development, which can occur for a variety of reasons.[1][2] When a joint is not moved for a period of time, extra connective tissue may grow around it, fixing it in place. Lack of joint movement also means that tendons connected to the joint are not stretched to their normal length, which can make normal joint movement difficult.[3]

In general, there are four causes for decreased fetal movement before birth:[3]

  1. Abnormal development of muscles. In most cases, the specific cause for this cannot be identified. Suspected causes include muscle diseases, maternal fever during pregnancy, and viruses which may damage the cells that transmit nerve impulses to the muscles.
  2. Insufficient room in the uterus for normal movement. For example, multiple fetuses may be present, the mother may lack normal amounts of amniotic fluid or there may be uterine structural abnormalities.
  3. Malformations of the central nervous system (the brain and/or spinal cord). In these cases, arthrogryposis is usually accompanied by a wide range of other symptoms.
  4. Tendons, bones, joints or joint linings may develop abnormally. For example, tendons may not be connected to the proper place in a joint.

AMC can be a component of numerous condition caused by environmental factors, single gene changes (autosomal dominant, autosomal recessive, X-linked), chromosomal abnormalities and various syndromes.[1]
Last updated: 1/13/2015

Is arthrogryposis multiplex congenita inherited?

Arthrogryposis multiplex congenita (AMC) is not inherited in most cases; however, a genetic cause can be identified in about 30% of affected people. It can be a component of many different genetic conditions, including those caused by a single gene change or a chromosomal abnormality, such as trisomy 18. Genetic conditions sometimes associated with AMC include some connective tissue disorders; muscle disorders such as muscular dystrophies or congenital myopathies; and certain mitochondrial disorders.[2] Depending on the underlying genetic cause, it may be inherited in an autosomal recessive, autosomal dominant or X-linked manner. Some cases are thought to have multifactorial inheritance, which means that both genetic and environmental factors may play a role in causing the condition.[1]
Last updated: 1/13/2015

How might arthrogryposis multiplex congenita be treated?

The treatment of arthrogryposis multiplex congenita (AMC) varies based on the signs and symptoms present in each person and the severity of the condition. Early in life, physical therapy to stretch contractures can improve the range of motion of affected joints and prevent muscle atrophy. Splits can also be used in combination with these stretching exercises. For most types of arthrogryposis, physical and occupational therapy have proven very beneficial in improving muscle strength and increasing the range of motion of affected joints.[3][1][2]

Some patients, however, have persistent functional difficulties despite a rigorous physical therapy regimen. In these cases, surgery may be recommended to achieve better positioning and increase the range of motion in certain joints. Rarely, tendon transfers have been done to improve muscle function.[3][1][2]
Last updated: 1/13/2015

What is the long-term outlook for people with arthrogryposis multiplex congenita?

The long-term outlook (prognosis) for people with arthrogryposis multiplex congenita (AMC) depends on the severity of the condition, the underlying cause, and the affected person's response to therapy. The degree to which muscles and joints are affected varies significantly from person to person. AMC can be associated with a variety of conditions that are each characterized by unique symptoms.[3][1]

In general, many people affected by AMC have a good prognosis. With physical therapy and other available treatments, substantial improvement in joint function and mobility is normally possible. Most people with AMC are of normal intelligence and are able to lead productive, independent lives as adults.[3][1]
Last updated: 1/13/2015

How can I find physicians who specialize in arthrogryposis multiplex congenita?

Since arthrogryposis multiplex congenita is a relatively rare group of conditions, few therapists or doctors have dealt with very many cases. Therefore, it is advisable to contact doctors and therapists in treatment centers where a large number of patients with this condition have been seen.[3] AVENUES, a national support group for arthrogryposis multiplex congenita, lists several treatment centers which are staffed by medical professionals with experience treating individuals with arthrogryposis multiplex congenita. Click here for the location of treatment centers near you.

Last updated: 1/14/2015

Where can I connect with other people who have family members with arthrogryposis multiplex congenita? 

AVENUES, a national support group for arthrogryposis multiplex congenita, offers many opportunities for families interested in networking, including local support groups with a directory of families interested in corresponding with others, and a pen-pal list for young correspondents. We encourage you to visit the following web page or contact AVENUES directly to learn more about these opportunites. 

AVENUES
P.O. Box 5192
Sonora CA 95370
Email: info@avenuesforamc.com
Web: http://www.avenuesforamc.com

To find other organizations that provide general or condition-specific support for arthrogryposis multiplex congenita, please click here.
Last updated: 1/14/2015

References
Other Names for this Disease
  • AMC
  • Amyoplasia congenita
  • Arthrogryposis
  • Arthromyodysplasia congenita
  • Congenital amyoplasia
See Disclaimer regarding information on this site. Some links on this page may take you to organizations outside of the National Institutes of Health.