Management of upper limb problems in arthrogryposis.

The management of upper limb problems in arthrogryposis multiplex congenita (AMC) is described on the basis of the author's own experience gained from the care of a large number of affected children. Emphasis is placed on evaluation of the disability by repeated testing and observation. In many cases, the deformities will be accepted and improvements in function will be gained by orthoses or attention to details of seating, dressing, and toileting. Surgery is indicated in some cases, especially at the elbow, to obtain mobility, flexor power, or both. Arthrodesing the wrist is also useful in some cases. When surgery is indicated, it is often desirable to rearrange all three levels--shoulder, elbow, and wrist.