Neonatal musculoskeletal syndrome in children symptoms causes and treatment

Arthrogryposis Multiplex Congenita (AMC) in Children is a congenital condition that affects the muscles and joints, limiting a child’s movement from birth. Although the deformities may seem alarming to parents, early diagnosis and proper treatment can significantly improve the child’s quality of life.In this article, we will discuss the causes of the syndrome, its symptoms, types, and treatment options including exercises, medications, and surgery. We will also provide practical tips for parents on how to support their child physically and emotionally.By following these steps, you can learn how to help your child achieve more natural movement, reduce complications, and improve daily life.

1️⃣ What is Arthrogryposis Multiplex Congenita (AMC)?

Arthrogryposis Multiplex Congenita is a condition in which a child is born with weak muscles and stiff joints, limiting natural movement and making daily activities difficult.

2️⃣ What Causes AMC?

Problems in the development of muscles or nerves during pregnancy.
Genetic factors and mutations that may be inherited from the parents.
Sometimes caused by reduced fetal movement or exposure to certain environmental factors during pregnancy.

3️⃣ How Do the Symptoms Appear?

Joint stiffness and difficulty moving the hands or legs from birth.
Muscle weakness and reduced strength.
Walking difficulties and sometimes limb deformities.

4️⃣ Can It Be Treated with Medication?

There is no medication that completely cures the condition.
Medications are used to relieve pain, treat muscle spasms, and support bones and muscles.

5️⃣ Is Surgery Needed?

In severe cases, the child may require surgery to straighten or stabilize joints and improve movement.

6️⃣ Is Exercise Therapy Useful?

Yes, exercises are an essential part of treatment to improve muscle strength, joint flexibility, and teach the child proper movement.

7️⃣ What is the Role of Physical Therapy?

Supports muscles and joints.
Improves balance.
Teaches the child proper positions for sitting and walking.

8️⃣ Can AMC Affect the Child’s Psychological or Social Development?

Yes, especially if the child feels different from peers.
Psychological support and appropriate activities are important to boost self-confidence.

9️⃣ How Can Parents Help?

Regular medical follow-up.
Adherence to physical therapy and daily exercises.
Use of supportive devices when needed.
Providing a healthy diet rich in calcium, vitamin D, and adequate protein.

Causes of AMC in Children

1️⃣ Muscle-Related Causes

Weak or underdeveloped muscles in the womb.
Some muscles may not form completely, leading to limited joint movement.

2️⃣ Nerve-Related Causes

Problems in the spinal cord or nerves that control muscles.
Weak nerve signals lead to joint stiffness and difficulty moving.

3️⃣ Genetic Causes

Genetic mutations or inherited syndromes passed from parents.
Affect muscles, nerves, or connective tissues.

4️⃣ Environmental Factors During Pregnancy

Reduced fetal movement due to placental problems or low amniotic fluid.
Maternal exposure to illnesses, medications, or environmental toxins during pregnancy.

5️⃣ Association with Other Conditions

Sometimes the syndrome appears alongside heart, urinary tract, or spinal deformities.

Symptoms of Arthrogryposis Multiplex Congenita (AMC) in Children

1️⃣ Joint Stiffness

Major joints such as shoulders, elbows, knees, or wrists are stiff and difficult to move.
Sometimes joints are abnormally bent or extended.

2️⃣ Muscle Weakness

Muscles around the joints are very weak, reducing mobility.
Difficulty raising arms, bending knees, or walking in older children.

3️⃣ Movement Difficulties

Walking or standing is challenging due to joint stiffness and muscle weakness.
Some children may need supportive devices or physical therapy to move.

4️⃣ Abnormal Limb Shape

Hands or feet may be deformed or curved (e.g., clubfoot or bent fingers).
Limb length may be shorter than normal in some cases.

5️⃣ Associated Problems

The syndrome may be linked with spinal, heart, or urinary tract deformities.
General growth may be affected due to limited mobility.

6️⃣ Other Signs in Some Children

Delay in fine motor skills such as grasping objects or writing.
Quick fatigue due to weak muscles.

Types of Arthrogryposis Multiplex Congenita

1️⃣ Classic AMC

Most common type.
Stiffness in large joints like shoulders, elbows, knees, and wrists.
Muscle weakness is evident and affects general movement.

2️⃣ Compound AMC

More complex, involving multiple joints.
May be associated with limb or spinal deformities.
Often requires intensive treatment.

3️⃣ Distal AMC

Limited to distal joints such as hands and feet.
Shoulder and knee movement is usually relatively normal.
Appears as bent or deformed fingers or feet.

4️⃣ Syndromic AMC

Associated with genetic syndromes or other deformities in the heart, urinary tract, or nervous system.
Requires comprehensive evaluation of all body systems.

5️⃣ Neuromuscular AMC

Results from problems in nerves or muscles during fetal development.
Leads to severe muscle weakness and limited movement from birth.

Stages of AMC in Children

1️⃣ Prenatal Stage (Fetus)

Reduced fetal movement in the womb may sometimes be seen on ultrasound.
Some muscles and joints may be malformed or underdeveloped.

2️⃣ Birth Stage

Joint stiffness is noticeable at birth.
Muscle weakness and limited hand or leg movement.
Sometimes limb or foot deformities are present.

3️⃣ Early Childhood (0 – 5 years)

Difficulty moving or walking if large joints are affected.
Requires follow-up with an orthopedic doctor and physical therapist to strengthen muscles.
Use of assistive devices like braces or supports to facilitate movement.

4️⃣ Middle Childhood (6 – 12 years)

Greater challenges in walking or performing daily activities due to joint stiffness.
Some children may need surgery to correct deformities or stabilize joints.
Continued physical therapy to support muscles and maintain mobility.

5️⃣ Adolescence and Young Adulthood

Final mobility depends on severity of the deformity and early treatment.
Psychological and social support is important to build confidence and adapt to physical differences.
Some cases may require ongoing monitoring or additional surgical intervention depending on growth.

Complications of AMC in Children

1️⃣ Motor and Skeletal Problems

Joint stiffness and difficulty moving hands or legs.
Weak muscles around joints, reducing mobility.
Difficulty walking or standing in older children.

2️⃣ Growth and Height Issues

Final height may be below normal in severe cases.
Affects balance while walking or performing daily activities.

3️⃣ Neurological Problems

Some cases involve nerve compression or spinal cord issues.
May cause weakness or numbness in limbs and difficulty with fine motor skills.

4️⃣ Respiratory or Heart Issues (in certain cases)

Chest or spinal deformities may affect lungs and heart.
Reduced ability to breathe normally and engage in physical activities.

5️⃣ Psychological and Social Complications

The child may feel different from peers due to body shape or movement limitations.
Exposure to bullying or embarrassment at school or social activities.

Psychological Impact on Parents

Continuous medical follow-up can create significant stress for families.

6️⃣ Rare and Severe Risks

In very severe cases, AMC may threaten life due to movement or breathing problems.
Some children may require urgent surgery to straighten or support joints.

Diagnosis of Arthrogryposis Multiplex Congenita in Children

1️⃣ Medical History and Clinical Examination

Observing joint stiffness and muscle weakness from birth.
Assessing joint movement and the range of bending or stretching.
Examining limbs, hands, and feet for any deformities.

2️⃣ Imaging Tests

X-ray: to evaluate bones and joint structure.
MRI: to examine muscles, nerves, and spinal cord.
Ultrasound (sometimes prenatal): to detect early joint stiffness before birth.

3️⃣ Genetic Testing

Identifies mutations or associated genetic syndromes.
Helps predict severity and possible involvement of other organs.

4️⃣ Motor Function Assessment

Evaluates walking ability, grasping objects, and fine motor skills.
Tracks muscle and joint development to determine the best treatment plan.

5️⃣ Specialist Consultation

Pediatric orthopedic doctor to monitor joint and bone growth.
Physical therapist to assess muscles and design a strengthening/exercise program.
In some cases, a surgeon for evaluation of surgical needs.

Medication Treatment for AMC in Children

Medications do not completely cure the deformity but help relieve symptoms and improve mobility, often used alongside physical therapy or surgery.

1️⃣ Pain Relievers

Reduce pain or stiffness in muscles and joints.
Examples: paracetamol or ibuprofen, as prescribed for the child’s age and dosage.

2️⃣ Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)

Reduce inflammation and swelling in muscles and joints.
Administered under medical supervision at child-appropriate doses.

3️⃣ Muscle Spasm Medications

Used when severe muscle spasms limit movement.
Helps improve joint flexibility and facilitate therapeutic exercises.

4️⃣ Bone and Muscle Support Supplements

Calcium and vitamin D to support bone growth and strength.
Protein and nutritional supplements to improve muscle growth and strength.

⚠️ Important Notes

Follow doctor’s instructions carefully to avoid complications.
Medication is part of a comprehensive plan including physical therapy and surgery if needed.
Medications improve quality of life and facilitate movement but do not cure the deformity.

Surgical Treatment for AMC in Children

Surgery is usually necessary in severe cases or when complications affect joint function.

1️⃣ Correction of Deformed Joints

Adjusting joint shape to improve movement and daily function.
May involve hands, feet, or large joints like knees and elbows.

2️⃣ Tendon and Muscle Release

In some cases, muscles or tendons are too short or tight, limiting movement.
Surgery helps lengthen tendons and muscles to improve mobility.

3️⃣ Joint Fusion (Arthrodesis)

Stabilizes joints that cannot be fully corrected to prevent pain or abnormal bends.
Helps children move with more stability and reduces complications as they grow.

4️⃣ Corrective Osteotomy for Hands or Feet

Cutting or adjusting bones to correct deformities and improve walking or grasping.

⚠️ Important Notes

Surgery is done after careful evaluation by a pediatric orthopedic specialist.
Some cases require long-term follow-up and physical therapy post-surgery.
Risks include bleeding, infection, or need for additional surgeries in the future.

Exercise Therapy for AMC in Children

Exercises are essential to support muscles and joints, improve mobility and flexibility, often used alongside medications or surgery.

1️⃣ Muscle Strengthening Exercises

Strengthen back, arm, and leg muscles to support joints and improve movement.
Helps maintain stability while walking or sitting.

2️⃣ Flexibility and Stretching Exercises

Increase joint flexibility to reduce stiffness.
Simple exercises for hands, feet, and arms gradually under a physical therapist’s guidance.

3️⃣ Postural Training

Teach proper positions while sitting or lying down.
Use pillows or braces to maintain correct joint alignment during sleep or sitting.

4️⃣ Hydrotherapy

Water-based exercises to reduce pressure on muscles and joints.
Allows children to move freely and safely strengthen muscles.

5️⃣ Use of Assistive Devices

Braces or supports to stabilize joints during movement.
Help reduce deformities and teach correct walking or sitting postures.

⚠️ Important Notes

Exercises must be supervised by a pediatric physical therapist.
Daily exercise adherence is crucial for optimal results.
In severe cases, physical therapy may be combined with surgery.

Tips for Managing AMC in Children

AMC requires continuous follow-up and multi-faceted support for children and parents.

1️⃣ Regular Medical Follow-Up

Periodic pediatric check-ups to monitor growth and joint development.
Consult an orthopedic or pediatric surgeon for any deformities or movement difficulties.
Imaging tests such as X-rays or MRI to assess joints and muscles.

2️⃣ Physical Therapy and Rehabilitation

Sessions to strengthen muscles around joints and improve balance.
Simple exercises under professional guidance to strengthen hands, feet, and arms.
Teach parents proper handling and positioning to reduce joint strain.

3️⃣ Use of Supportive Devices if Needed

Special braces or supports to stabilize joints during movement.
Help prevent worsening deformities and improve daily mobility.

4️⃣ Nutrition and Growth Support

Diet rich in calcium and vitamin D to support bone growth.
Adequate protein to strengthen muscles and support joints.

5️⃣ Monitoring Psychological and Social Development

Encourage play and age-appropriate activities to boost confidence.
Educate the family about psychological support to reduce stress and frustration.

6️⃣ Symptom Monitoring and Warning Signs

Watch for sudden pain or difficulty moving.
Track changes in joint shape or bends.
See a doctor immediately for severe symptoms like limb weakness or difficulty walking.

7️⃣ Surgical Intervention When Needed