Improving arm function by prosthetic limb replacement in a patient with severe arthrogryposis multiplex congenita.

Abstract

In patients with severe bilateral congenital arm deficiencies, even simple activities of daily living, such as feeding, may be major challenges. We report here a case of a patient with arthrogryposis multiplex congenita affecting all 4 extremities, who underwent prosthetic replacement after elective transhumeral amputation of his right functionless arm. A 22-year-old man with arthrogryposis multiplex congenita had severe deficits of his upper limbs. Previous surgeries for upper and lower limbs had enabled this patient to walk without aids; however, his upper limbs remained severely impaired. After prosthetic rehabilitation, including nerve and muscle transfers, a carefully planned elective amputation, signal processing and a comprehensive rehabilitation programme, the patient was able to independently conduct normal activities of daily living that had hitherto been impossible. The Disabilities of the Arm, Shoulder and Hand measure improved from 73.3 to 44.2, the Action Research Arm Test improved from 10 to 18 out of 57 points and the Southampton Hand Assessment Procedure improved from 8 to 23 after prosthetic replacement. Prosthetic replacement can improve upper limb function in patients with severe congenital limb deficiencies. In the case reported here, functional rehabilitation had a positive impact on the patient's quality of life and self-confidence, as he integrated the prosthesis into his body image.