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Arthrogryposis (Arthrogryposis Multiplex Congenita) is a muscle disorder that causes multiple joint contractures at birth. A contracture is a limitation in the range of motion of a joint. It is non-progressive. more...

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In some cases, few joints may be affected and the range of motion may be nearly normal. In the "classic" case of arthrogryposis, hands, wrists, elbows, shoulders, hips, feet and knees are affected. In the most severe cases, nearly every body joint may be involved, including the jaw and back. Frequently, the contractures are accompanied by muscle weakness, which further limits movement. Arthrogryposis is relatively rare, occurring in approximately one in 3,000 births. The majority of affected individuals survive but a minority die, usually due to respiratory muscle involvement.

In most cases, arthrogryposis is not a genetic condition and does not occur more than once in a family. In about 30% of the cases, a genetic cause can be identified. The risk of recurrence for these cases varies with the type of genetic disorder.

Research has shown that anything that prevents normal joint movement before birth can result in joint contractures. The joint itself may be normal. However, when a joint is not moved for a period of time, extra connective tissue tends to grow around it, fixing it in position. Lack of joint movement also means that tendons connecting to the joint are not stretched to their normal length; short tendons, in turn, make normal joint movement difficult. (This same kind of problem can develop after birth in joints that are immobilized for long periods of time in casts.)

In general, the causes can be classified into extrinsic and intrinsic factors:


  • There is insufficient room in the uterus for normal movement. For example, foetal crowding; the mother may lack a normal amount of amniotic fluid or have an abnormally shaped uterus.


  • Musculoskeletal/Neuromuscular - Muscles do not develop properly (atrophy). In most cases, the specific cause for muscular atrophy cannot be identified. Suspected causes include muscle diseases (for example, congenital muscular dystrophies), maternal fever during pregnancy, and viruses, which may damage cells that transmit nerve impulses to the muscles.
  • Neurological - Central nervous system and spinal cord are malformed. In these cases, a wide range of other conditions usually accompanies arthrogryposis.
  • Connective Tissue - Tendons, bones, joints or joint linings may develop abnormally. For example, tendons may not be connected to the proper place in a joint.


This usually consists of individually tailored orthopaedic correction of deformities.

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Wheels welcome
From Dance Magazine, 10/1/05 by Jessie Male

On a brightly-lit stage, members of Axis Dance Company climb on one another like mountaineers, scaling each other's wheelchairs as they pull their bodies upward. Feet replace hands and elbows lock with knees. Forming a tableau of mutual support, they are wheeled towards the audience as though part of a slow-moving wave. They are performing Ann Carlson's Flesh, a work created for the company. Carlson, a postmodern choreographer, looked to the dancers for inspiration. "They are purveyors of a new world of radical physicality," she says.

Mixed-ability companies--where disabled and able-bodied performers dance together--are not a means of rehabilitation. Dancing Wheels, Infinity Dance Theater, Joint Forces, Spitzer Dance Company, and Axis are part of a growing trend where wheelchairs and crutches expand choreographic possibilities. "For years critics and audience members were unable to make the distinction between performance quality and movement therapy," explains Judy Smith, co-founder of Oakland, California-based Axis. Viewers' perceptions began to shift once companies started commissioning work. Postmodern choreographers Stephen Petronio, Bill T. Jones, and Victoria Marks have all set pieces on mixed ability companies in the last few years. Davis Robertson of the Joffery Ballet choreographed a trio oil Axis dancers Nadia Adame, who was injured in a car accident and uses a cane, and Jacques Poulin-Denis, who lost his right foot in an auto accident. Completing the cast was Mikhail Baryshnikov.

When Mary Fletcher, who has the debilitating syndrome spina bifida, began Dancing Wheels in Cleveland 25 years ago, it was impossible to find studio space. A decade ago, Kitty Lunn, artistic director of New York's Infinity Dance Theater, was refused admittance to ballet class after she suffered a spinal cord injury that left her paralyzed from the mid-hips down. Prior to her accident, she had been a soloist in The Washington Ballet. And a decade ago, Alex Spitzer, a wheelchair dancer with the congenital muscle and joint disorder arthrogryposis, had to fight for the opportunity to attend the American College Dance Festival.

Today there are more than 30 groups, many that evolved from workshops and classes given by pioneers like Fletcher, Smith, and Lunn. This has led to a wealth of opportunity for established and upcoming choreographers to work with disabled dancers. Recently Fletcher has sought them out. When her company could no longer sustain an artistic director, she began acquiring and commissioning work from choreographers like Rosalind Newman, Young Park, and the late Homer Avila. "Nine new and very diverse pieces in a single season," she says proudly. "We have all become better dancers because of it."

This burst of choreographic exploration has been showcased at international festivals and conferences, drawing fresh attention to mixed-ability companies. "We turned the city into a performance playground," says Elena Widder of Very Special Arts, of the mixed-ability festival held in the summer of 2004 in Washington, D.C. Unsuspecting spectators included commuting congressmen emerging from their trains at Union Station, and patrons of the Smithsonian. At the Kennedy Center, Brazil's Pulsar Cia de Danca opened the event. Dancers, some wheelchair bound and others without disabilities, enveloped themselves in sheer colored fabrics, covering their faces. With feet flexed and hands protruding from the fabric, dancers' limbs were indistinguishable from each other. As the dancers broke through like butterflies from a chrysalis, the fabric hung from them limply, like some remnant of an earlier life stage.

The movement exploration involved in wheelchair dance attracts many different choreographers. Peter Pucci's collaboration with Kitty Lunn, In Time Like Air, garnered strong reviews when it debuted in 2001. Pucci created the sequences by renting a wheelchair, going into the studio and working with it before showing any movement to Lunn. "The way he approached it helped me to transpose Peter's movement to how my body and my chair move," Lunn says. "It was Peter who first got me to stand up. I never thought of trying, but I eventually found my balance." The result is a work that incorporates the wheelchair as thoroughly as the dancer. Surrounded by a small circle of light, Lunn stands behind it, supported by the handlebars. She drops to the floor and pushes it, allowing the wheelchair to twist and turn as if it has a mind of its own. Her chair becomes a 12-pound partner in a duet and an extension of her body.

Wheels off Fortune by Alito Alessi, a veteran of contact improvisation, is a witty duet with longtime dance partner Emery Blackwell, who has cerebral palsy. Blackwell rolls head first from his chair onto Alessi's curved back before landing on the floor. Alessi slides under the oversized wheels of the chair and crawls to the other side of the stage. "Excuse me," Blackwell calls out. "Excuse me," he repeats. "What?" Alessi responds as the audience laughs, partially from nervousness and partially from relief. "My chair. I'd like to have my chair back."

With new choreographic impetus and more venues, physically integrated companies are gradually gaining the visibility they desire. Where does the next obstacle lie? "Training. Training. Training," says Kitty Lunn, who requires all members of her company to study ballet and other techniques for seven years. "I cannot emphasize it enough." In mixed-ability companies, some performers lack any professional training or experience. For that to change, there needs to be a broad availability of movement workshops and classes open to dancers of all ages and abilities.

David Nau has performed with Dancing Wheels for five years. He had been working for the Cleveland Contractors Union when his car hit a deer and he incurred a spinal chord injury. Months later, after meeting a woman who also used a wheelchair, he followed her to an integrated ballet class. Eventually, she stopped coming, but he stayed.

"Dance keeps the mind exercised. This is 90 percent mental," he says. "I'm still a member of the Contractor's Union but I am also a member of a dance company. I never thought I would be a dancer. But look at me now."

And the question still remains: Will a Bill T. Jones piece performed by members of Axis Dance be seen with the same eyes as a Bill T. Jones piece performed by his company? When the audiences cheer or cry, are they responding to the choreography or to the presence of dancers who use wheelchairs? Can one critique the choreography while seeing past the disability?

Citing Carlson's piece, Time Out: NY dance critic Gia Kourlas feels it's not possible to separate the two. "Ann's piece put it out there for the audience. It dispelled any buried stereotypes they might have had. Some of the dancers are in wheelchairs--so what? There is still the same intensity. There is still the same honesty. I don't think it's possible to disregard the disability and I don't know if it would be positive."

Alex Spitzer disagrees. "For me the next step is the elimination of the mixed-ability terminology. I want to be viewed as a dancer, not as a disabled dancer." When directing members of Spitzer Dance Company, which is made up of abled dancers, Spitzer's muscular impairment means he cannot physically show a combination, but he can describe it. Spitzer also expects the end result to be judged by the same artistic standards as a choreographer who doesn't use a wheelchair. "I always felt I was just a dancer, and over time the audience sees me that way," he says. "If you say you're different, people see you as that."

Yet the disability is there, if not in the presence of a crutch or a wheelchair, then embodied in the performers. "My disability informs all aspects of my life. But I have to dance," Lunn says. "I don't personally feel we need to make a piece about the disability."

For Judy Smith of Axis, however, it is an opportunity to bring the art form to a wider audience. Asked if it is possible to disregard the disability, she replies, "If we try to be just a dance company, we are missing a vital aspect of our work. There are people who would never see a dance concert, but come because we are part of the disabled community."

That's the case for Lunn as well. During a curtain call after a performance at New York's Joyce SoHo Theater, there is a standing ovation. A man in the second row signs "Thank you, thank you." A mother takes the hands of her son with cerebral palsy and brings his palms together.

And at another New York venue, four members of Dancing Wheels turn the stage into a painter's palette in splattered costumes. Performing Young Park's State of Mind, Jenita McGowan extends her arm upwards as she strategically balances on Charlotte Heppner's handlebars. Liz Flynn slips down David Nau's torso until her wrists wrap around his footrests. The music escalates as chairs tilt at gravity-defying angles. The audience watches transfixed. Slight murmuring rises above the music and after each of the five pieces, the applause grows a little bit louder.


Axis Dance

Oakland, CA

Bethune Theatredanse/Infinite Dreams

Los Angeles, CA

CandoCo Dance Company

London, U.K.

Dance Detour

Chicago, IL

Dancing Wheels

Cleveland, OH

DanceAble at the Florida Dance Festival

Miami, FL

Full Radius Dance

Atlanta, GA

Infinity Dance Theater

New York, NY

Joint Forces Dance

Company/DanceAbility Project

Eugene, OR

Karen Peterson & Dancers Inc.

Miami, FL

Light Motion

Seattle, WA

Spitzer Dance Company

Atlanta, GA

Tokounou Dance Company

New York, NY

Touch Compass Dance Trust

Auckland, New Zealand

COPYRIGHT 2005 Dance Magazine, Inc.
COPYRIGHT 2005 Gale Group

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