Orthopedic findings in arthrogryposis and congenital Zika syndrome: A case series

Abstract

Background Congenital arthrogryposis (CA) consists of congenital joint contractures that affect at least two joints in different parts of the body. Approximately, 80% of CA cases are neurogenic, with changes to the formation, structure or functioning of the central and/or peripheral nervous systems. Most abnormalities are triggered either by motoneurons decreased activation in the corticospinal tract or by direct motoneurons injury. There had been few reports in the literature correlating congenital infection in humans with arthrogryposis until 2015. CA has recently been described associated with congenital Zika syndrome (CZS). Methods The objective of this study was to investigate and describe accurately the arthrogrypotic alterations in infants diagnosed with CZS and thus, suggest a possible pattern of orthopedic impairment. A total of 198 medical records of infants with CZS were evaluated. According to inclusion and exclusion criteria, 17 infants were included in the present study. Arthrogrypotic joints were orthopedically evaluated in four segments: right, left, upper, and lower limbs. All the four segments were assessed independently. Results Flexed wrists were the most frequently observed manifestation, associated with ulnar deviation (35.29%). Deformities were also commonly found in the third and fourth fingers (64.70%). Hip dislocation was found in 58.82% of the patients and talipes equinovarus and equinovalgus ankles were found in 29.41 and 23.52%. Conclusion There was a particular pattern of joint impairment related to CZS and arthogrypotic alterations of infants evaluated in this study.

Case Report: Multiorgan Involvement with Congenital Zika Syndrome

“…1 Arthrogryposis, one of the most limiting extracranial conditions, involves multiple joint contractures, and its association with CZS has been described with flexed wrists as the most common finding. 18 Other manifestations include talipes equinovarus (clubfoot), valgus deviation, and bilateral rotation of the lower limbs, and hip dislocation. 18 Physical therapy is recommended to improve postural control and mobility, 19 and has been suggested to improve this patient's clubfoot and angulation of the extremities.…”

“…18 Other manifestations include talipes equinovarus (clubfoot), valgus deviation, and bilateral rotation of the lower limbs, and hip dislocation. 18 Physical therapy is recommended to improve postural control and mobility, 19 and has been suggested to improve this patient's clubfoot and angulation of the extremities.…”

Covid-19 and Upper Limb Anomalies in Newborns: A Reason for Concern?

“…Unfortunately, the authors did not describe the results of orthopedic treatment for these patients. Serpa et al 26 described the arthrogrypotic alterations in 17 infants diagnosed with CZS. It was noted that the upper limbs' proximal segments were less affected, with a compromised concentration in the distal region of the upper limbs.…”

Hip Dysplasia in Congenital Zika Syndrome: A 5 Year Follow-Up

“…The occurrence of painful hip dislocation is directly related to the severity of neurological involvement and the child's ambulatory status [2]. Many studies reported that children with CZS presented a higher incidence of hip dislocation and hip dysplasia [3][4][5]. Authors have noted that hips may begin to displace as early as 18 months of age; therefore, it is advisable that the hips should be examined radiologically malformations of cortical development and calcification of the cortical-subcortical junction.…”