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Verbruggen SW, Kainz B, Shelmerdine SC, Hajnal JV, Rutherford MA, Arthurs OJ, Phillips ATM, Nowlan NC. Stresses and strains on the human fetal skeleton during development. J R Soc Interface 2019; 15:rsif.2017.0593. [PMID: 29367236 PMCID: PMC5805961 DOI: 10.1098/rsif.2017.0593] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 12/18/2017] [Indexed: 01/11/2023] Open
Abstract
Mechanical forces generated by fetal kicks and movements result in stimulation of the fetal skeleton in the form of stress and strain. This stimulation is known to be critical for prenatal musculoskeletal development; indeed, abnormal or absent movements have been implicated in multiple congenital disorders. However, the mechanical stress and strain experienced by the developing human skeleton in utero have never before been characterized. Here, we quantify the biomechanics of fetal movements during the second half of gestation by modelling fetal movements captured using novel cine-magnetic resonance imaging technology. By tracking these movements, quantifying fetal kick and muscle forces, and applying them to three-dimensional geometries of the fetal skeleton, we test the hypothesis that stress and strain change over ontogeny. We find that fetal kick force increases significantly from 20 to 30 weeks' gestation, before decreasing towards term. However, stress and strain in the fetal skeleton rises significantly over the latter half of gestation. This increasing trend with gestational age is important because changes in fetal movement patterns in late pregnancy have been linked to poor fetal outcomes and musculoskeletal malformations. This research represents the first quantification of kick force and mechanical stress and strain due to fetal movements in the human skeleton in utero, thus advancing our understanding of the biomechanical environment of the uterus. Further, by revealing a potential link between fetal biomechanics and skeletal malformations, our work will stimulate future research in tissue engineering and mechanobiology.
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Affiliation(s)
| | - Bernhard Kainz
- Department of Computing, Imperial College London, London, UK
| | | | - Joseph V Hajnal
- Department of Biomedical Engineering & Centre for the Developing Brain, School of Biomedical Engineering and Imaging Science, Kings College London, London, UK
| | - Mary A Rutherford
- Department of Perinatal Imaging and Health & Centre for the Developing Brain, School of Biomedical Engineering and Imaging Science, Kings College London, London, UK
| | - Owen J Arthurs
- UCL Great Ormond Street Institute of Child Health, London, UK
| | - Andrew T M Phillips
- Department of Civil and Environmental Engineering, Imperial College London, London, UK
| | - Niamh C Nowlan
- Department of Bioengineering, Imperial College London, London, UK
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2
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Tonni G, Lituania M. Arthrogryposis multiplex congenita-like syndrome associated with median cleft lip and palates: first prenatally detected case. Congenit Anom (Kyoto) 2013; 53:137-40. [PMID: 23356520 DOI: 10.1111/j.1741-4520.2012.00388.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/04/2012] [Indexed: 11/26/2022]
Abstract
An early second-trimester prenatal ultrasound diagnosis of an arthrogryposis multiplex congenita-like syndrome associated with median clefts is reported. A molecular biological work-up was performed to search for a potentially overlapping syndrome and dysostosis. Autopsy and postmortem radiogram were performed to confirm the ultrasound diagnosis. Prenatal diagnosis enabled early detection of multiple fetal malformations, thus allowing early termination of pregnancy. Moreover, three-dimensional ultrasound with volume rendering in the maximum surface mode demonstrated its value in diagnosing oro-facial clefts, even at an early stage of fetal development.
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Affiliation(s)
- Gabriele Tonni
- Prenatal Diagnostic Center, Guastalla Civil Hospital, Reggio Emilia, Italy.
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Filges I, Hall JG. Failure to identify antenatal multiple congenital contractures and fetal akinesia - proposal of guidelines to improve diagnosis. Prenat Diagn 2013; 33:61-74. [DOI: 10.1002/pd.4011] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- Isabel Filges
- Department of Medical Genetics, BC Children's and Women's Hospital, Child and Family Research Institute; University of British Columbia; Vancouver Canada
- Division of Medical Genetics, University Children's Hospital and Department of Biomedicine; University of Basel; Basel Switzerland
| | - Judith G. Hall
- Department of Medical Genetics, BC Children's and Women's Hospital, Child and Family Research Institute; University of British Columbia; Vancouver Canada
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4
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Kalampokas E, Kalampokas T, Sofoudis C, Deligeoroglou E, Botsis D. Diagnosing arthrogryposis multiplex congenita: a review. ISRN OBSTETRICS AND GYNECOLOGY 2012; 2012:264918. [PMID: 23050160 PMCID: PMC3461621 DOI: 10.5402/2012/264918] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/05/2012] [Accepted: 08/26/2012] [Indexed: 11/23/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) refers either to a syndromic or to a nonsyndromic group of conditions with varied etiology and complex clinical features, including multiple congenital contractures in different body areas. Its etiology still remains unclear but generally any cause that leads to reduced fetal movement may lead to congenital contractures and in severe cases to fetal akinesia deformation sequence (FADS).
It affects approximately 1 in 2-3000 live births with an approximately equal gender ratio. There are many known subgroups of AMC differing in signs, symptoms, and causes. The primary diagnosis is made when a lack of mobility and an abnormal position is noted in routine ultrasound scanning. Early diagnosis, prenatal evaluation, and further surveillance via image scanning (ultrasound and MRI) give the opportunity for family counseling concerning neonatal morbidity and mortality and labor or delivery planning. Better understanding of the ultrasound findings and the etiology of this clinical situation offers the opportunity for careful prenatal assessment.
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Affiliation(s)
- Emmanouil Kalampokas
- Second Department of Obstetrics and Gynecology, Aretaieion University Hospital, University of Athens, 76 Vas. Sofias Avenue, 11528 Athens, Greece
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Dimitraki M, Tsikouras P, Bouchlariotou S, Dafopoulos A, Konstantou E, Liberis V. Prenatal assessment of arthrogryposis. A review of the literature. J Matern Fetal Neonatal Med 2010; 24:32-6. [DOI: 10.3109/14767058.2010.482615] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Navti OB, Kinning E, Vasudevan P, Barrow M, Porter H, Howarth E, Konje J, Khare M. Review of perinatal management of arthrogryposis at a large UK teaching hospital serving a multiethnic population. Prenat Diagn 2009; 30:49-56. [DOI: 10.1002/pd.2411] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Lin IW, Chueh HY, Chang SD, Cheng PJ. The Application of Three-dimensional Ultrasonography in the Prenatal Diagnosis of Arthrogryposis. Taiwan J Obstet Gynecol 2008; 47:75-8. [DOI: 10.1016/s1028-4559(08)60058-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jiang M, Bian C, Li X, Man X, Ge W, Han W, Bao H, Li Y, Yi D, Guan Y, Li J. Molecular prenatal diagnosis for hereditary distal arthrogryposis type 2B. Prenat Diagn 2007; 27:468-70. [PMID: 17380469 DOI: 10.1002/pd.1705] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Autosomal dominant distal arthrogryposes (DAs) are a group of muscle diseases characterized by congenital contractures of the limbs. Currently, prenatal diagnosis of DAs depends upon ultrasound examination during late gestation. Recently, five genes encoding fast switch proteins located at 9p13.2, 11p15.5 and 17q13.1 were identified. These included TPM2, TNNI2/TNNT3, and MYH3/MYH8. Last year, we discovered a novel heterozygous mutation c.523_525delAAG (p.K175del) in the TNNI2 gene, which encodes the isoform of troponinI, in a seven-generation Chinese family affected with distal arthrogryposis type 2B (DA2B). Here, we report the molecular prenatal diagnosis of 3 high-risk fetuses of two women in the family by two-point linkage inferential analysis and deletion detection of the TNNI2 gene with chorionic villus sampling (CVS) or amniocentesis. To our knowledge, this is the first description of molecular prenatal diagnosis for DAs.
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Affiliation(s)
- Miao Jiang
- Key Laboratory of Reproductive Health of Liaoning Province, Shenyang, China
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Witters I, Moerman P, Fryns JP. Fetal akinesia deformation sequence: a study of 30 consecutive in utero diagnoses. AMERICAN JOURNAL OF MEDICAL GENETICS 2002; 113:23-8. [PMID: 12400062 DOI: 10.1002/ajmg.10698] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The etiology of the fetal akinesia deformation sequence (FADS) is heterogeneous and can be the result of neurogenic and myopathic disorders, restrictive dermopathy, teratogen exposure, and intrauterine constraint. We present the prenatal and fetopathological findings in a consecutive series of 30 affected fetuses with normal chromosomal results. According to the in utero time of onset of the fetal akinesia, the severity of the phenotype varied from a severe, generalized FADS in the early-onset group to milder defects, as isolated distal arthrogryposis in the late-onset group. No more than 10% (3/30) were diagnosed in the first trimester of pregnancy and all presented a severe phenotype. Twenty-seven of the thirty (90%) were diagnosed after the first trimester, with a severe FADS in 15/27 and a milder phenotype of distal arthrogryposis in 12/27. In all 30 patients, extensive neuropathological studies (brain, spinal cord, and muscles) were performed. In 16 patients (53%) a specific diagnosis could be made (central nervous system abnormalities 9/16; spinal cord 1/16; primary myopathy 3/16; syndromic 3/16). In 10 others (33%), pathological neuromuscular findings were present but no definitive diagnosis was established. In 4 patients (13%), neuromuscular findings were normal, and the etiology of the FADS remained unexplained.
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Affiliation(s)
- Ingrid Witters
- Department of Obstetrics and Gynecology, University of Leuven, Belgium
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Bonilla-Musoles F, Machado LE, Osborne NG. Multiple congenital contractures (congenital multiple arthrogryposis). J Perinat Med 2002; 30:99-104. [PMID: 11933662 DOI: 10.1515/jpm.2002.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Arthrogryposis, is the occurrence of joint contractures of variable etiology that start prenatally. Arthrogryposis may result from neurologic deficit, neuromuscular disorders, connective tissue abnormalities, amniotic bands, [figure: see text] or fetal crowding. Arthrogryposis may result from no apparent hereditary causes (neuropathic, for example) or may be the result of hereditary factors (myopathic form, for example). Ultrasound diagnosis depends on observation of scant or absent motion of fetal extremities. Prognosis depends on the specific etiology of the contractures.
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11
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Abstract
Arthrogryposis is defined as multiple joint contractures, the aetiology of which is variable. Prenatal diagnosis has focused on diminshed fetal movement and detection of joint contractures on ultrasound. These findings usually do not become evident until 16 to 18 weeks of gestation. Although others (Baty, 1989; Hyett et al., 1997) have reported the diagnosis of arthrogryposis in the first and early second trimester by the presence of nuchal oedema, these reports have all focused on lethal conditions. We report on two female siblings with non-lethal arthrogryposis multiplex congenita. The diagnosis was suspected in the second pregnancy at 13.5 weeks when a large cystic hygroma was detected on ultrasound. Multiple joint contractures became evident at 18 weeks. We hypothesize that the aetiology may be secondary to delay in lymphatic maturation with development of a large cystic hygroma resulting in restriction of fetal movement during early joint formation. Further, the fact that the two female siblings had a similar pattern of facial and joint development, and that their parents are second cousins, suggests an autosomal recessive basis for this form of AMC.
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Affiliation(s)
- H Scott
- Department of Obstetrics and Gynaecology, IWK-Grace Health Centre, 5980 University Avenue, Halifax, Nova Scotia, Canada, B3H 4N1
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13
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Van Horn J, Rosenn BM. Sonographic Diagnosis of Arthrogryposis Multiplex Congenita. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1997. [DOI: 10.1177/875647939701300203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Athrogryposis multiplex congenita or congenital joitt contractures may result from any process that constricts intrauterine fetal movement. In this case rport, the join contractures were determined to be the result of amyolasia conenita, or absence of muscle formation. Because athrogryposis has no specific etiology, complete ultrasonic surveillance of fetal anatomy and the uterine cavity is required. In addition, because arthrogryposis is asociated with genetic disorders, the patient should be offered the option of genetic counseling and genetic amniocentesis.
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Affiliation(s)
- Jacqueline Van Horn
- Perinatal Treatment Center, University of Cincinnati, Cincinnati, Ohlio; University of Cincinnati Hospital Perinatal Center, PO Box 670754, Cincinnati, OH 452670754
| | - Barak M. Rosenn
- Perinatal Treatment Center, University of Cincinnati, Cincinnati, Ohlio
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Paluda SM, Comstock CH, Kirk JS, Lee W, Smith RS. The significance of ultrasonographically diagnosed fetal wrist position anomalies. Am J Obstet Gynecol 1996; 174:1834-7; discussion 1837-9. [PMID: 8678148 DOI: 10.1016/s0002-9378(96)70218-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE Our purpose was to determine the clinical significance of ultrasonographically diagnosed fetal wrist position anomalies. STUDY DESIGN The relationship of the fetal hand to the forearm was prospectively evaluated in all second- and third-trimester scans over a 5-year period. If an abnormal wrist position was detected, a targeted scan, including echocardiography, was performed. The outcomes of abnormal pregnancies were obtained. RESULTS An abnormal relationship of the hand to the forearm was found in 22 fetuses in 27,467 scans. Nine had a normal karyotype, and 13 had an abnormal karyotype. Among the nine with normal chromosomes, three had evidence of a movement disorder. Three with normal karyotypes are alive; two of these are the only normally functioning survivors. They had no other major anomalies and were shown prenatally to have normal movement of the limbs. CONCLUSIONS An abnormal fetal wrist position is associated with a high incidence of karyotype and movement abnormalities.
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Affiliation(s)
- S M Paluda
- Department of Obstetrics and Gynecology, William Beaumont Hospital, Royal Oak, Michigan 48073, USA
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Robbins-Furman P, Hecht JT, Rocklin M, Maklad N, Greenhaw G, Wilkins I. Prenatal diagnosis of Freeman-Sheldon syndrome (whistling face). Prenat Diagn 1995; 15:179-82. [PMID: 7784371 DOI: 10.1002/pd.1970150212] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The diagnosis of Freeman-Sheldon syndrome was made by ultrasonographic evaluation of a 20-week fetus with a positive family history. The ultrasonographic features were abnormalities of the extremities and mouth.
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Affiliation(s)
- P Robbins-Furman
- Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Texas Medical School, Houston, U.S.A
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Robinson YJ, Rouse GA, de Lange M. Sonographic Evaluation of Arthrogrypotic Conditions. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 1994. [DOI: 10.1177/875647939401000105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The term arthrogryposis is applied to a large group of conditions that result in joint contractures, abnormal positioning of hands or feet, and other neuromuscular defects. Abnormalities of the brain, spinal cord, peripheral nerves, muscles, or connective tissue lead to similar joint stiffness and contractures. Careful sonographic examination of an affected fetus can provide valuable information that will help in the assessment of diagnosis, prognosis, and risk of recurrence.
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Affiliation(s)
| | - Glenn A. Rouse
- Department of Diagnostic Ultrasound, Loma Linda University Medical Center, Loma Linda, California
| | - Marie de Lange
- Department of Diagnostic Ultrasound, Loma Linda Universitv Medical Center, 11234 Anderson Street, Loma Linda, CA 92354
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Bui TH, Lindholm H, Demir N, Thomassen P. Prenatal diagnosis of distal arthrogryposis type I by ultrasonography. Prenat Diagn 1992; 12:1047-53. [PMID: 1287640 DOI: 10.1002/pd.1970121211] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Two consecutive pregnancies in a woman with initially undiagnosed type I distal arthrogryposis (DA) are reported. A prenatal diagnosis of the condition was made by ultrasound in the 17th week of gestation in one of the pregnancies, whereas in the subsequent pregnancy the disorder was excluded as early as 13 weeks' gestation. The diagnoses were verified at birth. The feasibility of prenatal diagnosis of DA type I in the second trimester is thus confirmed and its possibility in the late first trimester is suggested.
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Affiliation(s)
- T H Bui
- Department of Clinical Genetics, Karolinska Hospital, Stockholm, Sweden
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Chitayat D, Hodgkinson KA, Blaichman S, Chen ME, Watters GV, Khalife S, Hall JG. Syndrome of mental retardation and distal arthrogryposis in sibs. AMERICAN JOURNAL OF MEDICAL GENETICS 1991; 41:49-51. [PMID: 1951463 DOI: 10.1002/ajmg.1320410114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Two sisters presented with a syndrome of characteristic facial anomalies and distal arthrogryposis. The older sister is now 4 years old and is severely mentally retarded. Her sister died of respiratory failure due to hypoplastic lungs shortly after birth. The occurrence of this potentially lethal syndrome in 2 sisters with unaffected parents suggests autosomal recessive inheritance.
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Affiliation(s)
- D Chitayat
- Department of Pediatrics, Montreal Children's Hospital, Quebec, Canada
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Moore CA, Weaver DD. Familial distal arthrogryposis with craniofacial abnormalities: a new subtype of type II? AMERICAN JOURNAL OF MEDICAL GENETICS 1989; 33:231-7. [PMID: 2764034 DOI: 10.1002/ajmg.1320330218] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report on 5 relatives in 3 generations with an apparent new type of distal arthrogryposis. These individuals have manifestations of type I distal arthrogryposis, but in addition, have craniofacial anomalies that include facial asymmetry, hypertelorism, downslanting palpebral fissures, high nasal bridge, malar hypoplasia, micrognathia, highly arched palate, notched chin, and posteriorly angulated ears. Their intelligence is normal. Although these manifestations preclude us from placing this family in the type I (isolated) distal arthrogryposis category, we also are unable to place them in any of the recognized subtypes of type II distal arthrogryposis. Thus, we think this family may have a previously undescribed form of autosomal dominant type II distal arthrogryposis.
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Affiliation(s)
- C A Moore
- Department of Medical Genetics, Indiana University School of Medicine, Indianopolis 46202
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