Contractures

(Contracture Deformity)

Definition

Contractures refer to the permanent tightening of nonbony tissues, such as muscles, tendons, ligaments, or skin. It results in a loss of motion in the affected joints.Contracture is different from spasticity, but they are often related. Spasticity is an abnormal increase in muscle tone, which can worsen the development of contractures.
Contracture Deformity of the Hand
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Causes

Contractures may be caused by abnormalities of the structures surrounding a joint. These include:
  • Deformity
  • Immobility
  • Injury
  • Chronic inflammation
Certain disorders that affect nerves and muscles almost always lead to contractures. For example:Contractures are often also associated with spasticity resulting from injuries to the central nervous system, such as stroke or brain injury.

Risk Factors

Factors that may increase your risk of contractures include:

Symptoms

The primary symptom is loss of motion in a joint. Pain can also be a major symptom.

Diagnosis

The doctor will ask about your symptoms and medical history. Your joints will be examined for restricted movement and range of motion. Images may be taken of your bodily structures. This can be done with x-rays .

Treatment

Treatment includes:

Physical Therapy

Maintaining and improving range of motion is important. Ultrasound is often used for large joint contractures. Physical therapy helps to increase mobility, joint elasticity, and muscle strength. Some people also benefit from therapeutic massage.

Casts or Splints

Casts or splints help stretch the soft tissues surrounding the affected joint and can keep them in a more functional position. This method is often used when contractures are caused by nerve injury or immobility. Casts need to be changed regularly to reassess the joint position and avoid skin breakdown.

Medication

Medications to treat spasticity may help in the rehabilitation of contractures. This includes the use of botox and oral anti-spasm medications.

Nerve Blocks and Electrical Stimulation

In cases of severe spasticity, nerves to the affected muscles can be temporarily numbed with anesthetics. Alternatively, opposing muscles can be electrically stimulated. These actions can change the balance of forces across a joint. This therapy is often done with casting.

Surgery

Surgery may be necessary to release affected tendons, ligaments, and joints. This may be done for severe cases or for contractures that do not respond to other treatments.

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Prevention

Prevention of contractures depends on the cause. After acute injuries or orthopedic surgery, contractures may be prevented by:
  • Early movement
  • Physical therapy
  • Continuous passive motion (CPM) machines, which mechanically keep joints in motion
Aggressive medical treatment of inflammatory conditions such as rheumatoid arthritis may also delay or prevent contractures.

RESOURCES

American Academy of Physical Medicine and Rehabilitation
http://www.aapmr.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases
http://www.niams.nih.gov

CANADIAN RESOURCES

Canadian Centre for Occupational Health and Safety
http://www.ccohs.ca

Orthogate
http://www.orthogate.org

References

Fergusson D, Hutton B, et al. The epidemiology of major joint contractures: a systematic review of the literature. Clinical Orthopaedics & Related Research. 2007:456:22-299.

Huckstep RL. Management of neglected joint contractures. Clinical Orthopaedics & Related Research. 456:58-64, 2007 Mar.

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