DefinitionContractures 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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CausesContractures may be caused by abnormalities of the structures surrounding a joint. These include:
- Chronic inflammation
Risk FactorsFactors that may increase your risk of contractures include:
- Rheumatoid arthritis
- Tenosynovitis —inflammation of a tendon and its sheath
- Polio and other diseases of nerves and muscles
- Prolonged inactivity
SymptomsThe primary symptom is loss of motion in a joint. Pain can also be a major symptom.
DiagnosisThe 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 .
Physical TherapyMaintaining 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 SplintsCasts 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.
MedicationMedications 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 StimulationIn 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.
SurgerySurgery 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.
PreventionPrevention 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
American Academy of Physical Medicine and Rehabilitation
National Institute of Arthritis and Musculoskeletal and Skin Diseases
Canadian Centre for Occupational Health and Safety
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.
- Reviewer: Teresa Briedwell, DPT, OCS
- Review Date: 05/2014
- Update Date: 05/23/2014