Contractures: Difference between revisions
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It can occur for various reasons including: | It can occur for various reasons including: | ||
* Upper motor neuron lesions, such as [[stroke]], head injury, or [[Cerebral Palsy Introduction|cerebral palsy]] | * Upper motor neuron lesions, such as [[stroke]], head injury, or [[Cerebral Palsy Introduction|cerebral palsy]] <ref name=":2" /> | ||
* Muscle | * Muscle diseases, such as [[Spinal Muscular Atrophy (SMA)|spinal muscular atrophy]] or [[Muscular Dystrophy|muscular dystrophy]] <ref name=":2" /> | ||
* After a prolonged period of immobility such as bed confinement in the intensive care unit | * After a prolonged period of immobility such as bed confinement in the intensive care unit <ref name=":1" /> | ||
Contractures are generally myogenic and can mimic cramps. Often described by patients as exertional muscle stiffness or muscle cramping after arbitrary movement such as lifting heavy objects for more than a few seconds or after repetitive movements. Stretching the affected muscle during a contracture does not provide relief, and contractures generally last longer than muscle cramps. Painful contractures are prominent in metabolic myopathies such as McArdle disease, glycogenosis type V.<ref name=":0">Dijkstra JN, Boon E, Kruijt N, Brusse E, Ramdas S, Jungbluth H, van Engelen BG, Walters J, Voermans NC. Muscle cramps and contractures: causes and treatment. Practical Neurology. 2023 Feb 1;23(1):23-34.</ref> <ref>Berardo A, DiMauro S, Hirano M. A diagnostic algorithm for metabolic myopathies. Current neurology and neuroscience reports. 2010 Mar;10:118-26.</ref> | Contractures are generally myogenic and can mimic cramps. Often described by patients as exertional muscle stiffness or muscle cramping after arbitrary movement such as lifting heavy objects for more than a few seconds or after repetitive movements. Stretching the affected muscle during a contracture does not provide relief, and contractures generally last longer than muscle cramps. Painful contractures are prominent in metabolic myopathies such as McArdle disease, and glycogenosis type V.<ref name=":0">Dijkstra JN, Boon E, Kruijt N, Brusse E, Ramdas S, Jungbluth H, van Engelen BG, Walters J, Voermans NC. Muscle cramps and contractures: causes and treatment. Practical Neurology. 2023 Feb 1;23(1):23-34.</ref> <ref>Berardo A, DiMauro S, Hirano M. A diagnostic algorithm for metabolic myopathies. Current neurology and neuroscience reports. 2010 Mar;10:118-26.</ref> | ||
== Arthrogenic Contracture == | == Arthrogenic Contracture == | ||
Arthrogenic contractures are characterised by prominent changes in [[bone]], [[cartilage]], and the joint capsule, usually along with pain. This can be seen in [[osteoarthritis]], systemic sclerosis, osteochondritis, and intra-articular fractures, due to the damage and/or tightening of [[Connective Tissue|connective tissue]]. <ref name=":1" /> | |||
' | As a type of arthrogenic contracture, capsular contracture is a complication of implant surgery, characterized by the development of fibrosis between the implant and tissue. It occurs because of the body's inflammatory response to the foreign object. <ref>Sood A, Xue EY, Sangiovanni C, Therattil PJ, Lee ES. [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5749369/ Breast massage, implant displacement, and prevention of capsular contracture after breast augmentation with implants: a review of the literature]. Eplasty. 2017;17.</ref> | ||
Posttraumatic joint contractures can fall under the arthrogenic contracture group as well. Multiple factors can lead to posttraumatic joint contractures: pain, prolonged joint positioning (immobility), adhesions, heterotopic bone formation, joint incongruity and periarticular connective tissue changes. <ref name=":3">Tecer D, Yaşar E, Adıgüzel E, Kesikburun S, Köroğlu Ö, Taşkaynatan MA, Özgül A, Tan AK. Which treatment protocol is better in rehabilitation of joint contracture. Gülhane. Tip Derg. 2020 Mar 1;62:14-20.</ref> | |||
== Soft Tissue Contractures == | == Soft Tissue Contractures == | ||
Soft tissue contractures, also named scar contractures, are the type of contractures in which the cutaneous, subcutaneous and, loose connective tissue around the joint is involved.<ref name=":1" /> This is a common sequelae of burns and open wounds. <ref name=":1" /><ref>Schouten HJ, Nieuwenhuis MK, van Baar ME, van der Schans CP, Niemeijer AS, van Zuijlen PP. The prevalence and development of burn scar contractures: a prospective multicenter cohort study. Burns. 2019 Jun 1;45(4):783-90.</ref> | |||
== Management of Contractures == | == Management of Contractures == | ||
Management options for joint contractures include passive stretching, splinting, application of serial plasters, joint mobilisation, injection of botulinum toxin, electrical stimulation, and surgical manipulations. <ref name=":3" /> | |||
Management options | |||
Nonsurgical treatment options for muscle contractures in individuals with neurologic disorders include stretch, shockwave therapy, physical activity, botulinum toxin (BTX) treatment, electrical stimulation, and robot-assisted rehabilitation interventions. <ref>Svane C, Nielsen JB, Lorentzen J. [https://www.sciencedirect.com/science/article/pii/S2590109521000045 Nonsurgical treatment options for muscle contractures in individuals with neurologic disorders: A systematic review with meta-analysis]. Archives of Rehabilitation Research and Clinical Translation. 2021 Mar 1;3(1):100104.</ref> | Nonsurgical treatment options for muscle contractures in individuals with neurologic disorders include stretch, shockwave therapy, physical activity, botulinum toxin (BTX) treatment, electrical stimulation, and robot-assisted rehabilitation interventions. <ref>Svane C, Nielsen JB, Lorentzen J. [https://www.sciencedirect.com/science/article/pii/S2590109521000045 Nonsurgical treatment options for muscle contractures in individuals with neurologic disorders: A systematic review with meta-analysis]. Archives of Rehabilitation Research and Clinical Translation. 2021 Mar 1;3(1):100104.</ref> | ||
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Introduction[edit | edit source]
Joint contractures are divided into three groups according to the underlying cause: myogenic, arthrogenic, and soft tissue contractures. [1]
Myogenic Contractures[edit | edit source]
Muscle contractures are defined as shortenings of the muscle resulting in an inability of the muscle to relax normally,[2] in extreme cases, joint deformation. [3] It can also cause considerable pain, strength loss, and muscle atrophy. [4][5]
It can occur for various reasons including:
- Upper motor neuron lesions, such as stroke, head injury, or cerebral palsy [3]
- Muscle diseases, such as spinal muscular atrophy or muscular dystrophy [3]
- After a prolonged period of immobility such as bed confinement in the intensive care unit [1]
Contractures are generally myogenic and can mimic cramps. Often described by patients as exertional muscle stiffness or muscle cramping after arbitrary movement such as lifting heavy objects for more than a few seconds or after repetitive movements. Stretching the affected muscle during a contracture does not provide relief, and contractures generally last longer than muscle cramps. Painful contractures are prominent in metabolic myopathies such as McArdle disease, and glycogenosis type V.[2] [6]
Arthrogenic Contracture[edit | edit source]
Arthrogenic contractures are characterised by prominent changes in bone, cartilage, and the joint capsule, usually along with pain. This can be seen in osteoarthritis, systemic sclerosis, osteochondritis, and intra-articular fractures, due to the damage and/or tightening of connective tissue. [1]
As a type of arthrogenic contracture, capsular contracture is a complication of implant surgery, characterized by the development of fibrosis between the implant and tissue. It occurs because of the body's inflammatory response to the foreign object. [7]
Posttraumatic joint contractures can fall under the arthrogenic contracture group as well. Multiple factors can lead to posttraumatic joint contractures: pain, prolonged joint positioning (immobility), adhesions, heterotopic bone formation, joint incongruity and periarticular connective tissue changes. [8]
Soft Tissue Contractures[edit | edit source]
Soft tissue contractures, also named scar contractures, are the type of contractures in which the cutaneous, subcutaneous and, loose connective tissue around the joint is involved.[1] This is a common sequelae of burns and open wounds. [1][9]
Management of Contractures[edit | edit source]
Management options for joint contractures include passive stretching, splinting, application of serial plasters, joint mobilisation, injection of botulinum toxin, electrical stimulation, and surgical manipulations. [8]
Nonsurgical treatment options for muscle contractures in individuals with neurologic disorders include stretch, shockwave therapy, physical activity, botulinum toxin (BTX) treatment, electrical stimulation, and robot-assisted rehabilitation interventions. [10]
Resources[edit | edit source]
- Dupuytren’s Contracture
- Volkmann's Contracture
- Contracture Management in Spinal Cord Injury
- Contracture Management for Traumatic Brain Injury
- Principles of Biomechanics in Hip Flexion Contracture
References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 1.4 Tariq H, Collins K, Tait D, Dunn J, Altaf S, Porter S. Factors associated with joint contractures in adults: a systematic review with narrative synthesis. Disability and Rehabilitation. 2023 May 22;45(11):1755-72.
- ↑ 2.0 2.1 Dijkstra JN, Boon E, Kruijt N, Brusse E, Ramdas S, Jungbluth H, van Engelen BG, Walters J, Voermans NC. Muscle cramps and contractures: causes and treatment. Practical Neurology. 2023 Feb 1;23(1):23-34.
- ↑ 3.0 3.1 3.2 Lieber RL, Fridén J. Muscle contracture and passive mechanics in cerebral palsy. Journal of applied physiology. 2019 May 16.
- ↑ Smith LR, Lee KS, Ward SR, Chambers HG, Lieber RL. Hamstring contractures in children with spastic cerebral palsy result from a stiffer extracellular matrix and increased in vivo sarcomere length. The Journal of physiology. 2011 May 15;589(10):2625-39.
- ↑ Lindsay S. Child and youth experiences and perspectives of cerebral palsy: a qualitative systematic review. Child: care, health and development. 2016 Mar;42(2):153-75.
- ↑ Berardo A, DiMauro S, Hirano M. A diagnostic algorithm for metabolic myopathies. Current neurology and neuroscience reports. 2010 Mar;10:118-26.
- ↑ Sood A, Xue EY, Sangiovanni C, Therattil PJ, Lee ES. Breast massage, implant displacement, and prevention of capsular contracture after breast augmentation with implants: a review of the literature. Eplasty. 2017;17.
- ↑ 8.0 8.1 Tecer D, Yaşar E, Adıgüzel E, Kesikburun S, Köroğlu Ö, Taşkaynatan MA, Özgül A, Tan AK. Which treatment protocol is better in rehabilitation of joint contracture. Gülhane. Tip Derg. 2020 Mar 1;62:14-20.
- ↑ Schouten HJ, Nieuwenhuis MK, van Baar ME, van der Schans CP, Niemeijer AS, van Zuijlen PP. The prevalence and development of burn scar contractures: a prospective multicenter cohort study. Burns. 2019 Jun 1;45(4):783-90.
- ↑ Svane C, Nielsen JB, Lorentzen J. Nonsurgical treatment options for muscle contractures in individuals with neurologic disorders: A systematic review with meta-analysis. Archives of Rehabilitation Research and Clinical Translation. 2021 Mar 1;3(1):100104.
