Contractures: Difference between revisions
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== Introduction == | == Introduction == | ||
Joint contractures | Joint contractures is referred to as a limitation in passive joint [[Range of Motion|range of motion]] (PROM), occur due to structural changes in [[Connective Tissue|connective tissues]] around the joint(s). These changes restrict the joint's ability to move through its full [[Range of Motion|range of motion]] (ROM). Both intra-articular tissues ([[bone]], [[cartilage]], capsules) and extra-articular tissues ([[Muscle|muscles]], [[Tendon Anatomy|tendons]], skin) can impede joint movement. The specific type of connective tissue involved in restricting joint movement determines the contracture type, though pinpointing a single source of joint restriction is often challenging.<ref name=":1">Tariq H, Collins K, Tait D, Dunn J, Altaf S, Porter S. [https://www.tandfonline.com/doi/full/10.1080/09638288.2022.2071480 Factors associated with joint contractures in adults: a systematic review with narrative synthesis]. Disability and Rehabilitation. 2023 May 22;45(11):1755-72.</ref> | ||
There are three distinct types of joint contractures, each based on the specific underlying tissue involved: | |||
# Myogenic contractures. | |||
# Arthrogenic contractures. | |||
# Soft tissue contractures. | |||
== Myogenic Contractures == | == Myogenic Contractures == | ||
Muscle contractures are defined as shortenings | Muscle contractures are defined as muscle shortenings resulting in the muscle's inability to relax normally,<ref name=":0" /> in extreme cases, joint deformation. <ref name=":2">Lieber RL, Fridén J. [https://journals.physiology.org/doi/full/10.1152/japplphysiol.00278.2018?rfr_dat=cr_pub%20%200pubmed&url_ver=Z39.88-2003&rfr_id=ori%3Arid%3Acrossref.org&utm_source=TrendMD&utm_medium=cpc&utm_campaign=Journal_of_Applied_Physiology_TrendMD_1 Muscle contracture and passive mechanics in cerebral palsy]. Journal of applied physiology. 2019 May 16.</ref> It can also cause considerable pain, strength loss, and muscle atrophy. <ref>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.</ref><ref>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.</ref> | ||
It can occur for various reasons including: | It can occur for various reasons including: | ||
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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> | 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 | == Arthrogenic Contractures == | ||
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" /> | 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> | 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> | 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|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 == | ||
[[File:Complications of Hypertrophic Scarring.png|thumb|181x181px|Burn Contracture]] | [[File:Complications of Hypertrophic Scarring.png|thumb|181x181px|Burn Contracture]] | ||
Soft tissue contractures, also called scar contractures, involve the cutaneous, subcutaneous, and loose connective tissue around the joint. 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> | Soft tissue contractures, also called scar contractures, involve the cutaneous, subcutaneous, and loose [[Connective Tissue|connective tissue]] around the joint. This is a common sequelae of [[Burns Overview|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> | ||
Soft tissue contractures can have a traumatic origin, such as burns, fractures, dislocations, spinal cord injuries, traumatic brain injuries, or surgical procedures. They may also result from nontraumatic sources, such as congenital limb abnormalities, inflammatory arthritis, infection, or recurrent hemarthroses experienced by patients with hemophilia.<ref>Graves BR. [https://www.jisakos.com/article/S2059-7754(23)00581-3/pdf The examination and treatment of soft tissue contracture of the elbow.] J ISAKOS [Internet]. 2024;9(1):98–102.</ref> | |||
Soft tissue contractures can have a traumatic origin, such as [[Burns Overview|burns]], fractures, dislocations, [[Spinal Cord Injury|spinal cord injuries]], [[Traumatic Brain Injury|traumatic brain injuries]], or surgical procedures. They may also result from nontraumatic sources, such as congenital limb abnormalities, inflammatory [[arthritis]], infection, or recurrent hemarthroses experienced by patients with [[hemophilia]].<ref>Graves BR. [https://www.jisakos.com/article/S2059-7754(23)00581-3/pdf The examination and treatment of soft tissue contracture of the elbow.] J ISAKOS [Internet]. 2024;9(1):98–102.</ref> | |||
== Management of Contractures == | == Management of Contractures == | ||
[[File:Cord.jpg|thumb|Dupuyten's contracture]] | [[File:Cord.jpg|thumb|Dupuyten's contracture|241x241px]] | ||
Management options for joint contractures include passive stretching, splinting, application of serial plasters, joint | Management options for joint contractures include passive stretching, splinting, application of serial plasters, joint mobilization, injection of [[Botulinum Toxin in Therapy|botulinum toxin]], electrical stimulation, and surgical manipulations. <ref name=":3" /> | ||
Nonsurgical treatment options for muscle contractures in individuals with neurologic disorders include stretch, shockwave therapy, [[Physical Activity|physical activity]], botulinum toxin 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|physical activity]], botulinum toxin 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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<references /> | <references /> | ||
[[Category:Musculoskeletal/Orthopaedics]] | |||
[[Category:Muscles]] | |||
[[Category:Burns]] | |||
Revision as of 00:22, 27 June 2024
Original Editor - Habibu Salisu Badamasi
Top Contributors - Sehriban Ozmen, Habibu Salisu Badamasi and Pacifique Dusabeyezu
Introduction[edit | edit source]
Joint contractures is referred to as a limitation in passive joint range of motion (PROM), occur due to structural changes in connective tissues around the joint(s). These changes restrict the joint's ability to move through its full range of motion (ROM). Both intra-articular tissues (bone, cartilage, capsules) and extra-articular tissues (muscles, tendons, skin) can impede joint movement. The specific type of connective tissue involved in restricting joint movement determines the contracture type, though pinpointing a single source of joint restriction is often challenging.[1]
There are three distinct types of joint contractures, each based on the specific underlying tissue involved:
- Myogenic contractures.
- Arthrogenic contractures.
- Soft tissue contractures.
Myogenic Contractures[edit | edit source]
Muscle contractures are defined as muscle shortenings resulting in the muscle's inability 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 Contractures[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 called scar contractures, involve the cutaneous, subcutaneous, and loose connective tissue around the joint. This is a common sequelae of burns and open wounds. [1][9]
Soft tissue contractures can have a traumatic origin, such as burns, fractures, dislocations, spinal cord injuries, traumatic brain injuries, or surgical procedures. They may also result from nontraumatic sources, such as congenital limb abnormalities, inflammatory arthritis, infection, or recurrent hemarthroses experienced by patients with hemophilia.[10]
Management of Contractures[edit | edit source]
Management options for joint contractures include passive stretching, splinting, application of serial plasters, joint mobilization, 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 treatment, electrical stimulation, and robot-assisted rehabilitation interventions. [11]
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 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.
- ↑ Graves BR. The examination and treatment of soft tissue contracture of the elbow. J ISAKOS [Internet]. 2024;9(1):98–102.
- ↑ 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.
