Contractures: Difference between revisions
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== Introduction == | == Introduction == | ||
Joint contractures | Joint contractures are referred to as a limitation in passive joint [[Range of Motion|range of motion]] (PROM) that occurs 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 is no universally accepted definition of limb contracture, but reduced [[Range of Motion|range of motion]] (ROM) accompanied by increased mechanical resistance at the ends of the available range are accepted clinical signs.<ref>Nuckolls GH, Kinnett K, Dayanidhi S, Domenighetti AA, Duong T, Hathout Y, et al. [https://onlinelibrary.wiley.com/doi/epdf/10.1002/mus.26845 Conference report on contractures in musculoskeletal and neurological conditions.] Muscle & Nerve. 2020 Mar 7;61(6):740–4. | |||
</ref> | |||
== Epidemiology of Contractures == | |||
Despite the widespread occurrence of contractures in chronic illnesses, their exact prevalence is unclear due to inconsistent definitions, causes, and measurement methods. | |||
The prevalence of contractures in chronic neurological and musculoskeletal conditions varies widely, ranging from 16.2% to 67% in brain injury patients and affecting 66% of [[Spinal Cord Injury|spinal cord injury]] patients. Other conditions such as [[Multiple Sclerosis (MS)|multiple sclerosis]] show a prevalence of 56%, while [[osteoarthritis]] is the most common cause (93%) of knee contractures requiring surgical intervention. Standardized definitions and assessment methods are needed to better understand and address this prevalent issue.<ref name=":1" /> | |||
There are three distinct types of joint contractures, each based on the specific underlying tissue involved: | 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 == | ||
Revision as of 00:47, 27 June 2024
Original Editor - Habibu Salisu Badamasi
Top Contributors - Sehriban Ozmen, Habibu Salisu Badamasi and Pacifique Dusabeyezu
Introduction[edit | edit source]
Joint contractures are referred to as a limitation in passive joint range of motion (PROM) that occurs 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 is no universally accepted definition of limb contracture, but reduced range of motion (ROM) accompanied by increased mechanical resistance at the ends of the available range are accepted clinical signs.[2]
Epidemiology of Contractures[edit | edit source]
Despite the widespread occurrence of contractures in chronic illnesses, their exact prevalence is unclear due to inconsistent definitions, causes, and measurement methods.
The prevalence of contractures in chronic neurological and musculoskeletal conditions varies widely, ranging from 16.2% to 67% in brain injury patients and affecting 66% of spinal cord injury patients. Other conditions such as multiple sclerosis show a prevalence of 56%, while osteoarthritis is the most common cause (93%) of knee contractures requiring surgical intervention. Standardized definitions and assessment methods are needed to better understand and address this prevalent issue.[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,[3] in extreme cases, joint deformation. [4] It can also cause considerable pain, strength loss, and muscle atrophy. [5][6]
It can occur for various reasons including:
- Upper motor neuron lesions, such as stroke, head injury, or cerebral palsy [4]
- Muscle diseases, such as spinal muscular atrophy or muscular dystrophy [4]
- 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.[3] [7]
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. [8]
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. [9]
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][10]
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.[11]
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. [9]
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. [12]
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.
- ↑ Nuckolls GH, Kinnett K, Dayanidhi S, Domenighetti AA, Duong T, Hathout Y, et al. Conference report on contractures in musculoskeletal and neurological conditions. Muscle & Nerve. 2020 Mar 7;61(6):740–4.
- ↑ 3.0 3.1 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.
- ↑ 4.0 4.1 4.2 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.
- ↑ 9.0 9.1 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.
