Wade S. Gamber, Reenie Euhardy, in Geriatric Rehabilitation Manual (Second Edition), 2007 INTRODUCTION Contractures
Contracture
This article refers to permanent shortening of muscles, tendons, or ligaments. For short-term contraction of muscles, see Muscle contraction. A muscle contracture is a permanent shortening of a muscle or joint. It is usually in response to prolonged hypertonic spasticity in a concentrated muscle area, such as is seen in the tightest muscles of people with conditions like spastic cerebral pals…
What is contracture in geriatric rehabilitation?
A contracture is defined as a permanent shortening of a muscle, tendon or scar tissue resulting in a distortion or deformity. Identify and reduce a decrease range of motion which has the potential to lead to a contracture. Systematic Contracture management screens for all residents. Contracture assessments and interventions using modalities ...
What is a contracture?
con· trac· ture | \ kən-ˈtrak-chər \ Definition of contracture : a permanent shortening (as of muscle, tendon, or scar tissue) producing deformity or distortion Example Sentences Phrases …
What is stroke-related contracture rehabilitation?
Jul 12, 2017 · A Contracture is a condition causing shortening and hardening of muscles, tendons, or other tissue. Ongoing rehabilitation is crucial in management of contractures. Depending on the area of involvement and severity of contractures, it highly affects the functional status of a patient and therefore the quality of life.
What is the treatment for contracture?
contracture. [ kon-trak´cher] abnormal shortening of muscle tissue, rendering the muscle highly resistant to stretching; this can lead to permanent disability. It can be caused by fibrosis of the tissues supporting the muscle or the joint, or by disorders of the muscle fibers themselves. Improper support and positioning of joints affected by arthritis or injury, and inadequate …
What contracture means?
(kun-TRAK-cher) A permanent tightening of the muscles, tendons, skin, and nearby tissues that causes the joints to shorten and become very stiff. This prevents normal movement of a joint or other body part. Contractures may be caused by injury, scarring, and nerve damage, or by not using the muscles.
What is muscle contracture?
What Is a Contracture? A contracture occurs when your muscles, tendons, joints, or other tissues tighten or shorten causing a deformity. Contracture symptoms include pain and loss of movement in the joint. If this occurs, you should seek treatment right away.
What causes a contracture?
The most common causes of contracture are inactivity and scarring from an injury or burn. People who have other conditions that keep them from moving around are also at higher risk for contracture deformity. For example, people with severe osteoarthritis (OA) or rheumatoid arthritis (RA) often develop contractures.
What is contracture prevention and treatment?
Abstract. Contracture, or reduced joint mobility, is a common and disabling sequel of spinal cord injury. The primary intervention for the treatment and prevention of contracture is regular stretch to soft tissues.Jan 30, 2002
What is the most common type of contracture?
Duchenne and Becker Muscular Dystrophies The most common contractures observed in dystrophinopathies in the order of frequency are ankle plantar flexion, knee flexion, hip flexion, hip abduction, elbow flexion, and wrist flexion contractures.
Is muscle a contraction?
Muscle contraction is the tightening, shortening, or lengthening of muscles when you do some activity. It can happen when you hold or pick up something, or when you stretch or exercise with weights. Muscle contraction is often followed by muscle relaxation, when contracted muscles return to their normal state.Oct 25, 2021
Are contractures permanent?
Contracture from severe injuries, in which substantial amounts of tissue are destroyed, are irreversible. This may be the result of physical injury or surgery.
What do contractures feel like?
Symptoms of contractures include incredibly stiff and tight muscles that are resistant to stretching, which causes pain, decreased range of motion, and impaired joint mobility.Jun 22, 2021
How is contracture treated?
Depending on the cause and type of contracture, you may need tests such as an x-ray. Treatment may include physical therapy, medicines, and orthopedic braces. Surgery may be helpful for some types of contractures.
What is the difference between spasticity and contracture?
Spasticity refers to involuntary tightening or stiffening of muscles. The term contracture refers to abnormal positioning of a joint.Sep 21, 2020
What is flexion contracture?
Definition. A flexion contracture is a bent (flexed) joint that cannot be straightened actively or passively. It is thus a chronic loss of joint motion due to structural changes in muscle, tendons, ligaments, or skin that prevents normal movement of joints. [ from HPO]
What joints are affected most frequently by contractures?
The elbow was the joint most frequently affected by any contracture (76 [35.8% of the total number of joints affected]), followed by the ankle (51 [24.1%]), the knee (31 [14.6%]), the hip (30 [14.2%]) and the shoulder (24 [11.3%]) (Table 3).
What are the consequences of contracture?
Living with a contracture has a significant effect on one’s life. Complications range from hygiene issues in higher functioning individuals to debilitating contractures resulting in limited independence and permanently immobility.
What causes contracture in the body?
The most frequent cause of contracture is immobilization, but they can be also be caused by congenital conditions (e.g., Duchenne’s Muscular Dystrophy, Cerebral Palsy), muscle imbalances, arthritic conditions, heterotopic ossification, prolonged hypertonic spasticity, ulcers, burns, total knee arthroplasty (TKA), local trauma, diabetes, or in rare cases, hypothalamus-pituitary-adrenal axis (HPA) hormone deficiency. 1 Manual work and vibration exposure have also been associated with the development of Dupuytren’s contracture. 2,3
Why is it important to control lower limb contractures?
Controlling lower limb contractures is important to minimize their adverse effects on independent ambulation. Static positioning of both upper and lower limbs is an important cause of contracture formation. Mild upper limb contractures may not negatively impact function 21.
Why do you need to inspect a brace?
If bracing is used as a functional aid, it must be inspected for proper fit and pressure points because the contracture may have shifted, and the brace may need to be refitted.
What are the options for a fixed contracture?
These include surgical release of affected muscles, tenotomy or tendon lengthening, joint capsule release, or total joint replacement. In some cases, heterotopic bone can be removed.
What are the markers of contracture?
Other laboratory markers, including alkaline phosphatase, erythrocyte sedimentation rate, etc. can be used to identify underlying conditions such as heterotopic ossification, myopathy, etc.
What should be included in a history of a contracture?
History should include the etiology of the contracture, its natural course, and its impact on the patient’s functionality. This includes pain, difficulties in mobility and transfers, activities of daily living (ADLs), and hygiene. Details regarding caregiver burden should also be explored.
What is the treatment for a contracture?
Treatment of Contractures: The treatment of contractures includes different rehabilitation and positioning. If a contracture does not respond to conservative management and affects the quality of life, medical professionals may consider surgical intervention.
What is a contracture in a joint?
A Contracture is a fixed loss of range of motion of a joint. It is usually due to any pathology of soft tissues like muscles, tendons, ligaments, cartilages, or connective tissues.
Can a brain injury cause contractures?
For example, brain injury leads to spasticity (high tone in muscles) causing immobility of muscles or joints that leads to contractures. Conversely, orthopedic conditions which require casting or bracing the joints for long period of time (treatment of fractures with an immobilizer) can cause contractures as well.
Do contractures occur in upper extremities?
These kinds of contractures seem to be more common in upper extremities than lower extremities. Few contractures, in early stages, respond well to treatment. Consequently, clinicians, mainly rehabilitation professionals are able to gain either full or near-normal range of motion back. This also helps to gain a functional activity.
What is contracture in a muscle?
contracture. abnormal shortening of muscle tissue, rendering the muscle highly resistant to stretching; this can lead to permanent disability. It can be caused by fibrosis of the tissues supporting the muscle or the joint, or by disorders of the muscle fibers themselves.
What is a physiological contracture?
physiological contracture. A temporary condition in which tension and shortening of a muscle are maintained for a considerable time although there is no tetanus. It may be induced by injury, disease, heat, drug action, or acids.
What is the term for the shortening of muscle tissue?
contracture. Permanent shortening of tissue, such as muscle, tendon or skin, as a result of disuse, injury or disease. Contracture leads to the inability to straighten joints fully and to permanent deformity and disability. Skin contractures often follow burns.
What is Dupuytren's contracture?
Dupuytren's contracture a flexion deformity of the fingers or toes, due to shortening, thickening, and fibrosis of the palmar or plantar fascia. ischemic contracture muscular contracture and degeneration due to interference with the circulation due to pressure or to injury or cold.
What is static muscle shortening?
Static muscle shortening due to tonic spasm or fibrosis, to loss of muscular balance, to the antagonist being paralyzed, or to a loss of motion of the adjacent joint. [L. contractura, fr. contraho, to draw together] Farlex Partner Medical Dictionary © Farlex 2012.
What is pseudomyostatic contracture?
pseudomyostatic contracture. An apparent permanent contraction of a muscle due to a central nervous system lesion, resulting in loss of range of motion and resistance of the muscle to stretch.
What is a deformity?
n. 1. An abnormal, often permanent shortening, as of muscle or scar tissue, that results in distortion or deformity, especially of a joint of the body. 2. A deformity resulting from a contracture. The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company.
What is contracture in anatomy?
INTRODUCTION. Contractures are defined as the lack of full passive range of motion (ROM) of a joint resulting from structural changes of non-bony tissues , such as muscles, tendons, ligaments, joint capsules and/or skin.
What is the best treatment for contractures?
Other modalities may be of benefit when treating contractures. Deep heat, including ultrasound, can be used in conjunction with a stretching program. The elasticity of collagen increases as tissues are heated, hence a greater stretch can be achieved while the tissue is warmed.
How to prevent contractures in MD patients?
The easiest way to prevent contractures is to avoid prolonged joint immobility. In healthy subjects, normal activities usually take joints through their full range of motion. In MD patients, active and passive stretching of joints is critical to maintaining mobility.
What is myotatic contracture?
Myotatic contracture occurs in muscles that are not allowed to function within their full range of motion. The muscle tends to lose its stretch reflex capabilities, and a gradual shortening of the muscle occurs. Pain or immobilization of a part for a prolonged period leads to myotatic contracture.64
What is fibrous contracture?
Fibrotic Contracture of the Infraspinatus Muscle. Contracture is a shortening of the tendon-muscle unit that is not caused by active muscle contraction. Most or all of the muscle and/or associated tendon is replaced by fibrous tissue.
What joint is involved in flexor contracture?
The pastern joint may also be involved with contracture of the fetlock or the coffin joint.
What exercises are used to restore the forelimb muscles?
In cases in which there is significant disuse atrophy of the forelimb muscles, general conditioning exercises for the limb are used to gradually return the muscle to normal size and strength. Conditioning exercises include walking, jogging, and aquatic therapy.
What is a Contracture?
Contracture definition: A contracture occurs when soft, connective tissue in the body becomes very stiff, constricted, and/or shortened. The skin, tendons, ligaments, and muscles of your body are relatively soft and pliable which allows your body to move properly.
What Causes Contractures?
Contractures often result from inactivity of the body part, particularly from injury or arthritis. For example, if a person breaks their finger, they will likely have to wear a splint or cast on the affected finger to keep it immobilized. Additionally, people are much less likely to move a body part that is in pain.
Types of Contractures
There are several types of contractures classified by where they occur and their severity. For example, contractures can occur in the hands, arms, head, legs, and abdominal organs such as the intestines. Abdominal contractures can impair the digestion and absorption of food and nutrients.
What is a contracture in a stroke?
Contractures are a form of spasticity, a condition where muscles become stiff and tight after stroke. When spasticity is left unmanaged, contractures can develop. For example, if you had spasticity in your hand ...
How to prevent contractures from forming?
Gently stretching the affected muscles and taking them through their range of motion can help prevent contractures from forming. Most of all, massed practice of rehabilitation exercise can help manage spasticity, reduce contractures, and improve mobility.
What is orthosis for a therapist?
Orthoses include splints and props that are custom-fitted to support and gently stretch open the affected muscles and joints. They might be recommended by your therapist and will be adjusted to best suit your needs.
How to stretch your hand after a stroke?
When splints aren’t feasible, you can try using a basketball or other object to stretch your hand on. 2. Range of Motion Exercises. Next you’ll want to move your affected muscles through gentle range of motion exercises.
What is muscle contracture?
A muscle contracture involves the shortening and tightening of the muscles. Joints. If there’s contracture in the joint capsule where two or more bones connect, you’ll experience limited range of motion in that area of your body. Skin. Skin may contract where it’s been scarred from an injury, burn, or past surgery.
How to prevent contracture?
Follow their treatment recommendations to help prevent contracture. Physical therapy, occupational therapy, and devices that passively move your joints can also help prevent problem areas from stiffening. Last medically reviewed on October 2, 2019.
What is a contracture deformity?
A muscle contracture, or contracture deformity, is the result of stiffness or constriction in the connective tissues of your body. This can occur in: your muscles. tendons. ligaments. skin. You can also experience a contracture deformity in your joint capsules. This is the dense, fibrous connective tissue that stabilizes ...
Why do you need surgery?
Surgery may be needed to lengthen muscles or repair ligaments, tendons, or bones damaged in an accident. For example, your surgeon may repair a ligament in your knee, with the hope that you’ll regain full range of motion in the long term. When a joint is replaced because of arthritis, the contractures are released.
What causes joint contractures in children?
Other causes include diseases that are inherited or that develop in early childhood, such as: Muscular dystrophy.
What happens when your connective tissue becomes less flexible?
This means that your range of motion will be limited. You may have difficulty: moving your hands. stretching your legs. straightening your fingers. extending another part of your body.
What causes a person to contracture?
Common causes of contracture deformity. The most common causes of contracture are inactivity and scarring from an injury or burn. People who have other conditions that keep them from moving around are also at higher risk for contracture deformity.
Disease/Disorder
- Definition
Contractures are the chronic loss of joint mobility caused by structural changes in non-bony tissue, including muscles, ligaments, and tendons. They develop when these normally elastic tissues are replaced by inelastic tissues. This results in the shortening and hardening of these ti… - Etiology
Contractures are a final common pathway for many conditions. The most frequent cause of contracture is immobilization, but they can be also be caused by congenital conditions (e.g., Duchenne’s Muscular Dystrophy, Cerebral Palsy), muscle imbalances, arthritic conditions, hetero…
Essentials of Assessment
- History
History should include the etiology of the contracture, its natural course, and its impact on the patient’s functionality. This includes pain, difficulties in mobility and transfers, activities of daily living (ADLs), and hygiene. Details regarding caregiver burden should also be explored. - Physical examination
Ideally, the patient should be free from pain that may interfere with the examination. Inspect the patient for joint size, symmetry, and resting position compared with the contralateral side. A goniometer can measure residual range of motion and document changes over time. Joint defor…
Rehabilitation Management and Treatments
- General approach to Contractures: Key principles
The best treatment is to slow or prevent contracture formation. Clinically, this largely involves PROM and stretching exercises daily. However, some evidence-based research has made these longstanding interventions controversial. Cochrane review articles have suggested that passive … - Approach to contractures at different stages
Once a contracture has developed, prolonged and continuous stretching of the joint is accomplished through dynamic bracing or serial casting. After maximal stretching, an orthotic or cast is applied to fix the joint at that position. The device is removed every few days, and the pro…
Cutting Edge/Emerging and Unique Concepts and Practice
- Cutting edge concepts and practice
In one animal model, radiofrequency treatments successfully treated underlying collagen contractures and helped in new collagen formation.25 In another study comparing speed and torque in range of motion exercises using rats, high torque and long-duration static stretching w…
Gaps in The Evidence-Based Knowledge
- Gaps in the evidence-based knowledge
There is a lack of knowledge about the pathophysiology and disease course that lead to contractures. Due to the lack of standardization in assessment, quantification of disability, and evidence-based treatment, there remains a tremendous amount of individual interpretation with…
References
- Syriou V, Moisidis A, Tamouridis N, Alexandraki KI, Anapliotou M. Isolated adrenocorticotropin deficiency and flexion contractures syndrome. Hormones (Athens). 2008;7(4):320-4.
- Descatha A, Jauffret P, Chastang JF, Roquelaure Y, Leclerc A. Should we consider Dupuytren’s contracture as work-related? A review and meta-analysis of an old debate. BMC Musculoskelet Disord. 2011...
- Syriou V, Moisidis A, Tamouridis N, Alexandraki KI, Anapliotou M. Isolated adrenocorticotropin deficiency and flexion contractures syndrome. Hormones (Athens). 2008;7(4):320-4.
- Descatha A, Jauffret P, Chastang JF, Roquelaure Y, Leclerc A. Should we consider Dupuytren’s contracture as work-related? A review and meta-analysis of an old debate. BMC Musculoskelet Disord. 2011...
- Fadel M, Leclerc A, Evanoff B, Dale AM, Ngabirano L, Roquelaure Y, Descatha A . Association between occupational exposure and Dupuytren’s contracture using a job-exposure matrix and self-reported e...
- Fergusson D, Hutton B, Drodge A. The epidemiology of major joint contractures: a systematic review of the literature.ClinOrthop Relat Res. 2007;456:22-29.
