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by Badash M
(Contracture Deformity)

Definition

Contractures refer to the permanent tightening of tissues. This includes muscles, tendons, ligaments, or skin. It makes it hard or impossible to move the nearby joints.

Contracture Deformity of the Hand
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Causes

Contractures may be caused by:

  • Deformity
  • Immobility
  • Injury
  • Chronic inflammation

Certain disorders that affect nerves and muscles almost always lead to contractures. For example:

Spasticity is a change in muscle tone. It is caused by injuries to the brain or spine, such as stroke. It can often lead to contracture.

Risk Factors

Factors that may increase your risk of contractures include:

Symptoms

Contracture causes:

  • Loss of motion in a joint
  • Pain

Diagnosis

You will be asked about your symptoms and past health. Your joints will be examined for range of motion.

Images may be taken of your bodily structures. This can be done with x-rays .

Treatment

Treatment includes:

Therapy

  • Physical therapy can helps to increase mobility, joint elasticity, and muscle strength.
  • Occupational therapy can help bring back movement to do daily tasks.

The main goal is to maintain or improve range of motion. Treatmen may include:

  • Ultrasound—for large joint contractures
  • Therapeutic massage

Casts or Splints

Casts or splints can keep the joint in a better position. They may help to stretch soft tissues. They are often used for contractures cause by nerve injury or immobility. Casts need to be changed on a regular basis.

Surgery

Surgery may be needed to release tight tendons, ligaments, and joints. This may be used if other treatments have not worked well.

Prevention

Prevention 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—keep joints in motion

Aggressive care of issues like rheumatoid arthritis may also delay or prevent contractures.

RESOURCES

American Academy of Physical Medicine and Rehabilitation  http://www.aapmr.org 

National Institute of Arthritis and Musculoskeletal and Skin Diseases  http://www.niams.nih.gov 

CANADIAN RESOURCES

Canadian Centre for Occupational Health and Safety  http://www.ccohs.ca 

Ortho Info—American Academy of Orthopaedic Surgeons  http://orthoinfo.aaos.org 

References

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.

Occupational therapy's role in skilled nursing facilities. The American Occupational Therapy Association website. Available at: https://www.aota.org/-/media/corporate/files/aboutot/professionals/whatisot/rdp/facts/factsheet%5Fskillednursingfacilities.pdf. Accessed December 31, 2018.

Skalsky A, McDonald C. Prevention and management of limb contractures in neuromuscular diseases. Phys Med Rehabil Clin N Am. 2012 Aug;23(3):675-687.

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