Contracture is a restriction of mobility in a joint that occurs due to changes in the articular surfaces or soft tissues functionally associated with the joint.
There are flexion contractures, extension contractures, abductor contractures, adductor contractures and others.
Joint contractures can be congenital or acquired in origin.
Congenital joint contractures are based on underdevelopment of the muscles and joints themselves (torticollis, arthrogryposis, clubfoot).
Acquired joint contractures can be:
- neurogenic - as a result of disease or injury to the nervous system
- post-traumatic - as a result of intra-articular or periarticular injuries, injuries or burns of soft tissues with subsequent development of scars
Types of joint contractures
Types of joint contracture by origin:
- Dermatogenous contractures occur during the healing by secondary intention of large skin defects after burns, wounds, inflammation, etc.
- Desmogenic contractures develop when the fascia (connective tissue plates surrounding the muscles), ligaments and joint capsule shrink after their damage or inflammatory processes in them
- Myogenic contractures are caused by injuries, acute and chronic muscle inflammation, as well as some other pathological processes in the muscles
- Tendogenic contractures occur as a result of damage or inflammation of the tendons and their sheaths
- Arthrogenic contractures are associated with a pathological process in the joint - a violation of the integrity of the articular surfaces or changes in the ligamentous apparatus
- Neurogenic contractures occur in diseases of the central and peripheral nervous system
Dermatogenous joint contracture is observed after skin burns (thermal or chemical). It often occurs in children in the form of tightening, rough keloid scars of the skin, which lead to fusion of the fingers, pulling the forearm to the shoulder, and the shoulder to the body. Joint contracture can also occur as a result of skin defects due to mechanical trauma with subsequent ulceration.
Desmogenic joint contracture occurs due to the onset of wrinkling of the subcutaneous tissue after inflammatory processes. For example, after phlegmonous tonsillitis, torticollis may occur.
Myogenic joint contracture develops after damage to:
- acute or chronic muscle diseases (myositis)
- contractures can also develop due to acute circulatory disorders in the muscles (ischemia)
- myogenic-neurogenic type of contracture, after prolonged compression of the limb with a plaster cast or tightening with a tourniquet; this type of joint contracture is mixed, since with this pathology not only muscles, but also nerve trunks suffer
Neurogenic contracture of the joint occurs with flaccid and spastic paralysis due to injury or inflammatory processes, and also (rarely) against the background of hysteria.
There are several groups of neurogenic joint contractures:
- contractures developing due to paralysis or paresis of muscles, caused by hemorrhages in the brain or diseases of the central nervous system; in diseases of the spinal cord, they manifest themselves in the lower extremities in the form of convulsive extension in the hip and knee joints and flexion in the ankle joints
- with diffuse damage to the spinal cord, flexion contracture of the limbs occurs
- in some diseases of the central nervous system, contractures of all four limbs, both flexion and extension, are observed
Conditioned reflex contracture of the joint develops against the background of functional adaptive or compensatory reactions. For example, when the lower limb is shortened, the patient lengthens it due to plantar flexion of the foot and rests on its peripheral part (“horse foot”).
Pelvic distortion and the associated development of scoliosis (curvature of the spine) is observed with uneven length of the lower extremities.
With flexion contracture of the hip joints, compensatory excessive curvature (hyperlordosis) of the lumbar spine occurs.
Occupational joint contractures develop in connection with the performance of certain work in persons exposed to occupational hazards for a long time. Joint contractures occur acutely or can be caused by chronic injury against the background of functional loads of individual parts of the body.
Contractures of joints due to burns more often appear in people working in chemical industries, firemen, smelters, and foundries. Contractures of joints after incised wounds develop mainly in carvers, cutters, shoemakers and can be of a myogenic, tendogenic and neurogenic nature. Loaders experience joint contractures after rupture of the occipital or lumbar muscles. Soccer players may experience joint contractures after an Achilles tendon rupture. Joint contractures caused by chronic injury in the form of static scoliosis as a result of prolonged asymmetrical position of the body.
Symptoms of muscle contractures
You need to be careful and not miss the first “alarm bells” that may indicate the development of pathology:
- At the initial stage of the disease, the symptoms appear vaguely, and the patient may not pay attention to them. However, an alarming signal should be a feeling of fatigue and aching pain even after minimal physical activity, numbness and stiffness, especially in the morning after waking up, dry skin in the affected area.
- As the disease progresses, difficulty and pain arise when trying to fully bend or straighten a limb subject to contracture.
- In later stages, there is an inability to fully bend or straighten the limb.
Diagnosis of joint contracture
Symptoms and course of joint contracture depend on:
- causes of contracture
- localization of the affected joint
- patient's age
In chronic pathological processes, contractures develop slowly, and in acute inflammatory processes in joints, muscles and other tissues - quickly. The more severe the pathological process, the more pronounced the contracture.
Contracture is especially pronounced in diseases and injuries of the joints, often accompanied in these cases by atrophy of the soft tissues above and below the contracture. If contracture develops in childhood, the limb is stunted.
To clarify the nature of changes in the affected joint, the following is required:
- consultation with a doctor is the first step to determine the functionality of the joint
- CT (computed tomography) of the joint
- MRI (magnetic resonance imaging) of the joint
- radiography of the joint
Ankylosis
From a clinical point of view, ankylosis is divided into bone, or true, in which complete immobility of the joint is explained by bone fusion of the articular ends, and fibrous, or false, when the articular ends are fused together by fibrous, scar formations.
In the clinic, several differential signs are identified that make it possible to determine the nature of ankylosis. Firstly, with bone ankylosis, the immobilized joint is painless even with functional load; with fibrous ankylosis, increased functional load causes pain in the affected joint.
Secondly, the inflammatory process that caused bone ankylosis usually does not worsen in an immobilized joint; while fibrous ankylosis, which was a consequence of the same inflammatory arthritis, does not guarantee the patient against exacerbations of the inflammatory process.
Finally, corrective operations performed for bone ankylosis to correct the vicious position of the limb give lasting results - in contrast to fibrous ankylosis, in which the same corrective operations usually end in a relapse of the deformity.
X-ray examination allows us to definitively determine the nature of ankylosis.
There are ankyloses in the position of flexion, extension, adduction, abduction, external or internal rotation, supination, pronation. Combined forms of ankylosis are more common.
According to its functional significance, a limb can be fixed by ankylosis in a functionally advantageous or disadvantageous position. A functionally convenient installation is understood as a position of a limb that, in the absence of mobility in the joint, provides it with maximum performance. A functionally convenient position for the shoulder joint is abduction to an angle of 70°, elbow - flexion at an angle of 90°, wrist - dorsiflexion at an angle of 15°, hip - flexion 25-35° and abduction 8-10°, knee - flexion 5-10 °, ankle joint - plantar flexion 5°.
For some professions, functionally convenient joint positions generally accepted for ankylosis may be unfavorable, which must be taken into account when determining the patient’s ability to work.
Treatment of joint contracture
Conservative treatment of joint contracture consists of the use of therapeutic exercises, therapeutic massage, and physiotherapeutic procedures, which allow you to restore the full range of motion in the joint, completely remove the restriction in the joint, relieve pain symptoms when moving the joint, improve nutrition in the joint and increase the tone of weakened muscles.
Depending on the degree and type of damage to the joint during contracture, the following therapeutic actions are possible:
- drug therapy (NSAIDs, analgesics, hormones)
- therapeutic blockades - injection of drugs into the joint cavity
- manual therapy (muscle and joint techniques)
- physiotherapy (UHF, electrophoresis)
- shock wave therapy (Ekaterinburg Medical Center on Botanika)
- physiotherapy
- surgical treatment
There are contraindications. Read the instructions or consult a specialist.
Correction methods
When treating Dupuytren's contractures, there are two main directions: conservative and surgical. After carrying out all the necessary tests and studies, the doctor selects a method in each specific case.
One of the methods of surgical treatment of Dupuytren's contracture is the method of Professor Ulzibat .
When treating contractures with this method, the surgeon cuts the contractures using a special scalpel.
The advantages of this method of treating contractures are:
1. Minimal invasiveness, that is, the complete absence of incisions, and as a result, the complete absence of postoperative sutures and scars on the palmar surface of the hand.
2. Short operation time, approximately 15-20 minutes.
3. There is no need for postoperative immobilization.
4. The intervention is performed under one or another type of local anesthesia.
5. A short postoperative recovery period, which, when using traditional methods of surgical treatment of contractures, can last up to several months.
Risk factors
Although we do not know the exact cause, there are some factors associated with this pathology:
- Age. Dupuytren's contracture most often occurs after 50 years of age.
- Floor. Men are significantly more susceptible than women. Severe degrees of the disease are more common in men.
- Heredity and genetics. The disease is often inherited. Dupuytren's contracture is typical for residents of northern Europe.
- Tobacco and alcohol. Smoking increases the risk of developing Dupuytren's contracture, possibly due to capillary damage and chronic tissue ischemia. Alcohol abuse also worsens the prognosis.
- Diabetes. There are reports of an increase in the incidence of Dupuytren's contracture among diabetics.
How to warn?
Preventive measures:
- uniform distribution of physical activity;
- rejection of bad habits;
- proper nutrition;
- avoiding hypothermia of hands and feet.
Contracture is a disease that is easier to prevent than to cure. The first and main rule is diagnosis and timely treatment of injuries, inflammatory processes and infections. The prescribed course of treatment must be completed in full, following the doctor’s recommendations. You should not wear a cast or other constrictive bandages for longer than the prescribed time. It is imperative to develop a joint after an injury.
3. Treatment of the disease
Treatment of contracture can be conservative, requiring physiotherapy, gymnastics, massage, plaster casts and other procedures. In this case, it is unacceptable to immediately straighten the joint forcibly. Therapeutic gymnastics is also introduced gradually, moving from gentle movements to more active ones that develop ligaments.
If treatment of contracture with conservative methods fails, then surgery is resorted to. For surgical treatment of contracture, osteotomy, tendon transfer, resection of muscles and tendons, and removal of skin scars can be used.
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