Contracture of the knee joint after endoprosthetics: when the knee does not straighten

Diseases of the musculoskeletal system | Osteoarticular system

What ensures the mobility of our skeleton? First of all, joints, muscles, ligaments and nerves. You should also not ignore the heart and blood vessels (how will muscles work without nutrition and oxygen?), and other organs and tissues make a significant contribution to the possibility of movement.

What types of movements are there?

1. Active and passive. A person does the first of his own free will. The second is someone else (for diagnostic or therapeutic purposes), and no effort is required from the person himself.
2. Natural - harmonious, inherent in a healthy body, and pathological - performed in ranges and planes unusual for a healthy body.
3. Rotational and planar (adduction-abduction, flexion-extension).
4. Free and limited.

An example of movement limitation (both passive and active) is contracture. This term comes from Latin words meaning “constriction, contraction.” They can be inherent in the body from birth (for example, torticollis, clubfoot, etc.) or result from injuries and diseases of the nervous and musculoskeletal systems.

Knee massage

Knee massage

• stimulation of blood and lymph flow;
• pain reduction;
• ensuring rapid resorption of blood clots;
• restoration of leg mobility.

First, the thigh muscles are massaged. After this, massage is performed for tendinitis of the knee joint. Next, the effect is carried out on the tibialis anterior muscle. Movements used:

• stroking;
• rubbing;
• kneading;
• vibration.

Directly the place where the source of pain is localized is massaged from the 4th-5th day of illness. Knee joint massage goes well with thermal treatments. The procedure is completed by stroking the area from the back of the foot to the knee.

Treatment

Before prescribing treatment, the doctor determines the extent of damage to the knee joint. If he has been immobile for less than three weeks, light exercise is usually sufficient. If there is no movement for a longer period of time, conservative methods of solving the problem are used, which include:

• exercise therapy;
• Applying bandages;
• Mechanotherapy;
• Electrophoresis;
• Massage;
• Shock wave therapy;
• Use of special fixing devices.

Painkillers, anti-inflammatory and non-steroidal drugs are used to treat the patient at home. If the patient is in a hospital setting, hormonal agents are injected into the affected knee joint to help eliminate pain, slow down destructive processes in tissues, and also increase muscle tone.

In medical practice, a complex of individual physical therapy is often used in the treatment of contracture.

1. It is effective to hold the weight of a bent limb for a long time. At the same time, the leg is alternately lowered and straightened;
2. The straightened leg is placed on a fitness ball, pressing lightly on it. Then, using the shin, they make slow rotational movements;
3. The bicycle exercise should be performed alternately for each leg;
4. For squats, use a ball held between the knees;
5. It is also recommended to pull the legs towards the stomach, bending them alternately.

All exercises must be performed by the patient regularly, under the close supervision of an instructor. For the effect of exercise therapy to be obvious, each exercise must be performed at least ten times.

Massage for knee contracture is always performed according to a specific scheme, in which an active effect is applied to the weakened muscles of the limb, and a gentle effect is applied to the muscles with increased tone. At the beginning of the session there is a soft influence, then an active one and, after a set time interval, elements of resistance begin to be introduced.

Periarthritis of the knee

Therapeutic massage of the knee joint helps to cope with periarthritis. This is a group of diseases in which the soft tissues surrounding the knee become inflamed. These are usually where the tendons attach to the bone. The main symptom is pain. It develops as a result of the progression of degenerative processes and the development of reactive inflammation.

The causes of periarthritis of the knee are most often tendinitis or tendobursitis, which develops at the site of fixation of the pes anserine tendons. The inner surface of the knee hurts.

Purposes of massage:

Symptoms

If a temporary pathology is characterized by the presence of sharp pain, then the initial stage of development of a persistent type of disease passes without severe symptoms and usually does not cause a person any discomfort. The patient is prompted to pay attention to the problem and be examined by a doctor due to the appearance of lameness, which over time is joined by:

• Violation of habitual support;
• Severe swelling of the joint;
• Ankle curvature;
• Pain when walking;
• Discomfort when bending and straightening the knee;
• Noticeable shortening of the limb.

If the disturbing symptoms are not eliminated in time, the pathology can develop into arthrosis of the knee joint.

massage

massage

• relieve pain and inflammation;
• reduce swelling;
• ensure the outflow of lymph and prevent its accumulation in the periarticular tissue;
• relieve pain;
• ensure normal trophism of soft tissue structures and their regeneration.

Massage movements are carried out in the direction from the proximal part of the limb to the distal one. First, they stroke, then vigorously rub and lightly vibrate. The strongest effect is on the places of fixation of tendon structures to bone tissue. Be sure to warm up the muscles of the thigh and lower leg. Finish the massage with stroking. After the procedure, movements are performed in the knee.

Alternative Treatment

The use of traditional therapy methods for contracture can have a positive effect only at an early stage of the development of the pathological process. In combination with drug therapy, it enhances its effect. Most often, medicinal tinctures are used for rubbing joints.

Salt baths have a healing effect, restoring blood supply to tissues. They are usually used in the treatment of postoperative and post-traumatic contractures. Alternately immersing the knee joint in hot and then cold water promotes its enhanced microcirculation.

The use of warm baths with the addition of pine oils reduces muscle tension. Their use 20 minutes before scheduled physical procedures helps relieve muscle spasms, as well as pain from tight tendons and stretched scars.

Of great importance in the treatment of contracture is the timely referral of the patient to a specialist, the precisely established cause of the development of the disease and a well-chosen treatment method.

Knee massage after injury

Knee injury is a flexible concept. As a result of mechanical impact on the joint, a wide variety of pathological changes can occur: rupture of the cruciate or collateral ligaments, menisci, damage to the synovial bursa, intra-articular bone fractures, damage to hyaline cartilage, etc.

For severe injuries, massage does not play a major role in the healing process. Patients often require long-term limb immobilization or surgery. Therefore, we will consider situations when a knee joint is massaged after an injury that did not lead to significant tissue damage. This procedure is most effective when:

• bruise;
• traumatic bursitis;
• minor damage to the ligamentous apparatus.

As an auxiliary procedure, knee massage is also used for other pathologies, including bone fractures, complete rupture of ligaments, and significant damage to the menisci.

Traumatic bursitis

Diagnostics

For successful treatment of contracture, timely diagnosis is important, which will identify the pathology at its early stage, allowing for complete restoration of the joint. The reason for contacting a medical facility should be any changes in the position of the leg or the impossibility of full habitual movements.

Primary diagnosis consists of an external examination, allowing a specialist to determine the degree of deformation. After studying the anamnesis, a computed tomography, radiography or MRI is usually prescribed.

The neurogenic type of disease requires consultation with a psychiatrist, neurologist, and sometimes a neurosurgeon.

Traumatic bursitis

Traumatic bursitis
Often observed in the area of ​​the patella (prepatellar bursitis). It is an inflammation of the synovial bursa. Pathology can occur in acute or chronic form. Chronic bursitis is characterized by pain only with maximum flexion of the limb, as well as with palpation.

The massage begins with impact on the thigh muscles. Next, the anterolateral surface of the knee is stroked and rubbed. To do this, use the base of the palm and four fingers gathered in a bun. Massage the area above and below the patella. Finish with flexion and extension of the knee and stroking the entire injured leg.

Injury

With a bruise, hemarthrosis and synovitis can develop. Hemarthrosis is a consequence of vascular rupture. As a result, blood accumulates inside the joint. Inflammation after injury is reactive and leads to the accumulation of exudate in the knee.

Treatment requires joint puncture. A mobilization bandage is often applied. Massage is performed to resolve effusion, prevent atrophy of the quadriceps femoris muscle, and eliminate pain.

Ligament damage

Complete ligament rupture is treated surgically. Long-term immobilization of the knee is then required. Massage is used only for incomplete rupture, as part of conservative treatment, or at the rehabilitation stage. It helps relieve pain and restore joint function. They only affect the thigh muscles, and the knee joint itself is only stroked.

Meniscal damage

Meniscal tears are treated surgically in most cases. Occasionally, such injuries are treated conservatively (in case of minor injuries in the paracapsular zone of the meniscus).

During the acute period of injury, massage is done to reduce pain and speed up the resorption of effusion. It can reduce recovery time. Only the thigh muscles are massaged, stroked and kneaded. Massage of the knee itself can be done from the second or third day.

Reasons for the development of contracture

The appearance of contracture may be due to unsuccessful operation, prolonged immobilization of the knee joint, or improper behavior of the patient in the postoperative period. Note that a slight limitation of knee mobility in the first days after surgery is quite normal.

Table 1. Types of contractures.

A device for increasing the range of motion.

Functional temporary contracture is the least dangerous. With timely diagnosis and adequate treatment, you can quickly get rid of it. If the limitation of knee mobility is persistent and is accompanied by organic changes in the joint or periarticular tissues, it will be much more difficult to recover. Most likely, the only way to get rid of such contracture is through surgery.

Curious! Without active movement, muscles can gradually atrophy and become unable to contract normally. This can be avoided through early mobilization. That is why doctors make sure that the patient gets out of bed as early as possible with the help of crutches, begins to walk and perform special exercises.

Massage after a knee fracture

Massage after a knee fracture
Massage is done for the following purposes:

• prevention of hip muscle atrophy during the period of immobilization;
• strengthening regenerative processes;
• reducing pain and eliminating swelling.

If a plaster splint is applied, massage begins on the third or fourth day. It helps to quickly get rid of hematoma and swelling. After removing the plaster, a gentle massage of the knee is indicated. The main attention should be paid to the quadriceps femoris, as it is most susceptible to atrophic changes.

Massage for knee contracture

Contracture is stiffness. It is mainly the result of injury or surgery. Contracture is also a complication of long-term immobilization of the leg.

The problem with this disease is associated with anatomical changes in the soft tissues. Scars appear in it. The purpose of the massage is to loosen the scar, increase its mobility and develop the joint.

A massage effect is performed on the antagonist muscles. At the same time, muscle stretching exercises are performed. Often, after removal of the cast, patients experience atrophic processes in muscle tissue. The more pronounced they are, the softer the massage effect should be. Mainly muscles are massaged. This excludes techniques such as tapping, chopping or squeezing.

Massage accelerates blood flow in the muscles. It has a positive effect on metabolism, normalizes muscle tissue trophism, and improves joint mobility. But sometimes massage and exercises do not work, and then contractures have to be treated surgically.

Types of contractures

Quite often, acquired contracture results from neurological or post-traumatic causes. Based on the root causes of formation, pathologies of several types are distinguished:

1. Neurogenic. The neurogenic type is preceded by problems of the central nervous system, cerebral hemorrhages, paralysis or cerebral palsy;
2. Androgenic. The cause of this type of contracture is degenerative changes in the ligament system or joints. As a rule, such a disease is a consequence of intra-articular or periarticular dislocations, severe bruises or fractures;
3. Desmogenic. This type of contracture appears due to traumatic deformation of ligaments, as well as connective membranes and articular joints;
4. Dermatogenic contracture occurs as a result of thermal damage to the epidermis - wounds or burns affecting the knee area;
5. Myogenic. Muscle ischemia, as well as prolonged pressure on the muscles of the limbs and the chronic form of myositis lead to the appearance of stiffness;
6. The reflex form is a consequence of injuries that lead to incomplete mobility of the joint.