Limitation of joint mobility caused by certain conditions (disease, scar contraction, injury) is called joint contracture. Joint contracture is diagnosed and treated at the Yusupov Hospital. In the diagnostic center of the clinic, you can undergo a full examination, determine the cause of the development of contracture, and receive effective treatment.
Contracture of the knee joint
Joint contractures can be passive or structural, active or neurogenic, combined. Joint contractures are classified as flexion, extension, adduction, abduction. The reasons for the development of contracture are varied:
- congenital abnormalities of muscle and joint development;
- bruises and injuries to joints and tendons;
- joint fractures;
- diseases of joints and muscles;
- diseases of the nervous system;
- age-related changes;
- prolonged joint tension;
- gunshot wound.
Contractures of the knee joint can be flexion or extension. After injury, reflex contractures may develop. Traumatic contractures are characterized by periarticular changes in soft tissues, bones, and intra-articular changes. Some patients with damage to the nervous system require not only the help of an orthopedic surgeon, but also the help of a psychologist. Psychogenic and hysterical joint contractures are an active type of contracture, they develop very quickly, and are often the end of a hysterical attack.
Contracture of the knee joint: symptoms
Symptoms of contracture of the knee joint manifest themselves in the form of discomfort when moving, limited mobility of the knee joint or a complete lack of mobility, swelling, and pain. Symptoms of knee contracture depend on the cause of the disorder. With an inflammatory process in the joint, symptoms of flexion contracture appear very quickly. As the process develops and destructive changes appear in the joint, the contracture becomes persistent, and with subluxation of the knee joint, it becomes difficult to correct.
Extensor contracture of the knee joint
Extensor contracture of the knee joint occurs after prolonged wearing of a plaster cast. As a result, atrophy of cartilage tissue, pathological changes in the ligaments, capsule, and persistent extension contracture of the knee joint may develop. The cause of extension contracture of the knee joint can be a diaphyseal fracture of the femur. The changes that accompany a femoral shaft fracture lead to limited mobility of the knee joint. Fibrous changes in the quadriceps muscle can also cause knee extension contracture.
Contracture of the knee joint: recovery time
The recovery time depends on the cause of the disorder and the severity of the disease. In some cases, conservative treatment is not successful, the doctor prescribes surgical treatment. With the help of surgery, the shape of the joint is restored and scar tissue is removed. Joint contracture is a disease that can lead to disability. The greatest difficulty in treatment is the extension contracture of the knee joint. Traumatic joint contracture goes away immediately after treatment and elimination of the cause.
Contracture of the knee joint: exercises for rehabilitation
For contracture of the knee joint, rehabilitation therapy, which includes massage, physical therapy, and physiotherapeutic procedures, is of great importance. Physical therapy exercises for knee joint contracture are aimed at increasing muscle tone and improving the condition of the joint. Training should be done daily, exercises should be performed with caution so as not to harm yourself. Restoration of the extension and flexion functions of the knee joint and ankle occurs with the help of special simulators and a set of exercises. Exercise therapy begins with a small load on the joint with a gradual increase in load.
The set of exercises is performed in a standing, lying or sitting position, with your hands supporting your thighs. The joint is flexed and extended while lying on the stomach, lying on the back, or sitting on a chair. Exercises are also carried out near the gymnastic wall - kneading. A set of exercises is developed individually for each patient by a specialist from the rehabilitation department.
Treatment of post-traumatic contracture
“Prevention is easier than cure.” Prevention of contractures is important and effective.
- An effective measure is correct fixation of the injured limb (in a natural position without excessive compression of blood vessels and nerves). Some doctors have experience in providing conditions for rapid healing of fractures without applying a plaster cast.
- Promoting mobility of the joints of the injured limb as quickly as possible (passive and active gymnastics improves blood supply and nerve trophism, accelerates healing, and prevents the formation of scar tissue). If real movement is not possible, visualization of a variety of movements gives good results. Experiments have shown that people who did not stop training in their imagination recovered much faster and more fully, even after very serious injuries and a long period of complete immobility.
- Timely relief of pain and prevention of the development of edema and insufficient blood supply to tissues are the most important factors in the aggravation of contractures (pain relief, physiotherapy).
- If the injury does not require emergency hospitalization (and surgery), an osteopathy session (or sessions) provides an excellent effect. In this section of medicine there is the so-called. 72-hour rule: it is after this period that the injury is fixed in the tissues. Within three days from the moment of injury, there is a real opportunity to reconfigure the tissues to the “health matrix” and create conditions for the rapid and correct restoration of the integrity of the structures and their natural mobility.
Contracture of the elbow joint
Contracture of the elbow joint refers to pathological conditions characterized by difficulty in flexion, extension, and turning the forearm inward and outward. The most common flexion and extension contractures of the elbow joint. The reasons for this violation are:
- developmental anomaly;
- injury;
- degenerative-dystrophic process in the elbow joint;
- long-term immobilization;
- connecting scar.
Disability due to contracture of the elbow joint rarely develops, unlike contractures that affect the joints of the legs and often lead to disability.
Contracture of the elbow joint after a fracture
There are contractures with limitation of movements: flexion, extension, supination and pronation. The elbow joint is most often affected by flexion contractures. The cause of the development of contracture of the elbow joint is periarticular fractures and dislocations, incorrect alignment of bone fragments after a fracture. The cause of contracture can be hemarthrosis, the formation of adhesions and the inflammatory process in the periarticular tissues.
Extracorporeal shock wave therapy
Shock wave therapy is based on the use of therapeutic mechanisms of shock wave action on pathological tissues of the body. Shock waves are high-energy sound pulses in the low or high frequency range.
ESWT promotes the formation of new vessels in the treatment area, due to which tissue regeneration processes are accelerated, pain is relieved and the function of the affected limb or organ is restored. A number of researchers confirm the feasibility of using shock waves in the treatment of diseases of the musculoskeletal system.
In patients with contractures, muscle tone decreases, bone growths loosen, dense pathological foci in tissues soften, and blood supply in the affected area improves.
Rice. 5. Use of ESWT in the treatment of diseases of the musculoskeletal system
Contracture of the wrist joint after a fracture
Contracture of the wrist joint is one of the complications after a fracture. The wrist joint is a complex anatomical complex formed by a large number of bones; the full functioning of the joint is carried out by various connective tissue structures and muscles. The most common fracture of the radius occurs near the synovial joint, resulting in contracture. It is not the fracture of the wrist bone itself that causes damage to the joint, but damage to the connective tissue structures involved in the functioning of the joint. Contracture can be caused by an intra-articular fracture, which is accompanied by damage to the articular cartilage tissue, ligaments and capsule.
Literature review
A group of Russian doctors studied the effectiveness of shockwave therapy for contractures. For the study, they selected 86 patients whose disease duration was up to 3 years. All were prescribed a course of shockwave therapy consisting of 5 sessions. During each procedure, the doctor first identified trigger points and then impacted them with impulses of varying depths. After completing the course of therapy, 80% of patients noted a significant positive effect - pain was relieved, muscle hyperspasm disappeared, trigger zones were eliminated, which collectively led to relief from contractures.
Another group of Russian scientists studied the effectiveness of shockwave therapy for myofascial syndrome. The authors included 650 patients in the study; all patients were prescribed a course of shock wave therapy. After the end of treatment, pain was relieved in 96% of the subjects and range of motion was restored.
Another group of Russian doctors conducted a study on 46 patients with post-traumatic contracture of the shoulder joint after a long period of immobilization. All patients received 5-6 sessions of shock wave therapy. After completing the course, 60% of patients noted a complete restoration of the range of motion in the joint. One patient had no effect. The rest confirmed a decrease or complete relief of pain.
Several medical groups have noted the positive effect of shockwave therapy for osteoarthritis accompanied by the formation of contractures. The inclusion of shock waves and low-frequency laser radiation in complex therapy allowed 70% of patients to achieve a pronounced therapeutic effect - pain relief and restoration of joint movements.
A study on the effectiveness of using shockwave therapy in the treatment of Dupuytren's contracture in miners was conducted by O.V. Makhotina. After a course of shock wave treatment, 57% of patients experienced a significant reduction in pain, an increase in range of motion, and a decrease in the size of pathological formations on the palmar aponeurosis.
Combined contracture of the hip joints
Contracture in the hip joint is most often observed in the position of adduction and flexion, and in most cases develops in older people. The main reason for the development of contracture is a fracture of the femoral neck, deforming coxarthrosis. In young people, contracture of the hip joints occurs due to innervation in the lower spine. Extensor contracture of the hip joints develops with damage to the spinal cord; it manifests itself in the form of a tonic extension position of the lower extremities (hips, legs). The most common is combined contracture of the hip joints.
The Yusupov Hospital diagnoses and treats fractures, injuries, and complications that develop subsequently. Diagnosis of contracture can be done in a diagnostic center using modern medical equipment from leading manufacturers in the world. The hospital provides inpatient services and a rehabilitation center. In the rehabilitation center, the patient will be able to undergo recovery from illness according to an individual program developed by a rehabilitation specialist. Classes at the center are conducted with an instructor, patients perform physical therapy exercises, and exercise on simulators. You can make an appointment with a doctor by calling the Yusupov Hospital.