Contracture of the shoulder joint is a tightening of the soft tissues of the shoulder by the resulting scars, resulting in impaired mobility of the limb. The immediate cause of the development of such a disease is scarring of the joint capsules, tendons, or tightening of the subcutaneous tissue or skin. Contracture of the shoulder joint often appears after injuries associated with damage to the integrity of the joints. Burn scars also cause the skin to tighten.
Muscle atrophy and myogenic contracture are possible when wearing a cast for a long time. Neurogenic reflex contracture is caused by nerve damage. Acute inflammation is characterized by rapid development of contracture, while chronic inflammation is characterized by slow development.
Causes
To understand what contracture of the shoulder joint is, it is worth analyzing the main causes of its occurrence? This pathology can be caused by prolonged immobilization of the limb, damage to the articular surfaces, or a disease with an inflammatory process.
The main causes of shoulder contracture include the following factors:
- Various shoulder injuries;
- The appearance of scars on the skin after a burn;
- Surgical operations in the cervical and shoulder areas;
- Improper immobilization for a fracture;
- Neurological pathologies in the form of stroke, tabes dorsalis, syringomyelia, cervical osteochondrosis with transition to scapulohumeral periarthritis;
- Pathological formations that compress blood vessels;
- Development of joint ischemia due to atherosclerosis;
- Diseases accompanied by inflammation;
- Age-related pathologies, for example, arthrosis;
- Mental disorders;
- Pathologies of the musculoskeletal system at birth.
Classification
Contractures of the shoulder joint can be structural (passive) or neurogenic (active). The neurogenic form is characterized by a change in the innervation of the elbow joint. Active contractures are:
- Psychogenic nature – hysterical contractures;
- Central neurogenic contractures: spinal or cerebral;
- Peripheral contractures, which occur when the peripheral system is disrupted.
Pathology of this form can be provoked by mental experiences, paresis or paralysis, manifested due to neurological pathologies or abnormal brain activity. These deviations occur due to a negative effect on nerve endings.
With passive contractures, structural interference interferes with the function of the joint. The factor preventing normal joint activity may be the joint itself or the periarticular tissues. represented by tendons, muscles and fascia. Formed scar tissue, shortening of muscle length, joint deformation, inflammatory process - all this can give rise to the development of the disease. Also, the cause of impaired shoulder mobility can be injury caused by physical activity or prolonged immobilization of the joint in one position.
Contractures after injuries
After receiving even
After an insignificant injury, the body subconsciously begins to limit the movement of the affected area, providing the damaged tissue with rest. This method of self-medication may lead to complete recovery of the injured joint.
For more serious injuries, immobilization of the injured shoulder is required.
Symptoms
Inadequate activity of the shoulder joint is the main symptom of shoulder contracture.
Often the pathology is accompanied by swelling, the affected joint is difficult to straighten and bend. Scar ties stretch the affected limb, fixing it in an incorrect position. An arm may be shorter than the other due to congenital contracture of the shoulder joint.
Types and degrees of contracture of the shoulder joint
There are different types of shoulder contracture. Their classification is carried out according to a number of parameters :
- plane of limited mobility (adductor or abductor contracture of the shoulder joint, flexion or extension, rotation or total);
- tissue damage (dermatogenic - skin, myogenic - muscle, neurogenic - neurological, tendon - tendon, osteogenic - bone, arthrogenic - joint);
- cause of development (post-traumatic, ischemic, inflammatory, cicatricial, degenerative, neuropathic, immobilization).
In most cases, a combined contracture of the shoulder joint develops, in which all movements of the upper limb are limited. It is typical for post-traumatic conditions and for patients who have suffered acute cerebrovascular accident. In all other cases, one or two types of contracture develop simultaneously.
During the initial diagnosis, it is important to establish the exact degree of contracture of the shoulder joint, since the choice of future treatment tactics depends on this. Orthopedists distinguish three stages of pathology development:
- true contracture is only the first degree of damage, in which limited mobility in the joint and a slight change in the skin with the appearance of pallor and tension are determined;
- at the second stage, a diagnosis of rigidity is already established, there is a significant limitation of mobility, the skin is deformed, scars may be observed in the deep layers of the epidermis;
- the third stage of contracture development is ankylosis, the formation of persistent pathological connections of the structural parts of the joint occurs, complete muscle atrophy and lack of mobility are observed.
It is possible to obtain a positive result with the help of conservative treatment only at the first stage of contracture development. If stiffness occurs, endoscopic surgery using arthroscopy may be required. During the intervention, the surgeon restores the integrity of the damaged tissues, removing connections that are already beginning to form between different structures and parts of the joint. In the third stage, only endoprosthetics (replacement) surgery will help restore the physiological mobility of the joint.
It is important to seek medical help at an early stage of contracture formation. In this case, it is possible to fully restore the function of the upper limb and reduce the risk of disability.
Treatment
To achieve results
The patient will have to undergo a complex of long-term and persistent therapy. The course of treatment is selected individually, depending on the reasons that provoked the disease.
Kinesiotherapy
The therapy is aimed at developing the shoulder joint. The technique includes two types of movement:
- Passive movements are performed only by a doctor and are aimed at smoothly and carefully stretching the muscles and tendons around the joint.
- Active exercises can be done independently. The patient performs movements with the maximum possible amplitude with a gradual increase in load. It is good to do similar gymnastics in a warm bath with the addition of aromatic oils, sea salt or relaxing herbs.
Massage
Before kinesiotherapy, experts recommend a massage session that will relax the muscles, relieve pain and warm up the shoulder joint. When treating contracture, there are several methods of influencing zones: the massage therapist actively presses on weakened muscles, kneading and rubbing the shoulder, while relaxing smooth movements are applied to the area of antagonists. During the massage, manual therapy techniques can be used.
Physiotherapy
Physiotherapy exercises for contracture of the shoulder joint are prescribed after reducing pain symptoms and relieving the inflammatory process. Exercise therapy exercises are aimed at developing muscles and strengthening antagonists. When an extensor spasm occurs, it is necessary to stretch the flexors and, accordingly, vice versa.
Joint contractures
Treatment should be comprehensive, taking into account the cause of development and the nature of pathological changes. Conservative therapy for structural contractures includes massage, physiotherapy (novocaine electrophoresis and diadynamic currents), a complex of exercise therapy with active and passive exercises, as well as muscle relaxation exercises. For more persistent restriction of movements, paraffin, ozokerite, and injections of vitreous or pyrogenal are prescribed. If the tissues have retained sufficient elasticity, staged plaster casts or one-stage redress (forced straightening of the limb) are used.
Mechanotherapy is practiced using block units and pendulum devices. To reduce inflammation and relieve pain resulting from significant stress on the affected joint, analgesics and NSAIDs are prescribed, and intradermal blockades are performed. Sometimes Ilizarov apparatuses and hinge-distraction devices are used to restore movements. The disadvantage of this method is the massiveness of the external structures - the devices have to be applied to two adjacent segments (for example, the shoulder and forearm); the advantages include the “smoothness” of the development of the joint.
If conservative therapy does not give the desired effect, surgical operations are performed. For dermatogenic and desmogenic joint contractures, scars are excised and skin grafting is performed. When the fascia shrinks, a fasciotomy is performed; when the muscles and tendons are shortened, a tenotomy and tendon lengthening are performed. For arthrogenic contractures, depending on the nature of the pathological changes, dissection of the joint capsule (capsulotomy), dissection of adhesions in the joint (arthrolysis), restoration of articular surfaces (arthroplasty) or dissection of the bone (osteotomy) may be indicated.
Treatment of neurogenic joint contractures is also complex, combining general and local measures, more often conservative. For psychogenic (hysterical) contractures, psychiatric or psychotherapeutic treatment is necessary. Treatment of central neurogenic contractures is carried out in close connection with the therapy of the underlying disease. Patients are prescribed massage, exercise therapy and rhythmic galvanization. If necessary, plaster casts are applied to prevent the limb from being placed in a vicious position.
For spinal joint contractures, the underlying disease is treated, and joint prophylaxis and treatment are carried out. Various orthopedic devices are widely used: splints, cuff and adhesive traction, structures with weights designed for gradual straightening of bent joints, etc. Exercise therapy, massage and warm baths are prescribed. For chronic contractures that prevent standing and walking, orthopedic devices and staged plaster casts are used. In some cases, surgical operations are performed.
For peripheral neurogenic contractures, therapy for the underlying disease is also carried out. To restore movements, exercise therapy, massage, stage bandages, electrical stimulation, mud therapy and balneotherapy are used. If necessary, surgical interventions are performed to restore nerve conduction and eliminate secondary adhesions in the joint area.
Prevention
To prevent the development of contracture of the shoulder joint, it is necessary to promptly and fully treat any injury, using the entire complex of rehabilitation therapy.
Correct fixation of the joint
at the required angle will help avoid rupture or stretching of the joint capsule, as well as the progression of edema and possible ischemia of the tissue around the joint. The injured arm can be fixed in an abducted position at a certain angle to prevent contractures.
Passivity of muscle tissue can lead to irreversible consequences.
To avoid such pathologies, the patient should strictly follow the specialist’s recommendations regarding the development and treatment of the affected joint, preparing himself for difficult work. The recovery period may be long, but a persistent patient will be able to overcome all difficulties and return to a full life.
Post-traumatic contracture after a humerus fracture
The most commonly diagnosed type of lesion is post-traumatic contracture of the shoulder joint, which can develop after the following injuries:
- fracture of the radius;
- rupture or sprain of the ligaments and tendons of the shoulder joint;
- rupture of the joint capsule;
- habitual shoulder dislocation.
Post-traumatic contracture of the left shoulder joint can occur with injuries to the scapula, collarbone, and spine. However, the right limb can suffer to the same extent from such injuries.
Contracture after a fracture of the humerus is often immobilization. To heal the broken bone, a plaster cast is applied and the joint is fixed in a certain position. The plaster is removed after 25–35 days, when the results of an X-ray examination show that a callus has formed. All this time there is no mobility in the shoulder joint.
If, after the plaster is removed, characteristic symptoms of contracture formation appear, it is necessary to immediately begin comprehensive rehabilitation. You need to make an appointment with an orthopedist if you have the following clinical signs:
- there was a feeling of stiffness when trying to bend or straighten, raise or lower, abduct or bring your arm towards you;
- there is no opportunity to perform the usual movement of the wound;
- the amplitude of mobility has decreased (can be compared with the opposite upper limb);
- all movements cause slight pain or a feeling of tightness in the muscles, ligaments or skin;
- external deformations of the articulation of bones are visible;
- The muscles of the upper limb and shoulder girdle are deformed and reduced in volume.
Various extraneous sounds that occur when moving your hand (creaking, crunching, clicking, crepitation, etc.) may also alert you.
To carry out differential diagnosis, you need to visit an orthopedic doctor. During the initial examination, the specialist will conduct a series of diagnostic functional texts and determine the degree of development of contracture. Then the doctor’s efforts will be aimed at eliminating the potential cause of the pathological changes. The prescription of treatment will take into account the patient's ability to perform various gymnastic exercises.