Definition and Overview

Contractures are deformities or “permanent shortening” of the muscles or joints that occur when the soft tissue under the skin loses its elasticity and becomes unable to stretch. It may also affect tendons and ligaments, and may occur in any part of the body. The most common trigger is prolonged muscle spasticity in the affected area, usually as a result of an underlying condition such as cerebral palsy. They often result in restricted or limited movement of the affected body part, as well as pain, thus prompting patients to seek treatment in the form of physical therapy.

Cause of Condition

Contractures are formed when muscles or joints remain too tight for a prolonged period, causing them to become shorter and thus unable to function as normal. The common belief is that once a contracture forms, it cannot be fixed by exercise or stretching. Common causes include:

  1. Underlying conditions of the brain and nerves - Contractures of the muscles and joints can be due to several underlying conditions or disorders affecting the brain and nervous system, such as cerebral palsy, polio, rheumatoid arthritis, stroke, and nerve damage.

  2. Genetic condition – They also sometimes occur as an inherited disease, such as in the case of muscular dystrophy, a condition characterized by weak muscles and tissue loss

  3. Prolonged lack of mobility in the affected limb

  4. Traumatic injury

  5. Burns

Due to their possible causes, muscle and joint contractures are considered to be both orthopedic and neurological in nature.

Key Symptoms

Stiffened and shortened muscles, joints, and soft tissues cause only a few but very specific and easily recognizable symptoms, namely:

  • Pain in the affected area
  • Some inflammation
  • Restricted movement or limited range of motion

Shortened muscles may also present in different identified forms, such as:

  • Volkmann’s contracture – Also known as an ischemic contracture, this type of problem affects the hand near the wrist and causes the fingers to become deformed, appearing like claws. It also hinders the patient from extending the fingers or makes doing so very painful.

  • Dupuytren’s contracture – This affects the connective tissue in the palm, which can thicken and eventually form a benign nodule or lump. The lump is caused by cords of tissue, which becomes shortened. Although these are usually painless, they can worsen over time.

Who to See and Types of Treatment Available

Anyone experiencing a sudden limited range of movement in a specific body part should seek medical attention, as this is a sign of a contracture. This can be brought to the attention of a general physician who can make a referral to an orthopedist or physical therapist for succeeding treatment. Contractures are typically diagnosed with the help of x-ray scans.

Treatment for contractures usually involve a combination of:

  • Medications – When muscle contractures are causing pain and inflammation, medications may be used to relieve these symptoms.

  • Physical therapy – Physical therapy sessions are important in the treatment of muscle or joint deformities. The purpose of these sessions is to strengthen the muscles, prevent further contractures, and try to increase the patient’s range of motion. However, these are more effective when done on a continuous basis, and when supported by exercises that the patient can do at home. Physical therapy can also be used as a preventative measure by people with an increased risk of contractures, such as those suffering from cerebral palsy or those who stay in the hospital for a prolonged period.

  • Assistive devices - The use of braces, splints, or wheelchairs are of great help for people suffering from contractures.

  • Electrical stimulation or heat therapy – These are newer, non-traditional techniques that may also be used in an attempt to postpone or avoid surgery

  • Surgery – The above treatments are, however, not long-term solutions and are merely geared towards relieving symptoms. Contractures can only be completely resolved or treated through orthopedic surgery, in which the tightened muscles are released.

If treatment is started at an early stage, there is a good chance that the patient will regain full range of motion in the affected body part. On the other hand, the longer it takes for a contracture to be treated, the more difficult it will be for the patient to regain motion.

Contractures are also easier to prevent than to treat. Regular exercise can help keep muscles and joints from stiffening.

References:

  • Campbell M, Dudek N, Trudel G. Joint contractures. In: Frontera WR, Silver JK, Rizzo TD Jr., eds. Essentials of Physical Medicine and Rehabilitation. 3rd ed. Philadelphia, PA: Saunders Elsevier; 2014:chap 126.

  • Skalsky AJ, McDonald CM. Prevention and management of limb contractures in neuromuscular diseases. Phys Med Rehabil Clin N Am. 2012;23:675-687.

  • Tufaro PA, Bondoc SL. Therapist's movement of the burned hand. In: Skirven TM, Osterman AL, Fedorczyk J, Amadio P, eds. Rehabilitation of the Hand and Upper Extremity. 6th ed. Philadelphia, PA: Mosby Elsevier; 2011:chap 26.

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