Contractures reduce joint mobility and impair motor tasks and limit the activities of people with spinal cord injuries. They reduce a person`s independence. Information about contractures (patient education) and commitment to good care (proper positioning/passive movements) by patients and caregivers can help prevent the development of contractures. In addition, the identification of joints with a higher risk of contractures by the therapist is very important so that they can be used in a targeted manner through intensive preventive rehabilitation interventions. [2] [3] DOCTORS AT UPMC Orthopaedic Care offer many contracture treatments to loosen and relax stiff areas. Inflection deformities can be caused by various causes. Two types of knee flexion contracture can be distinguished Patients with flexion contractures often go with a bent knee passage. Patients often report sleeping with a pillow below the knee or in the fetal position. All these activities exacerbate the bending contracture.
This causes an increasing load on the quadriceps and an increase in load contact forces in the patellofemoral joint and in the tibiofemoral joint when the flexion deformation is greater than 15 degressions of the stretch delay. There is no evidence that botulinum toxin alone produces a clinically rewarding or sustained treatment effect on contractures. To confirm a diagnosis of contracture, your doctor may also order imaging tests, such as: Factors predisposing patients to contractures[4]: Exercise is essential to maintain the passive mechanical properties of soft tissues. Animal models show that soft tissues undergo a remodeling process when subjected to prolonged immobilization in a shortened position, resulting in loss of extensibility and length, and then limitations in the joint area[7][8][9][10][11][12][13][14][15]. A study with ultrasound imaging showed that muscle tendon units and muscle facicles are shorter at high tension in muscles with contractures in people with brain damage [16]. Your doctor may use one or more of the following measures to treat your contracture: Spasticity is a change in muscle tone. It is caused by injuries to the brain or spine, such as . B stroke. It can also lead to contractures. People without early signs of motor recovery are prone to contractures.[17][18][19] Muscle weakness after acquired brain injury is due to impaired neuronal input due to brain damage that interferes with neuronal recruitment and voluntary muscle activation.
Muscles can be further weakened by non-use. Severe weakness or lack of muscle activation immobilizes a limb and deprives the soft tissues of stretching. This predisposes muscles placed in shortened positions to contractures. Similarly, a muscle imbalance (resulting from the fact that a muscle group is much weaker than the antagonist group) can put the joints in fixed positions and increase the risk of contractures. A number of studies have demonstrated the strong link between contractures and muscle weakness or associated motor deficits such as decreased dexterity, functioning and mobility. [17] [20] [21] [22] [23] Spasticity is one of the well-known contributors to contractures. Interventions that reduce spasticity appear to be helpful in preventing or correcting contractures. Treatment indications are based on the effects of the disease on the patient`s quality of life. Many patients with a positive table test, 30-degree MCP contracture or 15-20 degree PIP contracture will opt for treatment.
A contracture occurs when your muscles, tendons, joints, or other tissues tighten or shorten, causing deformity. Symptoms of contracture include pain and loss of movement in the joint. If this is the case, you should seek treatment immediately. Doctors can treat contractures with medications, casts and physiotherapy. Plaster castings are a viable approach to treating contractures. These are non-removable external gypsum or gypsum adhesive tape devices that are used to modify the structural or functional properties of the neuromuscular system [7]. The affected joint is heated to moist heat and stretched manually to maintain maximum range of motion. The cast is applied by the therapist and left for two to seven days, depending on the treatment. It was removed so that the skin could be checked for pressure sores and then reapplied in a new position with greater stretching for several days until the contracture disappeared enough to allow for adequate ROM [2]. Electrical stimulation is potentially useful in treating the causes of contractures because of its effects on improving muscle strength and spasticity [52][53][54][55][56][57][58]. Passive stretching was the most widely used method to prevent and correct contractures.
Observations that soft tissues are structurally reshaped and elongated when exposed to prolonged stretching support the rationale for using passive stretching for contracture management. A standard protocol for the postoperative treatment of Dupuytren`s disease is presented below (Engstrand et al. in 2009). [8] According to a prospective cohort that looked at the frequency of contractures after one year after spinal cord injury, 66% of patients developed at least one contracture in each joint one year after an acute spinal cord injury. The proportion of participants with spinal cord injury who developed at least one contracture in a joint was 47%, while the proportion of participants with tetraplegia who had at least one contracture in one joint was 83%. [3] Baagã ̧e SK, Kofoed-Hansen M, et al. Development of muscle contractures and spasticity during subacute rehabilitation after severe acquired brain injury: a prospective cohort study. Brain damage. 2019; 33(11):1460-1466. The orthosis reduces contractures by prolonging stretching with a low load and maintains the length of the joints. Splints can be used to prevent and reduce contractures. Orthotics can be used to reduce contractures by prolonged stretching at low load.
The splint can help prevent and manage length-related changes in muscles and connective tissue. Splints can be combined with passive movements, active tissue stretching procedures and/or stressful exercises. Splints can be used overnight to apply sustained stretches for muscle lengthening.[7] The dynamic splint is another option to get repeated stretches. A spring or elastic band provides tension to move the joint in the desired direction. [2] Depending on the etiology and severity of the deformation, different management programs are required. .