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Contractures

(Contracture Deformity)

Definition

Contractures refer to the permanent tightening of non-bony tissues, such as muscles, tendons, ligaments, or skin. The result is a loss of motion in the affected joints.

Contracture is different than spasticity, but they are often related. Spasticity is an abnormal increase in muscle tone. This can worsen the development of contractures.

Contracture Deformity of the Hand

Causes

Contractures may be caused by abnormalities of the structures surrounding a joint. These include:

Deformity
Immobility
Injury
Chronic inflammation

Certain disorders that affect nerves and muscles almost always lead to contractures. For example:

Contractures are often also associated with spasticity resulting from injuries to the central nervous system.

Risk Factors

A risk factor is something that increases your chances of getting a disease or condition.

Each of these conditions increases the risk for contractures:

Rheumatoid arthritis
Tenosynovitis (inflammation of a tendon and its sheath)
Polio and other diseases of nerves and muscles
Trauma
Burns
Scarring
Prolonged inactivity

Symptoms

The primary symptom is loss of motion in a joint. Pain can also be a major symptom.

Diagnosis

The doctor will ask about your symptoms and medical history. Your joints will be examined for restricted movement and range of motion. X-rays may be taken as well.

Treatment

Treatment includes:

Physical Therapy

Maintaining and improving range of motion is most important. Physical modalities can also be used. For example, ultrasound is often used for large joint contractures. Physical therapy helps to increase mobility, joint elasticity, and muscle strength. Some people also benefit from therapeutic massage.

Casts or Splints

Casts or splints help stretch the soft tissues surrounding the affected joint and can keep them in a more functional position. This method is often used when contractures are caused by nerve injury or immobility. Casts need to be changed regularly to reassess the joint position and avoid skin breakdown.

Medication

Medications to treat spasticity may help in the rehabilitation of contractures.

Nerve Blocks and Electrical Stimulation

In cases of severe spasticity, nerves to the affected muscles can be temporarily numbed with anesthetics. Alternatively, opposing muscles can be electrically stimulated. These actions can change the balance of forces across a joint. This therapy is often done with casting.

Surgery

Surgery may be necessary to release affected tendons, ligaments, and joints. This may be done for severe cases or for contractures unresponsive to other treatments.

Prevention

Prevention of contractures depends on the cause. After acute injuries or orthopedic surgery, contractures may be prevented by:

Early movement
Physical therapy
Continuous passive motion (CPM) machines, which mechanically keep joints in motion

Aggressive medical treatment of inflammatory conditions such as rheumatoid arthritis may also delay or prevent contractures.

RESOURCES

American Academy of Physical Medicine and Rehabilitation http://www.aapmr.org

Muscular Dystrophy Association http://www.mdausa.org

National Institute of Arthritis and Musculoskeletal and Skin Diseases http://www.niams.nih.gov

CANADIAN RESOURCES

Canadian Centre for Occupational Health and Safety http://www.ccohs.ca/

Internet Association of Orthopaedic Surgery and Trauma http://www.orthogate.org/

References

Garden F. Frontera. Essentials of Physical Medicine and Rehabilitation . Philadelphia, PA; Hanley and Belfus; 2002. Ch. 103.

Fergusson D. Hutton B. Drodge A. The epidemiology of major joint contractures: a systematic review of the literature. Clinical Orthopaedics & Related Research . 2007:456:22-299.

Huckstep RL. Management of neglected joint contractures. Clinical Orthopaedics & Related Research . 456:58-64, 2007 Mar.

Muscular Dystrophy Association. Available at: http://www.mdausa.org .

National Institute of Arthritis and Musculoskeletal and Skin Diseases. Available at: http://www.niams.nih.gov .

Revision Information

Reviewer: Teresa Briedwell, DPT, OCS
Review Date: 03/2013 -
Update Date: 00/31/2013 -

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

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