Answer Posted / trimurtulu
Definition
Contractures are the chronic loss of joint motion due to
structural changes in non-bony tissue. These non-bony
tissues include muscles, ligaments, and tendons.
Description
Contractures can occur at any joint of the body. This joint
dysfunction may be a result of immobilization from injury
or disease; nerve injury, such as spinal cord damage and
stroke; or muscle, tendon, or ligament disease.
Causes and symptoms
There are a number of pathologies and diseases that can
lead to joint contractures. The primary causes resulting in
a joint contraction are muscle imbalance, pain, prolonged
bed rest, and immobilization. Because of the frequency of
fractures and surgery, immobilization is the most frequent
cause of joint contractures. Symptoms include a significant
loss of motion to any specific joint that results in
immobility. If the contracture is of a significant degree,
pain can result even without any voluntary joint movement.
Diagnosis
Manual testing of joint mobility by a healthcare
professional skilled in joint mobilization techniques
(e.g., a physical therapist) will identify indications of
restricted structures within the joint. Measuring the
motion of the joint with a device termed a "goniometer" can
be useful if the decrease of motion can be shown to be a
proven result of a joint contracture. X rays can be of some
benefit in the diagnosis of contractures, because a visible
decrease in joint space may indicate a tight, contracted
joint. Most physicians will make the diagnosis after a
thorough physical examination involving physical and manual
testing of the joint motion.
Treatment
Manual techniques
Joint mobilization and stretching of soft tissues is a
common technique used to increase joint elasticity.
Structures are stretched in similar directions to those
which take place upon normal joint motion. Some healthcare
professionals may use some form of heat prior to the
stretching and mobilization. If appropriate, exercise may
follow manual techniques to help maintain the additional
motion achieved.
Mechanical techniques
Devices known as continuous passive motion machines are
very popular, especially following surgery of joints.
Continuous passive motion machines (CPM) are specifically
adjusted to each individual's need. This method is
administered within the first 24-72 hours after the injury
or surgery. The joint is mechanically moved through the
patient's tolerable motion. CPM machines have been proved
to accelerate the return motion process, allowing patients
more function in less time.
Casting or splinting
Casting or splinting techniques are used to provide a
constant stretch to the soft tissues surrounding a joint.
It is most effective when used to increase motion of a
joint from prolonged immobilization. It is also popular for
treating contractures resulting from an increase in muscle
tone from nerve injury. After an initial holding cast is
applied for seven to 10 days, a series of positional casts
are applied at weekly intervals. Before the application of
each new cast, the joint is moved as much as can be
tolerated by the patient, and measured by a goniometer.
When as much motion as possible is obtained after
stretching, another final cast is applied to maintain the
newly acquired motion.
Surgery
In some cases, the contracture may be severe and not
respond to conservative treatment. In this event,
manipulation of the joint under a general anesthesia may be
necessary.
Alternative treatment
In some areas of the body, chiropractic techniques have
been found to be useful to improve motion. Massage therapy
can be beneficial by promoting additional circulation to
joint structures, causing better elasticity. Yoga can help
prevent as well as rehabilitate a contracture and can
facilitate the return of joint mobility.
Prognosis
Prognosis of contractures will depend upon the cause of the
contracture. In general, the earlier the treatment for the
contracture begins, the better the prognosis.
Prevention
Prevention of contractures and deformities from spinal cord
injury, fracture, and immobilization is achieved through a
program of positioning, splinting if appropriate, and range-
of-motion exercises either manually or mechanically aided.
These activities should be started as early as possible for
optimal results.
Key Terms
Mobilization
Making movable, restoring the power of motion in a joint.
Movement which increases joint mobility.
Muscle tone
Also termed tonus; the normal state of balanced tension in
the tissues of the body, especially the muscles.
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