Contracture

Hendy Buana Vijaya

 Description
• Tissue contractures are commonly caused by the shortening or stiffening of
muscles and/or other connective tissues. When a contracture occurs in
muscles, tendons, or ligaments around a joint, the range of motion (ROM)
of the joint will be restricted.
• Can occur at any joint of the body. This joint dysfunction may be a result of
: immobilization from injury or disease nerve injury (spinal cord damage &
stroke) or muscle, tendon, or ligament disease.
 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: Muscular dystrophy, Cerebral palsy
• Contractures are often also associated with spasticity resulting from injuries to the
central
 Diagnosis
• Manual testing of joint mobility
• Measuring the motion of the joint with a device termed a "goniometer“
• X rays
• physical examination involving physical and manual testing of the joint
motion
Mc Cauley classification
 Risk
• A risk factor is something that increases your chances of getting a disease or
condition.
• Each of these conditions increases the risk for contractures:
a. Rheumatoid arthritis
b. Tenosynovitis (inflammation of a tendon and its sheath)
c. Polio and other diseases of nerves and muscles
d. Trauma ◦ Burns ◦ Scarring
e. Prolonged inactivity
 Symptom
• The primary symptom is loss of motion in a joint.
• Pain can also be a major symptom
 Treatment
Manual techniques
• Joint mobilization and stretching of soft tissues
Mechanical techniques
• continuous passive motion machines
• following surgery of joints.
• 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
 Treatment
Casting or splinting
• used to provide a constant stretch to the soft tissues surrounding a joint.
• initial holding cast is applied for 7 to 10 days, a series of positional casts are applied at weekly
intervals.
Surgery
• manipulation of the joint under a general anesthesia
Alternative treatment
• 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.
Hand splinting
 Surgery

Fasciotomy Tendon repair

Flap Z dan flap interpolasi
 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
• 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
 Prognosis
• Depend upon the cause of the contracture.
• In general, the earlier the treatment for the contracture begins, the better the
prognosis.