dr Yuda Handaya, SpB,FInaCs,FMAS

Contractures are the chronic loss of joint motion structural changes in non-bony tissue

These non-bony tissues include muscles, ligaments, and tendons.

Can occur at any joint of the body This joint dysfunction may be a result of :

immobilization from injury or diseasenerve injury (spinal cord damage &

stroke) or muscle, tendon, or ligament

disease.

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 nervous system.

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

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

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

Manual techniquesJoint 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.

Casting or splinting◦ used to provide a constant stretch to the soft tissues

surrounding a joint.◦ initial holding cast is applied for seven 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.

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.

Prognosis◦ Depend upon the cause of the contracture. ◦ In general, the earlier the treatment for the

contracture begins, the better the prognosis. Prevention

◦ 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.