CONTRACT

CONTRACT - limiting the normal amplitude of movements in the joint. Reduction of mobility is usually due to shortening of extraarticular soft tissues as a result of damage or disease.

Congenital contractures are a component of such congenital malformations, such as clubfoot , muscular torticollis, arthrogryposis, etc. A favorable outcome in these cases is possible with timely diagnosis of the underlying disease and targeted treatment of contracture.

Acquired contractures develop as a result of scarring in the field of traumatic, infectious and other injuries of joints and surrounding tissues, after injuries to tendons and amputations, as a result of reflex muscle tension, muscle balance disorders with flaccid and spastic paralysis, and long limb immobility.

Depending on what kind of tissue prevails in the resulting contracture, distinguish between dermatogenic, desmogenic, tendogenic, myogenic and arthrogenic contractures. Dermatogenic (skin) contractures are caused by skin scars after burns or inflammatory diseases.

Desmogenous contractures are the result of the wrinkling of the fascia and ligaments after deep damage, with chronic inflammatory processes, and also develop in certain diseases (for example, Dupuytren's contracture is fibrotic aponeurosis).

Tendogenous (tendon) contractures are caused by shortening of the tendons or difficulty in sliding them in the synovial sheaths as a result of damage, inflammation leading to adhesion and persistent forced position of the limb segment.

Myogenic (muscle) contractures are associated with a shortening of the muscles during their reflex contraction or with an inflammatory process in the muscles. These contractures include the limitations of joint movements caused by a violation of muscular balance in central and peripheral paralysis (paralytic contracture), a prolonged muscle contraction in spastic paralysis and paresis, a protective muscle tension in response to a pain stimulus. Myogenic contractures can develop with chronic overfatigue and muscle strain during sports training, in connection with monotonous monotonous work.

Arthrogenous (joint) contractures develop due to changes in articular ends and ligamentous-capsular apparatus of the joint, for example, in the dystrophic process in the joint (see Arthrosis), immobilization after injuries. There are also psychogenic, or hysterical contractures that appear suddenly in a hysterical fit. Contractures are evaluated as functionally beneficial and disadvantageous, based on how much the remaining volume of movements ensures the performance of the limb.

To determine the prospects for restorative treatment of contractures, its resistance is assessed - compliance to external corrective effects. Distinct soft compliance of myogenic contracture and rigid elastic counteraction of fixed arthrogenic contracture.

Treatment includes a set of conservative and operational measures. Conservative treatment is primarily subject to contractures that are amenable to correction. Apply drugs that are aimed at eliminating pain, muscle relaxants, physiotherapy (Novocain electrophoresis, diadynamic currents), active and passive physical exercises in warm water (baths with a temperature of up to 36 ° C),

Curative gymnastics (active exercises aimed mainly at relaxing the muscles).

With more resistant, for example, arthrogenic contractures, a course of vitreous or pyrogenal injections, paraffin-ozocerite applications, intensive massage of scars and adhesions, therapeutic gymnastics (active and passive movements on stretching of cut tissues), mechanotherapy with the help of block installations and pendulum apparatuses are prescribed. Less commonly, methods are used to correct the position of the joints with the help of gradual cast plaster and one-stage redress (forcible straightening). Favorable results in the treatment of persistent contractures can be obtained by using hinged-distraction apparatus.

With fixed contractures that do not lend themselves to conservative treatment, various types of surgical interventions are shown, for example, excision of constrictive skin scars, lengthening of muscles, tendons, their release from the scars, dissection of the capsule of the joint.

Prevention. In case of injuries to the musculoskeletal system, the limb should be fixed in a functionally advantageous position for a strictly defined period, in due time apply therapeutic gymnastics and other means aimed at restoring the motor function of the limb.