CONTRACTURE - limitation of the normal range of motion in the joint. The decrease in mobility is usually due to the shortening of extraarticular soft tissues as a result of damage or disease.
Congenital contractures are a component of such congenital malformations as clubfoot , muscle 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 area of traumatic, infectious and other lesions of the joints and surrounding tissues, after injuries of tendons and amputations, as a result of reflex muscle tension, impaired muscle balance with flaccid and spastic paralysis, and prolonged limb immobility.
Depending on which tissue predominates in the resulting contracture, dermatogenic, desmogenic, tendogenic, myogenic and arthrogenic contractures are distinguished. Dermatogenic (skin) contractures are caused by skin scars after burns or inflammatory diseases.
Desmogenic contractures are the result of wrinkling of the fascia and ligaments after deep damage, in chronic inflammatory processes, and also develop in some diseases (for example, Dupuytren's contracture is fibrosis of the palmar aponeurosis).
Tendogenic (tendon) contractures are caused by shortening of the tendons or difficulty in sliding them in the synovial vagina as a result of damage, inflammation, leading to the formation of adhesions and the persistent forced position of the limb segment.
Myogenic (muscle) contractures are associated with shortening of muscles during reflex contraction or with an inflammatory process in the muscles. These contractures include restrictions on joint movements caused by impaired muscle balance in central and peripheral paralysis (paralytic contracture), prolonged muscle contraction during spastic paralysis and paresis, and protective muscle tension in response to a pain stimulus. Myogenic contractures can develop with chronic overwork and muscle strain during sports training, due to monotonous monotonous labor.
Arthrogenic (articular) contractures develop as a result of changes in the articular ends and ligament-capsular apparatus of the joint, for example, with a dystrophic process in the joint (see Arthrosis), immobilization after injuries. Psychogenic or hysterical contractures that appear suddenly during a hysterical seizure are also distinguished. Contractures are assessed as functionally advantageous and unprofitable, based on how much the preserved range of movements ensures the efficiency of the limb.
To determine the prospects of reconstructive treatment of contracture, its resistance is assessed - compliance with external corrective action. There are soft compliance of myogenic contracture and rigid elastic resistance of fixed arthrogenic contracture.
Treatment includes a set of conservative and surgical measures. Conservative treatment is primarily subject to contracture, amenable to correction. Apply drugs whose action is aimed at eliminating pain, muscle relaxants, physiotherapy (electrophoresis of novocaine, diadynamic currents), active and passive physical exercises in warm water (baths with temperatures up to 36 ° C),
medical gymnastics (active exercises aimed mainly at muscle relaxation).
With more persistent, for example, arthrogenic contractures, a course of injections of the vitreous body or pyrogenal, paraffin-ozocerite applications, intensive massage of scars and adhesions, therapeutic exercises (active and passive movements to stretch the contracted tissues), mechanotherapy using block devices and pendulum devices are prescribed. Less commonly used are methods of correcting the position of joints with the help of staged gypsum dressings and simultaneous redress (forced straightening). Favorable results in the treatment of persistent contractures can be obtained using articulated distraction devices.
With fixed contractures that are not amenable to conservative treatment, various types of surgical interventions are shown, for example, excision of constricting skin scars, muscle lengthening, tendons, their release from scars, dissection of the joint capsule.
Prevention In case of damage to the musculoskeletal system, the limb should be fixed in a functionally advantageous position for a strictly defined period, timely use therapeutic exercises and other means aimed at restoring the motor function of the limb.