CONTRACTURE - limit the normal range of motion in the joint. Reduced mobility is usually due to the shortening of extra-articular soft tissue as a result of injury or disease.
Congenital contractures are a component of such congenital malformations, such as club foot , muscle torticollis , arthrogryposis, and others. 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 tendon injuries and amputations, as a result of muscle reflex tension, muscle imbalance disturbances in flaccid and spastic paralysis, and long limb immobility.
Depending on which tissue prevails in the formed contracture, dermatogenous, 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 shrinking fascias and ligaments after deep injuries, 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 the difficulty of their slipping in the synovial sheaths as a result of damage, inflammation, leading to the formation of adhesions and persistent forced position of the limb segment.
Myogenic (muscle) contractures are associated with shortening of the muscles during their reflex contraction or inflammation of the muscles. These contractures include movement restrictions in the joints caused by muscular imbalance in central and peripheral paralysis (paralytic contracture), prolonged muscle contraction with spastic paralysis and paresis, and protective muscle tension in response to a painful stimulus. Myogenic contractures can develop during chronic overwork and overstrain of muscles in the process of sports training, due to monotonous monotonous work.
Arthrogenic (articular) contractures develop as a result of changes in the articular ends and the 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, which appear suddenly in a hysterical seizure. Contractures are evaluated as functionally advantageous and disadvantageous, based on how well the preserved range of movements ensures the performance of the limb.
To determine the prospects for rehabilitation treatment of contracture, its persistence is evaluated - compliance with external corrective action. There is a soft compliance of myogenic contracture and rigid elastic resistance to a fixed arthrogenic contracture.
Treatment includes a complex of conservative and operational measures. Conservative treatment is primarily subject to contracture, amenable to correction. Apply drugs whose action is aimed at eliminating pain, muscle relaxants, physiotherapy (novocaine electrophoresis, diadynamic currents), active and passive exercise in warm water (baths with temperatures up to 36 ° C)
remedial gymnastics (active exercises aimed mainly at relaxing the muscles).
With more persistent, for example, arthrogenic contractures, a course of vitreous body or pyrogenal, paraffin-ozokerite applications, intensive massage of scars and adhesions, therapeutic exercises (active and passive stretching movements of contracted tissues), mechanotherapy with block units and pendulum apparatus are prescribed. Less frequently, methods are used to correct the position of the joints using graded plaster castings and simultaneous redressing (forced straightening). Favorable results in the treatment of persistent contractures can be obtained by 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 tightening skin scars, lengthening of muscles, tendons, their release from scars, dissection of a joint capsule.
Prevention. In case of injuries of the musculoskeletal system, the limb should be fixed in a functionally advantageous position for a strictly defined period, and timely use of therapeutic exercises and other means aimed at restoring the motor function of the limb.