Joint contracture: causes, symptoms, types and treatments

Joint contracture is a steady decrease in the amplitude of movements due to changes in soft tissues and other structures around them. This condition interferes with the performance of the usual actions and can significantly impair the quality of life.

In this article, we will understand what joint contracture is, how to distinguish it from other problems, when diagnosis is needed and what treatment methods are used.

What is joint contracture?

In simple words, contracture is a condition where a joint cannot fully bend or extend. Most often, the reason lies in pathological changes in tissues: capsules, ligaments, tendons, fasciae, skin, and sometimes intra-articular structures.

IN medical practiceIt is believed that contractures are formed when elastic soft tissues are replaced by more rigid ones, and this leads to chronic loss of mobility.

Contractures can be the result of various pathological changes: injuries, inflammation, long immobilization, neurological disorders, degenerative processes. Regardless of the nature, they require diagnosis and treatment. The earlier recovery begins, the easier it is to restore joint function without radical interventions.

How contracture differs from ankylosis

Both problems have similar manifestations — stiffness and a decrease in the volume of movements in the joint. But their The mechanisms are different:

1. Contracturemainly associated with changes in soft tissues and their shortening.
2. Ankylosis— this is a restriction of movements due to fibrosis or even fusion within the joint.

What are the types of joint contracture?

Joint contracture is a large group of pathologies that are similar in symptoms, but different in origin and course. To choose the right method of treatment, you must first make an accurate diagnosis. Next, consider the classification.

By the mechanism of occurrence

The causes of pathology are divided into:

• muscular (myogenic)— shortening or spasm of muscles;
• articular (arthrogenic)— changes in the capsule, cartilage, intra-articular structures;
• cicatricial or cutaneous (dermatogenic)— tightening of the skin after burns, wounds, surgery;
• nervous (neurogenic)— tone, spasticity, impaired movement control after damage to the nervous system.

There are also contractures of combined origin, when the restriction is affected by several structures at once.

By the nature of the restriction of movements

Flexural contracture — when the joint is fixed in a bent position and does not extend to the end. Extensional — when the limb is straightened and cannot bend in sufficient volume.

In progress

Acute conditions are considered when changes occur suddenly, such as after an injury or inflammation. They need early inspection and correction. The earlier help is provided, the less likely the problem will be fixed.

Chronic joint contracture is a persistent disorder that is maintained for months or years. It causes additional risks of secondary problems — improper muscle load, wear of joint structures, pain.

Main causes and origin of contracture

Contractures usually occur in the following scenarios:

• immobilization after fractures and injuries (plaster, orthosis, forced rest);
• postoperative changes and scarring of tissues;
• chronic inflammation with arthritis or the consequences of joint overload;
• neurological conditions with spasticity or weakness;
• burns and skin damage in the joint area.

A separate example is the brush. There, pathological changes can occur against the background of tendon or connective tissue disease (for example, palmar fibromatosis), as well as after finger injuries.

Symptoms of joint contracture

Key features are:

• decrease in the amplitude of movement without relief over time;
• feeling of tension in the muscles or tissues around;
• pain syndrome when trying to bend or bend a limb;
• restriction of mobility after sleep or prolonged static posture;
• visual change in the position of the joint or fingers.

How does contracture affect daily activity?

Usually, patients go to the doctor when contracture begins to interfere with everyday affairs. It becomes more difficult to dress, work with your hands, climb stairs, keep balance. If the joint does not extend, the body changes the technique of movement, and this leads to an overload of other zones: back, pelvis, healthy limb.

This looks like a vicious circle:

1. Less movement due to stiffness.
2. Less load.
3. Lower elasticity of fabrics.
4. More stiffness.
5. Even fewer movements.

Risk factors for developing contracture

The exact causes of joint contracture are not always known. But science identifies the following factors that increase the risk of developing pathology:

• age and decreased elasticity of tissues;
• repeated injuries of one joint;
• arthrosis;
• work with monotonous loads on one muscle group;
• diabetes, smoking, systemic inflammatory diseases;
• periods of forced inactivity (after surgery, stroke, prolonged pain).

Possible complications

Without medical care, the problem can worsen, causing the following consequences:

• increased deformation and persistent loss of joint function;
• chronic pain and changes in gait or posture;
• overload of ligaments and tendons;
• decrease in muscle strength due to forced restriction of activity;
• psychological changes due to the abandonment of the usual way of life.

Diagnosis of the disease

Immediately after symptoms appear, a doctor should be consulted to assess the changes — the nature, extent and impact on the structures around.

Diagnosis usually includes:

• collection of anamnesis and assessment of complaints;
• examination, measurement of the volume of movements in the joint, tests for muscle elasticity;
• assessment of pain, sensitivity, strength, tendon work;
• if necessary — instrumental methods and other studies to clarify the reasons for the changes.

This allows you to choose the optimal treatment tactics for a particular patient.

Methods of treatment of articular contracture

In Mashtaler Ortho&Trauma Center, conservative and minimally invasive methods are preferred — they are easier to tolerate by patients, have fewer consequences and a shorter rehabilitation period. But in the case of persistent violations, we recommend surgery, which allows greater efficiency and lower risks of recurrence in such cases.

Conservative treatment

Physical and drug therapy is used to restore movement:

• dosed stretching;
• strengthening and increasing muscle elasticity;
• load control;
• the use of therapeutic physical education and massage;
• taking anti-inflammatory drugs, etc.

In difficult cases, parallel may be required Treatment of arthrosis. Such systemic assistance increases efficiency and reduces the likelihood of relapses.

For the brush and fingers, static progressive and dynamic tires are often considered effective non-operative methods.

Orthopedic methods

If the joints are already firmly holding the wrong position, orthoses, splints and night locks can be used. They are used in both treatment and rehabilitation — to consolidate the result and reduce the likelihood of regression.

Surgical treatment

If the contracture has been formed for a long time or there are gross structural disorders, surgical intervention is considered. This is true when conservative methods do not make progress, the restriction of movements increases, or the limb is fixed in a forced position.

In modern practice, the following approaches are used:

• Arthrolysis— release of the joint from scar adhesions and blocks to restore the volume of movements;
• capsulotomy— dissection or relaxation of the dense joint capsule when it is reduced;
• tenolysis— freeing the tendons from scar joints, if they do not slide well;
• Fasciotomy or fasciectomy— removal of pathologically altered fascia in certain types of contractures;
• corrective operationson soft tissues and ligaments, if they hold the joint in the wrong position.

After surgery, phased development, orthoses or sequential plastering are often used to consolidate the result and not lose the mobility achieved.

There are specific solutions for the brush, in particular the treatment of Dupuytren's contracture (palmar fibromatosis) with minimally invasive methods. Needling or needle aponeurotomy reduces tissue injury and simplifies rehabilitation. But it has its limitations, and therefore surgical treatment with the removal of pathological weights continues to be used in difficult cases.

Rehabilitation after treatment and restoration of mobility

The main task after the active phase of treatment is to maintain the achieved amplitude and regain control of movement. In the first 1-2 weeks, the main emphasis is on the gentle restoration of movements without jerks, so that the joint gets used to working in a new volume. Then add exercises for coordination and accuracy, especially when it comes to the hand and fingers. At 3-6 weeks, the load is gradually connected to the strength so that the muscles stabilize the joint again and there is no feeling of weakness during household tasks.

Rehabilitation often includes home exercises, muscle work, a gradual increase in load, and sometimes orthoses at night. Orthosis helps to hold the correct position while the tissues adapt and reduces the risk of regression. In the rehabilitation of any type of contracture, regularity is a priority. Systematic exercises are much more useful than one-time attempts to shake the joint due to pain, resistance and discomfort.

If after training the symptoms increase sharply or persistent swelling appears, the program should be adjusted together with a specialist.

Prevention of joint contracture

The main thing in prevention is to create conditions for free movement and uniform load. It includes:

• compliance with the recommendations of the doctor during rehabilitation after injuries and operations;
• gradual return of mobility after a temporary limitation, without overexertion;
• tracking pain — especially in people who perform heavy physical labor;
• maintaining muscle strength around the problem joint;
• timely contact a doctor in case of a feeling of blocking of movement.

Where to go for diagnosis and treatment of contracture?

If you experience persistent movement restriction, tissue compaction, pain or impaired joint function, make an appointment for a consultation at Mashtaler Ortho&Trauma Medical Center. We apply an integrated approach to diagnosis and treatment of contractures — from the initial assessment of joints and tissues to the selection of therapy and rehabilitation strategy for each patient.

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