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Joint contractures

Joint contractures

Contracture - is the restriction of mobility in joints that occurs as a result of changes in articular surfaces or functionally related to the joint tissues. Distinguish flexion contracture, extensor contracture, the outlet contracture resulting contracture, and others.

Joint contractures at birth may be congenital or acquired. The basis of congenital contractures of the joints is hypoplasia of muscles and joints themselves (torticollis, arthrogryposis, clubfoot). Acquired contracture of joints can be:

  • neurogenic - as a result of illness or injury of the nervous system
  • post-traumatic - a consequence of intra-articular or periarticular injuries, trauma or burns, soft tissue with the subsequent development of scar

Joint contracture types

Joint contracture types at birth:

  • Cicatrical joint contracture (dermostenosis) occur in the healing by secondary intention of large skin defects after burns, wounds, inflammation, and others.
  • Desmognathous joint contracture developed during contraction fascia (connective tissue plate, surrounding muscles), ligaments and joint capsule after injury or inflammatory processes in them.
  • Myogenic joint contraction, due to injuries, acute and chronic inflammation of muscles, as well as some other pathological processes in muscle.
  • Tendogenic joint contracture occur as a result of injury or inflammation of the tendons and their sheaths.
  • Artrogenic joint contracture associated with the pathological process in the joint - a impairment of the integrity of the articular surfaces or changes in the ligamentous apparatus
  • Neurogenic joint contractions, occur in diseases of the central and peripheral nervous system.

 

Cicatrical joint contracture (dermostenosis)

Cicatrical joint contracture (dermostenosis) is observed after suffered skin burns (thermal or chemical). Often occurs in children as a tightening of gross keloids skin, which lead to the concretionary fingers, pull the forearm to the shoulder, arm and torso. Joint contractures may also occur due to skin defects on the basis of mechanical trauma with subsequent ulceration of her.

 

Desmognathous joint contracture

Desmognathous joint contracture occurs due to the upcoming of wrinkling subcutaneous tissue after inflammatory processes. For example, after quinsy torticollis may occur.

 

Myogenic joint contracture

Myogenic joint contracture develops after joint injury:

  • acute or chronic diseases of the muscles (myositis).
  • contractures may also develop as a result of acute circulatory disorders in the muscle (ischemia)
  • myogenic-neurogenic form of contracture after crush limb plaster cast or pulling wiring; this kind of joint contractures is mixed, since this disease affects not only muscles but also the nerve trunks

 

Neurogenic joint contracture

Neurogenic joint contracture occur when flaccid and spastic paralysis on the grounds of injury or inflammation, and (rarely) on the background of hysteria.

There are several groups of neurogenic contractures of joints:

  • contracture, developing on the basis of paralysis or paresis of muscles caused by bleeding in the brain or central nervous system diseases, with diseases of the spinal cord they appear in the lower extremities in the form of convulsive extension in the hip and knee joints and flexion at the ankle joints
  • with diffuse spinal cord damage occurs flexion contracture of the limbs
  • in some diseases of the central nervous system are observed contractures of all four limbs, as flexion and extensor

Conditioned reflex contracture of the joint develops in the presence of functional adaptive or compensatory responses. For example, by shortening of the lower extremity patient extend it due to plantar flexion of the foot and rests it on the peripheral division (strephopodia).

Misalignment of the pelvis and the associated development of scoliosis (spinal curvature) is observed in case of irregular length of the lower extremities.

When hip flexion contracture occurs compensatory excessive bending (hyperlordosis) of the lumbar spine.

Professional joint contractures develop in connection with the performance of certain work in individuals exposed to long-term occupational hazard. Joint contractures occur acutely or may be due to chronic trauma on the background of functional loads parts of the body.

Joint contractures on the basis of burns appear more frequently in individuals working in the chemical industries, the stokers, smelters, casters. Joint contractures after the cut wounds develop mainly from carvers, cutters, shoemakers, and are myogenic, and neurogenic tendogennogo character. Do movers observed joint contractures after breaking neck or the lumbar muscles. Do football players may have joint contractures after rupture of Achilles tendon.

Joint contractures resulting from chronic injury in a static scoliosis as a result of a long asymmetric torso.

 

Joint contracture diagnosis

Symptoms and clinical manifestation of joint contractures depend on:

  • causes contracture
  • localization of the affected joint
  • age of the patient

In chronic pathological processes contracture develops slowly, and in acute inflammatory processes in joints, muscles and other tissues - rapidly. The more difficult the disease process, the more sharply pronounced contracture.

MRI of the shoulder joint in the axial proektsiipri for contracture shoulder (scapulohumeral periarthrosis).

Particularly sharp contraction expressed in diseases and injuries of the joints, often accompanied in these cases, the atrophy of the soft tissue above and below the contracture. If the contracture has developed in childhood, certainly lagging behind in growth.

MRI of the hip in the sagittal projection (ligaments, cartilage) when contracture.

To clarify the nature of the changes in the affected joint is required:

  • medical consultation - carried out the first step to clarify the functionality of the joint
  • CT (computed tomography) joint
  • MRI (magnetic resonance imaging) joint
  • pneumoarthrography
MRI of the knee in the sagittal projection (ligament, meniscus, articular cartilage) in contracture.

 

Joint contracture treatment

Conservative treatment of contractures of joints is the use of therapeutic exercises, therapeutic massage, physical therapy procedures, which allow you to restore a full range of motion in the joint, completely remove the restriction in the joint, remove the painful symptoms of motion of the joint, to improve nutrition in the joint and improve the tone of weakened muscles.

Depending on the degree and type of joint damage during contraction, the following therapeutic action:

  • drug therapy (NSAIDs, analgesics, hormones)
  • therapeutic blockade - the introduction of drugs into the joint cavity
  • manual therapy (myofascial release and chiropractic)
  • Physiotherapy (UHF, electrophoresis)
  • physiotherapy
  • surgery
In the treatment of joint contractures eliminate swelling, inflammation, pain, restore range of motion in the knee joint and its muscles accelerated by the use of physiotherapy.