A Contracture is a fixed loss of range of motion of a joint. It is usually due to any pathology of soft tissues like muscles, tendons, ligaments, cartilages, or connective tissues.
Types of Contracture:
There are two main types of contractures:
- Reversible contractures
- Irreversible or fixed contractures.
Etiology of Contractures:
Contractures can occur mainly after immobilization or after spasticity. For example, brain injury leads to spasticity (high tone in muscles) causing immobility of muscles or joints that leads to contractures. Conversely, orthopedic conditions which require casting or bracing the joints for long period of time (treatment of fractures with an immobilizer) can cause contractures as well. These kinds of contractures seem to be more common in upper extremities than lower extremities.
Few contractures, in early stages, respond well to treatment. Consequently, clinicians, mainly rehabilitation professionals are able to gain either full or near-normal range of motion back. This also helps to gain a functional activity.
Treatment of Contractures:
The treatment of contractures includes different rehabilitation and positioning. If a contracture does not respond to conservative management and affects the quality of life, medical professionals may consider surgical intervention.
The treatment approaches include PROM or AAROM, Stretching, Proper Positioning and heat modalities. Also, Serial Casting is another option some occupational therapists will consider to gain ROM.
The main group of medications is muscle relaxants, analgesics etc to reduce pain and spasms of muscles. While some physicians consider injections in extreme cases of contractures, others do not support the use of injection for major muscle groups of lower extremities. Some injections like Botox or Phenol nerve block injection help to loosen the muscles or tendons. In turn, these types of injections also make it easier to perform ROM and stretching to improve flexibility.
- Intra Thecal Baclofen Pump
- Tendon Release (Myotendinous Lengthening)