Joint contracture is an ailment that helps to limit mobility. It has many causes. The contracture is not limited to the appearance in any one joint. Moreover, the degree of limitation of mobility may be different. Most often found in the knee, ankle and elbow joints.
The concept
Joint contracture can occur due to the dynamics of adjacent soft tissues, as well as other causes, including the passage of inflammatory processes. Movements in a person become limited, which can contribute to their disability. The main treatment is performed by orthopedic traumatologists. With the progression of the disease, neurologists, psychologists, rheumatologists and surgeons can be involved.
Classification
Joint contracture can be an acquired and congenital disease. In addition, it is divided into active (neurogenic) and passive (structural). The latter, in turn, is divided into several varieties:
- myogenic - appearing with impaired muscle function;
- immobilization - arising from specially carried out measures to limit the mobility of joints (application of gypsum, tight dressings, etc.);
- dermatogenic - appearing after lacerations, burns, purulent processes against the background of epidermal scars;
- ischemic - occurring after fractures, are characteristic mainly for children;
- arthrogenic - consequences of joint pathologies;
- desmogenic - appearing as a result of limiting movements due to scars that are formed by connective tissue;
- tendogenic - associated with the traumatic or inflammatory dynamics of the ligaments.
In a separate group, there are such restrictions that appear after injuries received from firearms.
Active joint contractures for reasons of occurrence are divided into the following forms:
- psychogenic - arise with hysteria;
- neurogenic - pain (with a fixed position of the limb, formed due to an ailment), reflex (appearing with prolonged irritation of the nerves), irrigation-paretic (arising from a violation of autonomic innervation);
- central cerebral - appearing with injuries or ailments of the brain;
- spinal - developing with diseases of the spinal cord.
Each contracture is characterized by its own characteristics, in connection with which the following varieties are distinguished:
- pronational;
- leading;
- extensor;
- flexion;
- supination;
- diverting.
In addition, classification can be carried out to maintain the health of the limb. If the restrictions are functionally beneficial in nature, then the person serves himself, since his movements are targeted and specific.
With functionally disadvantageous restrictions, work cannot be performed by a person independently, since the restrictions obtained create serious obstacles. Sometimes different types combine the characteristics of both active and passive contractures. The greatest pain syndromes are observed with the development of temporary diseases. The development of their resistant varieties occurs in the first stages subtle and painless.
ICD joint contracture
The international classification of diseases is a single systematization used by physicians in the world. It is reviewed once a decade. The next review is scheduled for 2018. Here, verbal diagnoses are digitized to facilitate the analysis, storage and retrieval of data. All diseases are divided into 21 classes, and diagnosis codes include Latin letters and numbers.
The ICD-10 joint contracture belongs to the XIII class “Diseases of the musculoskeletal system and connective tissue”, it is assigned the code M24.5.
Causes
Congenital contractures appear due to genetic or chromosomal mutations or develop due to fetal malformations. In children in this case, there may be crank or torticollis.
Acquired contractures have a large list of reasons:
- prolonged immobilization;
- burns;
- gunshot wounds;
- adaptation of the body to various deformations;
- injuries and inflammatory processes in the nervous system;
- stroke;
- long fixation with plaster, tight dressings and tourniquets;
- autoimmune lesions;
- inflammatory processes in the joints;
- degenerative-dystrophic diseases ;
- ischemia;
- fatty tissue inflammation;
- joint fractures;
- soft tissue injury.
Contractures may result from surgery, spastic or flaccid paralysis. Sometimes they develop for unexplained reasons.
Developmental stages
There are three of them. At the first, there is a limitation of the amplitude of movements, but some mobility is preserved.
The second stage is called rigidity, while the joint retains limited mobility, which, with a simple examination, is not detected, but is measured using special techniques.
Ankylosis - the third stage - is characterized by the absence of any movements in the joints.
Knee Restriction
The reasons for this phenomenon may be a decrease in the elasticity of muscle tissues, a violation of the nervous system, and a genetic predisposition. Contracture of the knee joint may appear as a result of the passage of inflammatory processes, various injuries and damage to the legs.
The symptom of the disease is the inability to perform bending-extension of the legs in the knee or their implementation with great difficulty. In addition, the following phenomena are observed:
- curvature of the lower leg;
- violation of support;
- joint deformation;
- swelling
- pain in the area of damage.
With the progression of knee contracture for a long time, processes characteristic of arthrosis are detected. Diagnosis is carried out by a general examination, CT scan and MRI, as well as x-rays of the damaged area.
Restriction of movement at the elbow
Elbow joint contracture occurs for the following reasons:
- erroneous comparison of bone fragments arising from fractures;
- brain diseases;
- burns;
- congenital malformations of the elbow joints;
- purulent arthritis;
- articular hemorrhage;
- deformation or shortening of the limb;
- prolonged fixation of a certain position of the hand;
- swelling.
Shoulder Restrictions
The causes of contracture of the shoulder joint can be:
- diseases and injuries of the rotational cuff;
- mental disorders;
- joint ischemia;
- pathology of the nervous system;
- improperly applied gypsum;
- operations on the shoulders, neck, chest;
- burns, resulting in scarring;
- cervical osteochondrosis and its complications.
The disease can develop as a result of congenital abnormalities or age-related changes. Sometimes the range of motion does not exceed ten degrees, which makes the shoulder joint incapacitated. With any movement, aching pains are provoked in it. The patient hardly bends and extends his arms; he cannot bring them back or raise them.
Hip restriction
With such an ailment, the patient puts his legs in an uncomfortable position. Hip joint contracture is mainly due to hip dysplasia, Perthes disease, which are congenital pathologies, or develops after deforming coxarthrosis or injuries.
Symptoms of this ailment:
- limb shortening;
- beginning atrophy of the gluteal and femoral muscles;
- pain syndromes;
- limitation of the movements of the hip joint.
If conservative treatment does not help, do a joint replacement. Diagnosing this ailment in a child can lead to the development of arthrosis and the appearance of pain in the operated area. The girl may later encounter problems during childbirth.
Ankle restriction
It is most mobile in humans and most prone to sprains and injuries. A very large load falls on the foot. The leg often tucks with the formation of a dislocation, which leads to damage to the tendons and the onset of the inflammatory process. Ankle contracture develops to a large extent after injuries to the ankles, feet and lower leg. As a result of this, functional lengthening of the foot, curvature of the spine, flat feet can be observed.
The reasons for this contracture are:
- tendon damage;
- rheumatoid arthritis;
- prolonged immobilization;
- improperly applied gypsum;
- lesions of arthrosis.
In this case, pain, swelling, deformation of the joint, the impossibility of bending it are noted. When the disease is not treated, the motor function is disturbed, and also the leg ceases to act as a support.
Wrist contracture
It is noted by wrinkling of the articular bag, after which pathological dynamics are observed on the articular ends of the bones.
In this case, the movements of the fingers are insignificant. The movement of adjacent fingers is also limited. The greatest obstacle to their bending is the second of them fixed in an unbent state. The contracture prevents the movement of other fingers. For the purpose of prevention, they need to be given a functionally correct position. Improvement in treatment is possibly negligible.
Treatment
For all types of the disease in question, it goes according to one scheme. The treatment of joint contracture is first performed by conservative methods, and if they are useless, surgical intervention is prescribed.
The first type is based on a complex effect on the affected area with physiotherapeutic procedures (novacoin electrophoresis and diadynamic currents) and drugs. The patient is prescribed exercise therapy, in which passive and active exercises are performed under the supervision of a doctor.
In case of a more persistent disease, vitreous injections, Pyrogenalum are prescribed, and paraffin and ozokerite are treated. With elastic tissues, they can forcefully straighten the limbs or apply plaster bandages. Limit mobility with orthopedic dressings. In addition, a set of exercises on simulators can be assigned.
The operation can be performed in various ways:
- osteotomy - bone dissection to eliminate deformation;
- capsulotomy - opening the inner articular part to access the area that is needed;
- fibrotomy - dissection of the muscles;
- tenotomy - an operation with incision and extension of tendons, used for arthrogenic contractures;
- arthroscopic arthrolysis - dissection of fibrous adhesions;
- arthroplasty and endoprosthetics - replacement of the affected joint with an implant.
The type of operation is selected depending on the degree of damage to the joints, the severity of the disease, the form of contracture. Rehabilitation consists of exercise therapy and massage.
Treatment of contracture of the elbow joint involves arthrolytic arthrolysis in the presence of additional bonds and limiters in order to increase the strength of the lesion site. To increase mobility and reduce pain, thermal procedures are performed. For passive development of the elbow, traction is prescribed using a special apparatus. Fix the limb in the correct position when using fixing dressings and plaster. In addition, intra-articular oxygen and hydrocartisone can be used to reduce muscle retraction. Pain medications are also prescribed.
Mild contracture can be completely cured. But this will require a large time interval. Long contracture has a less favorable prognosis. In case of untimely treatment procedures, secondary arthrosis may develop, motor functions may be lost, deformation of healthy tissues may occur and flatfoot may develop.
It must be remembered that the disease is characterized by relapse. They usually occur after 5 years, so the patient must be prepared for the fact that the disease can return. Therefore, it is necessary to monitor the condition of the joints and muscles. It is better to identify the ailment in the first stages, which will completely restore the normal functioning of joints, ligaments and muscles.
Finally
Joint contracture is a serious illness that can completely immobilize a person, making him disabled. It is difficult to treat, especially in the later stages of development. Mostly conservative and surgical intervention. As the first, drug treatment, physiotherapy, exercise therapy and training on simulators are used. The type of operation is selected depending on the form and severity of the disease. Pathology is characterized by relapses, so a person who has suffered this ailment should be ready for his return after some time. To prevent this, do your health from a young age.