Contracture is a condition in which the mobility of the joint is limited. This phenomenon causes a pathological cicatricial contraction of the soft tissues surrounding the joint: muscles, skin, subcutaneous tissue.
Muscle contracture
With muscle contracture, a pathological tone or stiffness of muscles, ligaments, and tendons is observed. If this process progresses, muscle fibrosis is observed, that is, muscle tissue capable of contracting is converted to fibrous, which has lost such a function. In other words, the joint is not able to fully bend or straighten because the muscle bundles associated with it cannot completely relax and allow the bones of the joint to take one of the extreme physiological positions.
Most often, muscle contracture develops as a result of injuries, inflammatory diseases, operations. This is especially true in cases where for a long time the affected limb was fixed in a fixed position. As a result of pathological muscle tone, nerve signals change and contracture forms.
In some cases, contracture (photos demonstrating this condition are available in the article) develops when the muscles are injured and their recovery is incomplete, as a result of which the muscles are unable to perform their functions in full. Intense pain syndrome further aggravates the course of the pathological process, since pain in the joints or muscles in one way or another causes a person to restrict movement.
Kinds
Symptoms and causes of structural changes in the joints and adjacent tissues are diverse, so it is difficult to classify contractures. The generally recognized division system is based on the immediate cause of their development.
- Structural (passive) contracture. It occurs as a result of a structural change in local tissues (tendons, joints, muscles, ligaments, fascia or skin). It develops with gross violations of blood supply or prolonged immobility of the joint.
- Neurogenic (active) contracture. It causes prolonged tension of certain muscles, as a result of which cicatricial-dystrophic changes develop in the joint capsule and muscles.
These two species are inextricably linked and act as stages of the same process. They are characterized by pathological disorders in the muscular system.
In addition, contracture can have both acquired and congenital character. Acquired, in turn, is divided into neurogenic and post-traumatic.
This disease most often affects small joints. For example, contracture can develop with a complete loss of mobility of the joints of the fingers over several months. It is called immobilization. Of the conditions affecting large joints, hip contracture and shoulder contracture are distinguished.
Palmar fibromatosis
The contracture of the fingers, or Dupuytren, is the most common and at the same time dangerous type of this pathology. Developing nodes in the palm of your hand are often mistaken for corns. The normal movement of the fingers is gradually disturbed. The thickening of the connective tissue at some point becomes so large that the fingers are no longer able to straighten and remain in such a twisted position. Most often, the disease affects the ring finger and little finger. For what reasons the contracture of the hand develops, today it is not known reliably. There is evidence that this condition most often occurs in middle-aged and older men. The older the person, the higher the risk of this ailment. In addition, contracture of the hand more often develops in people suffering from diabetes mellitus, epileptic seizures. There is also a genetic predisposition. That is, if one of the relatives had a contracture of the hand, then the likelihood of illness increases significantly.
A conservative method is used to treat Dupuytren's contracture . At the initial stage, massage and physiotherapy will help to stop the further development of pathology. But with a strong restriction of finger mobility, special enzyme preparations are used (for example, injections of the Lidase drug), which help soften tissues. Some clinics use the method of shock wave therapy, which allows you to achieve pretty good results. Severe contracture of fingers requires surgical intervention.
Causes of pathology
Contracture is the most common complication of joint damage, such as dislocations, bruises, fractures, gunshot wounds, inflammations, diseases of the nervous system, etc.
At risk are athletes and people who engage in heavy physical labor, as in this case the risk of damage to joints, bones, muscles is increased. People who work in the chemical industry are prone to burn contractures. Violators, pianists and other musicians may develop contracture of the fingers, as during prolonged training, the fingers experience intense tension.
Passive contracture develops as a result of mechanical obstructions both in the joint itself and in the tendons, muscles, fascia or skin. People with active contractures have no mechanical obstruction in the joint area or in the surrounding tissues. Instead, there is a violation or restriction of motor activity. Moreover, in individual muscle groups, prolonged tonic tension is observed. The balance between the antagonist muscles is disturbed, as a result, the joints “wedge”. This is the mechanism for the development of active contractures. At the initial stage of existence, they are still unstable and amenable to relatively simple correction. Active contractures disappear after motor activity has normalized. However, over time, they become more persistent.
There are mixed forms, when the root cause of the restriction of movements is difficult to determine. This happens if, during the first examination of the patient, there are signs of both mechanical damage and damage to the nervous system.
Stages
Neurogenic. Inactivity of the damaged limb provokes persistent foci of excitation in the central nervous system. These foci send impulses to the periphery, thereby forming a pathological tone. At the same time, biochemical changes develop in the tissues of the limb.
Myogenic. Due to biochemical changes and a neurogenic reaction, changes occur in muscle tissue (degeneration and atrophy).
Miodesmogenic. The weight and volume of the limb decrease sharply, degenerative changes develop in the muscles. Muscle hypertrophy occurs, which, progressing, develops into atrophy.
Atrogenic Thickening and wrinkling of the capsule of the joint is observed, articular cartilage becomes less durable and elastic. Scars appear that solder the capsule and cartilage. Fascia shrinks, intermuscular connective tissue grows, and partially replaces muscle tissue. Soft tissues and bones are soldered. Third fixation points that impede the movement of the joint develop.
Possible complications
Contracture is a serious pathology, and if left untreated, complications such as stiffness and even ankylosis (complete immobility with degeneration of articular tissues) can develop. Often the disease covers adjacent joints. So, for example, in case of violation of the normal functioning of the ankle joint , the foot, knee, hip joint (contracture of the hip joint), lumbar, and then the thoracic and cervical spine become involved in the pathological process over time.
Pathologies of the upper extremities are no less dangerous. So, ulnar contracture leads to a decrease in the functionality of the hand. This makes it difficult self-care at the household level and basic work.
Diagnostics
Preliminary diagnosis includes questioning the patient and examining him. The doctor will also find out if there were cases of this pathology in close relatives. After that, the specialist will determine whether the limb is able to perform actions and what is the degree of deformation. Palpation of the affected area will detect the most painful areas. As a rule, such manipulations make it possible to make an accurate diagnosis, and additional studies are not necessary. In some cases, an X-ray may be required to accurately determine the location of the abnormal area.
Contracture: treatment
Before starting treatment, it is necessary to completely eliminate the cause that provoked the development of this ailment. But, unfortunately, this is not always possible. Next, let's talk about the methods that are used to get rid of pathology.
Conservative treatment
As a rule, with contracture, conservative therapy is prescribed aimed at restoring the normal amplitude of limb movements. It includes:
drug therapy (non-steroidal anti-inflammatory drugs, hormones, analgesics, muscle relaxants);
therapeutic blockades - drugs that have a resolving effect are injected into the joint cavity;
manual therapy and massage;
mechanotherapy;
physiotherapy (electrophoresis, UHF);
orthopedic methods (elastic traction, twist, orthoses);
traction (traction);
step plaster bandages.
Surgical intervention
The main goal of the above measures is to eliminate the symptoms of inflammation, relieve swelling, and restore joint mobility. However, all these methods do not involve muscle work in the process. But muscle is the main “engine” of joints. Therefore, in some cases, if contracture is detected, surgery is a necessity.
Surgical treatment includes:
In some cases, surgery is indispensable. But for tissues, this is a traumatic process. With the help of the operation, you can get rid of the mechanical cause of contracture, but the pathological tone and pain will not go anywhere. Restoration of normal muscle activity is in any case necessary, because, having eliminated only a mechanical obstacle, contracture will disappear only partially, and normal movement in the joint will not be fully restored.
Natural treatments
Contracture is a pathology that needs to be treated systemically. Natural methods do not help fight symptoms, but eliminate the causes of the development of the disease. If contracture has developed, treatment includes:
power kinesitherapy;
manual therapy, mechanotherapy, physiotherapy exercises;
balneotherapy, therapeutic baths;
physiotherapy;
herbal medicine;
Conclusion
To prevent the occurrence of contracture, it is important to prevent the development of the inflammatory process in the body, so all diseases should be treated in a timely manner. It is always necessary to monitor the position of your body: if the elbow joint must be kept bent for a long time, then it should be bent at a right angle, the best position for the fingers of the hand is half-bent, for the legs, the most optimal position is straightened.
If there was such a nuisance as a bone fracture or dislocation of the joint, and prolonged immobilization is necessary, do not despair. The risk of developing muscle contracture can be minimized, provided that from the first day active muscle work will be carried out. If a fracture of bones of one limb occurs, physical exercises can be performed with a healthy hand or foot. Recovery processes after muscle activity, in addition to the worked muscles, also affect the muscles in the problem area. Moreover, the regeneration process will be more pronounced if you work out large muscles. Take care of yourself and be healthy!