Contractures
What are contractures?
When arm or leg is in a bent position for a long time, some of the muscles become shorter, so that the limb cannot fully straighten. Or shortened muscles may hold a joint straight, so it cannot be bend. We say the joint has a contracture.
Contractures can develop in any joint of body. (Pictures)
When can a contracture develop?
Contracture can develop whenever a limb or joint is not moved regularly through its full range of motion. This can happen is one of the following situations:
- A weak or sick person is in bed for a long time. (Picture)
- A person with an amputation keeps joints bend (Picture)
- A paralyzed limb is kept bent or hanging (Picture)
- A person has joint pain that prevents him/her from straightening the joints (Picture)
Why it is important to know about contractures?
- Most of the contractures can be prevented through exercise and other measures.
- Contractures make functions of daily living difficult. They must be corrected.
- Correction of contractures is slow, costly and often very uncomfortable of painful
- It is best not to let contractures develop and if they develop, to correct them as soon as possible. Early contractures can be easily corrected at home by exercises and positioning. Old or advanced contractures are much difficult to correct and require gradual stretching with serial plasters or surgery
Prevention and early management of contractures
Positioning
Lying on the back
Correct positioning (Picture)Incorrect positioning (Picture)
Lying on the stomach
Correct positioning (Pictures)
Sitting
Correct positioning (Pictures)Incorrect positioning (Picture)
Active/Passive Joint range of motions
IDEAL (Handouts), Kishner book for Pictures
Stretching exercises (Four ways to do stretching)
-Passive stretching exercises
Family member/CBR worker/Therapist does the stretching for the patient.
-Active stretching exercises
Patient does the stretching on his/her own without using the shortened muscle
-Active assisted stretching exercises
Patient does active movements using the shortened muscles assisted by stretching exercises by family member/CBR worker or therapist
-Stretching doing activities of daily living
Patient gets involved in daily activities to stretch shortened muscles and prevent contractures
Serial plastering/orthotic management
When a contracture is in advanced stage, it is corrected by special techniques like casts, braces or special equipment that keeps a continuous stretch on affected joints.
Picture showing series of plaster casts.
Instructions:
- Casts should be done by a therapist or under supervision
- Check for sores, pain or signs of uneasiness when in cast
- Casts should be changed in a clinic or rehabilitation centre
Picture showing adjustable braces
In old and severe cases, surgery may be required.
Picture showing surgery of a shortened tendon