Contracture of the knee joint: joint

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Content

  • 1Contracture of the knee joint
    • 1.1Classification
    • 1.2Symptoms of contracture of the knee joint
    • 1.3Forecast
  • 2Contracture of the knee joint
    • 2.1Features
    • 2.2Causes
    • 2.3Kinds
    • 2.4Temporary
    • 2.5Stable
    • 2.6Symptomatology
    • 2.7Diagnostics
    • 2.8Treatment
    • 2.9Conservative
    • 2.10Operational
    • 2.11The people's
    • 2.12Complications
    • 2.13Prevention
    • 2.14LFK (video)
    • 2.15Books
  • 3Contracture of the knee joint
  • 4Treatment of contracture of the knee joint
    • 4.1Epidemiology, symptoms and causes
    • 4.2Diagnostics
    • 4.3Features of therapy
    • 4.4Conservative therapy
    • 4.5Treatment by position
    • 4.6Kinesitherapy
    • 4.7Operative treatment
    • 4.8Prevention
    • 4.9Forecast
  • 5Contracture of the knee joint: what is it, knee treatment
    • 5.1Symptoms typical for contracture
    • 5.2Factors provoking the development of contracture
    • 5.3Treatment with conservative methods
    • 5.4Surgery
    • 5.5Forecast

Contracture of the knee joint

Contracture of the knee joint- a pathological condition characterized by a decrease in the volume of movements. It is possible to limit both flexion and extension.

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The degree of contracture can vary considerably - from moderate restriction to almost complete immobility.

The cause of development can be a congenital anomaly, traumatic damage to bones, ligaments, capsules and muscles, burn, degenerative-dystrophic process, inflammation or prolonged immobilization.

Usually accompanied by external deformation and pain syndrome of varying severity. To clarify the diagnosis and identify the cause of the contracture can be appointed X-ray, CT, MRI, arthroscopy and other studies. Treatment can be both conservative and operative.

Contracture of the knee joint (from the Latin contractio - connect) - persistent restriction of movements, conditioned trauma, congenital malformation, inflammation, degenerative-dystrophic process or prolonged immobilization. It is a fairly widespread pathology, often becomes the cause of disability and disability. The treatment of contractures involved traumatologists and orthopedists.

Classification

Depending on the cause of the onset, two large groups of joint contractures are distinguished: active (neurogenic) and passive (structural) ones.

Structural contractures occur when there is something that prevents movement in the joint.

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Neurogenic contractures are a consequence of impaired innervation and develop in paralysis, paresis and certain mental illnesses.

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Depending on the location of the obstacle, all structural contractures are divided into:

  • Arthrogenic - with joint deformities.
  • Myogenic - with shortening of muscles.
  • Desmogenic - when forming connective tissue scars.
  • Dermatogenic - with the formation of scars on the skin.
  • Immobilization - with prolonged restriction of mobility.

Given the reason for the occurrence of neurogenic contractures are divided into:

  • Central neurogenic - caused by injuries and diseases of the brain and spinal cord.
  • Psychogenic - arising from hysteria.
  • Peripheral - developing when peripheral nerves are damaged. They can be painful, reflex, irritative-paretic, or are a consequence of violations of autonomic innervation.

In addition, depending on the type of restriction of movements in traumatology and orthopedics, the flexor (the joint is brought together in the flexion position) and extensor (the joint is brought together in the unbending position) of the contracture.

The most common causes of contracture development are trauma and degenerative-degenerative processes (gonarthrosis).

In gonarthrosis, the limitation of mobility arises as a result of gradually worsening changes all structures of the joint, as well as a violation of the shape of the articular surfaces of the femoral and tibial bones.

With injuries of the knee joint, contracture can be formed as a result of several mechanisms.

Perhaps direct damage to the joint with a violation of its shape and the formation of scar in soft tissues (with intra-articular fractures), shortening of the quadriceps muscle due to long stay of the limb in the position of extension (with fractures of the thigh and shin fractures, fixed by a cast bandage), as well as changes in the structure of articular cartilage due to prolonged stillness.

It is established that the contracture of the knee joint can develop even if immobilized within 3 weeks. Each week immobilization of muscle strength is reduced by 20%.

In this case, for 6 weeks, the stiffness of the joint bag increases about 10 times. That is, for the normal movement, the patient has to exert much more force, while his muscles are significantly weakened.

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Prevention of immobilization contractures is one of the most important tasks for fractures of the hip and shin.

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In order to avoid the negative consequences of prolonged immobilization, it is now increasingly used operative methods of treatment (fixation by plates, rods and apparatus of external fixation) and prescribe early exercises Exercise therapy.

In addition, the limitation of mobility of the knee joint can arise due to purulent arthritis and extensive burns with the formation of skin tightening scars.

Rarely, the cause of the restriction of movements are scars after deep ragged and rvanouhibirovannyh wounds in the knee, on the front and back of the thigh and on the back of the shin.

Among congenital anomalies of knee development, in which contractures can be observed, are congenital dislocation of the knee joint, hypoplasia and aplasia of the tibia.

Symptoms of contracture of the knee joint

The main symptom is the restriction of flexion or extension. As a rule, there is more or less severe deformation of the joint.

One or more of the following symptoms may be observed: edema, impaired support, joint pain, shortening and forced limb position. The rest of the clinical picture depends on the underlying disease.

With the long existence of contracture, signs of arthrosis of the knee joint are usually revealed. To assess the severity of the contracture, measurements of the volume of active and passive movements are made.

Diagnosis of knee contracture

The diagnosis is made on the basis of an external examination. To clarify the cause of the pathology, the doctor finds out an anamnesis of the disease and assigns a radiograph of the knee joint.

If suspected scar changes of the soft tissue structures of the patient can be directed to arthroscopy, CT or MRI of the knee joint.

If a neurogenic contracture is suspected due to damage to the peripheral nerves, brain or spinal cord, a consultation of a neurologist or a neurosurgeon is indicated. With hysterical contractures, consultation with a psychiatrist or a psychotherapist is necessary.

Treatment can be both conservative and operative and performed in the conditions of a trauma unit, traumatological or orthopedic department.

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The main methods of conservative therapy are exercise therapy, physiotherapy (electrophoresis, shock wave therapy), massage, mechanotherapy and bloodless correction of the position of the limb with the use of replaceable gypsum dressings and special fixative devices. With ineffectiveness of conservative treatment, surgical operations are performed.

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Operative intervention can be carried out through open access or using arthroscopic equipment.

The purpose of the operation is to restore the shape of articular surfaces, the removal of scar tissue or lengthening of the muscles.

With a significant destruction of the articular surfaces and the preservation of the muscles of the thigh and lower leg, endoprosthetics of the knee joint are performed.

In some cases, the optimal solution is arthrodesis of the joint in a functionally advantageous position. In the postoperative period, therapeutic exercise is prescribed. To increase muscle tone and improve blood flow, massage and physiotherapy are used.

The effectiveness of treatment of neurogenic contractures depends to a large extent on the success of therapy for the underlying disease.

With flexion contractures that have arisen due to cerebral or spinal paralysis, tires are straightened to straighten the limb or devices with weights are used.

With hysterical contractures, psychiatric treatment is performed or various psychotherapeutic techniques are used.

Forecast

The prognosis depends to a large extent on the underlying disease, the severity of the pathological changes in the joint and surrounding tissues.

Fresh immobilization contractures with adequate treatment and regular sessions of physiotherapy exercises, as a rule, are well amenable to conservative correction.

With chronic contractures of any genesis, the prognosis is less favorable, because over time, changes in the joint are aggravated, cicatricial degeneration of not only damaged, but also previously healthy tissues, secondary arthrosis.

A source: http://www.krasotaimedicina.ru/diseases/traumatology/knee-contracture

Contracture of the knee joint

Contracture of the knee joint is a pathological condition of the lower limbs, which is characterized by the inability to bend and unbend the joint completely.

Most often, it is observed after a prolonged wearing of the plaster bandage. Despite the variety of stiffness, it is simply necessary to consult a doctor with a congenital or mechanical contracture.

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In order for the articulation to function without discomfort and other unpleasant sensations, it is necessary to arrive in time for an appointment with a traumatologist and undergo a proper course of treatment.

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If the patient does not seek the help of a specialist, then this condition can lead to disability.

Features

Contracture of the knee joint

Contracture is considered to be a permanent or temporary restriction of motor activity in the knee articulation.

Stiffness can be diagnosed not only on the lower limbs, but also on the upper limbs.

Contracture of the knee joint is a particularly unpleasant ailment, as it is accompanied by tightness and acute pain.

If she is not eliminated on time, the patient risks becoming disabled. Proceeding from the Latin name of this ailment, meaning contraction, it is possible to explain the essence of the disease quite simply.

This pathological condition occurs as a result of degeneration in soft tissues as a result of contraction or contraction of the knee joints, which subsequently leads to the restriction of its movements.

The process of atrophy of the ligamentous and muscular apparatus begins as a result of prolonged inactivity of the lower extremities.

Because of this, muscle tissue, tendon and ligamentous apparatus lose their elasticity, preventing the articulation from fully unbending.

Causes

Many specialists do not consider contracture as a separate ailment, as it is often the result of traumatism or any diseases. In most cases, this is indeed the case.

Often injuries or serious damage leave scars on the tissues, which lead to a decrease in their elasticity, and this, in turn, reduces the length of the ligaments, deforms the knee joint and, accordingly, limits the motor activity.

Stiffness may arise due to:

  • Injury of the knee-joint articulation and inflammation in it.
  • Defeats in the nervous system.
  • Arthrosis and arthritis, leading to the fact that the knee, or rather, the joint begins to gradually collapse.
  • Reducing the length and reducing the elasticity of the muscle and ligament apparatus.
  • Congenital articular pathologies.
  • Mechanical damage.

This pathological condition can also be caused by the patient's activity. The risk group includes people with hard physical work and those who professionally engage in sports.

Kinds

Pain and difficulty in knee flexion

Stiffness in the knee is classified for reasons of its appearance. They may be:

  • Arthrogenic. Appear as a result of degeneration in the joint articulation, not only on the surface, but also in the ligamentous apparatus.
  • Neurogenic. They appear as a result of paralysis, hemorrhages in the brain and problems with the nervous system.
  • Dermatogenic. Contracture appears as a result of serious defects in the epidermis, represented by burns and wounds that grab the knee area.
  • Tendogenous. Appears due to inflammatory or traumatic changes in the ligamentous or tendon apparatus.
  • Desmogenic. Such a contracture appears as a result of the wrinkling of the tissues surrounding the articular articulation. It can occur due to trauma or a strong inflammation of ligaments or fasciae.
  • Myogenic. The appearance of stiffness leads to a long squeezing of the muscular apparatus, as well as myositis and muscle ischemia.
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With contracture, problems can occur with flexion, extension, rotational movements, and leg movements from side to side.

Temporary

Often, temporary type of stiffness appears as a result of incorrect joint articulation. This condition is caused by reflex contraction of the muscles, which keep the comfortable position of the joint at the moment of flexion.

After the knee has been fully developed, the pain will disappear, the blood flow will improve in the affected area and scar tissue will disintegrate, which would prevent bending.

But if the articulation is not engaged, the contracture will acquire a combined character and it will be very difficult to get rid of it.

Stable

Based on medical practice, the emergence of persistent contracture is facilitated by the prolonged wearing of the plaster bandage.

With every week of inactivity, muscle tissue loses its elasticity by twenty percent.

And after two months of wearing orthosis, the elastic functions of the articular pouch are reduced tenfold.

Persistent contracture can be congenital. Often, it occurs due to violations in the lower extremities in infants developed in the womb. An example of such stiffness is the diagnosis of clubfoot, as an innate disease.

For this reason, treating a resistant creature is very difficult and long. To undergo therapeutic courses, one must be patient with and follow all the recommendations of a rehabilitologist.

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If the patient deviates from the course of treatment, this will only worsen the condition of the lower limb.

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And forced straightening and bending will only strengthen the site, affected by contracture.

Symptomatology

Sometimes after going through the main therapy, the patient begins to notice that it is more difficult to move the knee. The leg stops bending, as it was before the injury, and its fixation manifests itself most in a certain position.

If temporary stiffness is accompanied by a sharp pain, then its persistent type, does not cause any discomfort.

At the initial stage of treatment, restrictions on mobility practically do not cause the patient anxiety and only when he is already beginning to limp while walking, he turns to an orthopedist or traumatologist.

Regarding more severe symptoms, it can be represented by:

The rest of the symptomatology depends on the complexity and course of the disease. If anxiety symptoms are not eliminated, this can lead to arthrosis in the damaged joint.

Diagnostics

MRI of the joint creature

A positive therapeutic effect in eliminating contracture will be observed if it is diagnosed at the initial stage. Thus, it will be possible to completely restore mobility to the injured knee.

If the patient, after trauma or removal of the orthosis, began to notice problems in flexion of the limb, a change articular articulation, as well as the inability to perform the usual movements, he must turn to the doctor.

To make the correct diagnosis, the specialist conducts a palpation examination of the limb, then sends the patient to X-ray, CT and MRI. In some cases, the patient is referred to a neurologist, a psychiatrist and a neurosurgeon.

Treatment

The healing process and restoration of the motor activity of the joint depend on how seriously the patient was engaged in the development of the knee and how much time he devoted to it. In addition, conservative therapy or surgical treatment can be used in the treatment of the joint.

Conservative

Treatment of a conservative type can be carried out both in a hospital and at home.

It is aimed at restoring the motor activity of the knee articulation, eliminating the pain of improving blood flow in the damaged area.

To eliminate all of the above symptoms, the doctor prescribes analgesics and hormonal medications, injections into the joint, massage procedures, exercises and physiotherapy.

Operational

If on the examination the expert has revealed cicatricial degeneration of tissues, operative interference with the help of which scars are eliminated, and the elasticity of ligamentous and muscular apparatus.

The people's

If a patient has contracture of the knee joint, then treatment at home, combined with conservative methods, will accelerate the recovery processes and return the joint flexibility to the joint.

To improve the blood flow in the injured knee, you can prepare a grinder with a warming effect. To do this, take a container and pour into it a glass of kerosene and sunflower oil.

Then put fresh crushed red pepper. The resulting ingredients are mixed and leave to be infused in a sealed container for a week.

Wipe the grated rind, and use this medication to rub the damaged joint.

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Tincture from crushed chestnuts also works well. For its preparation, take 300 grams of crushed chestnut fruit and pour out 500 grams of alcohol.

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Then close the container with a lid, put it in a dark place and insist for two weeks. Rinse your knee with a remedy before going to bed, every day.

If you have a knee joint contracture, you can take hot baths with essential oils, decoction of cranberries, nettle and sea salt. Such water procedures have a beneficial effect on the joint, helping to restore mobility to it faster.

To avoid side effects and complications, before using prescriptions for alternative medicine, consult a specialist.

Complications

If stiffness does not begin to be treated in a timely manner, then it can lead to complete immobility of the lower limb, which is only corrected by surgery. Therefore, to avoid surgery, the specialist should be treated immediately after the discovery of the first symptoms.

The launched creature reduces the patient's physical activity to a minimum, and leads to partial disability.

Prevention

To avoid stiffness of the lower limb, and to prevent complications, it is necessary:

  • Provide the injured knee with a normal physiological position under the plaster bandage.
  • Carry out a timely correction of trophic processes occurring in tissues.
  • Maximally quickly eliminate discomfort and algia.
  • Start the joint development as early as possible.

Carrying out preventive measures, you can avoid complications, eliminate contracture and quickly return limbs full mobility.

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Contracture of the knee joint

In the treatment of fractures of the upper and lower extremities, a temporary rational therapeutic immobilization is carried out: skeletal traction, gypsum dressing, osteosynthesis. Immobilization is carried out in order to create favorable conditions for the consolidation of bone fragments.

However, due to immobility of the limb, a number of complications arise. Thus, very often after fractures of the lower extremities, one can observe limitations of amplitude characteristics, in other words - contractures of knee joints.

It is the immobility of the limb in the immobilization period that most often causes the formation of contractures. Therefore, in the rehabilitation of patients with injuries of the lower limbs, one of the main tasks of the postimmobilization period is the struggle with contractures.

Treatment of contractures- the process is not easy.

When it comes to the treatment of contractures of the joints of the lower limbs, doctors face a number of difficulties that must be solved: on the one hand, the damaged joint for healing requires a long rest, and on the other hand - the joint requires early movements in order to restore its normal function. And the sooner the movement begins in the affected joint, the better, the sooner its function will be restored. After all, thanks to the movements in the joints, the physiological tone of the muscles is maintained, the movements prevent muscle atrophy, the formation of adhesions, obliteration of the joint space, ossification of the joint tissues, and, importantly, prevent contractures in joints.
As a result of prolonged immobilization, inhibition of the restoration of joint function occurs, so, a week of immobilization leads to the fact that muscles lose up to 20% of their force, after six weeks of immobilization, the articular bag becomes rigid to such an extent that to perform any movement it is necessary to attach a tenfold an effort. After eight weeks of immobilization, it may happen that the vital articular cartilage at the ends of the bones will never return to its normal functioning, also, after eight weeks of immobilization, the ligaments can lose up to 40% of their strength, and in order for the function of the joint to fully recover, it may be necessary not one year.
Basically, the volume of movements in the joint is restored in a period of up to 1 year. Then a significant increase in the volume of movements in the joint, as a rule, is not observed. And if you do not carry out the appropriate treatment, then there may be a complete loss of joint mobility - ankylosis. But due to the fact that sometimes immobilization with fractures of the bones of the lower extremities lasts for months, there is a persistent limitation of mobility in the joints lower extremities, which requires a long-term comprehensive treatment, and the emphasis in this treatment should be placed on kinesitherapy - treatment movement. After all, the means and methods of exercise therapy (physiotherapy exercises) in contracture, which are rationally combined, are of primary importance in the treatment of contractures of the knee joint.

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In the special tasks of LH (therapeutic gymnastics) in the treatment of contractures of the knee joint is:

a) stretching of the contracted tissues
b) strengthening of muscles, stretched out due to contracture
c) increased mobility of the knee joint
c) prevention of complications, such as deformity of the spine and flat feet on a healthy leg.

Physiotherapy exercises with knee joint contractionhas its own characteristics, which are as follows:

- the earlier to apply motor therapy, the more likely the patient will have a functional recovery of the affected joint
- it is necessary to abandon the use of gross violence, because pain causes reflex tension muscles, and this is a serious obstacle to the elimination of contracture and may even contribute to its consolidating
- the corrective force should be continuous: the fact is that the forces that fix the joint in a vicious position are very small, but their action is constant and long, and the same should be the force that leads the joint out of the vicious position, this force must be continuous, incremented gradually, and therefore it may not initially be felt
- fatigue can not be tolerated, since excessively long procedures can lead to overload and a negative reaction of the neuromuscular apparatus, so the physical load should be dosed and based on the tasks of the specific treatment period, manifestations of the disease, functional capabilities, age, sex of the patient, as well as the type of higher nervous activity and tolerance to physical load
- Classes should be systematic (at least 2-4 times a day for 25-30 minutes)
- Exercises exercise therapy and LH with contracture of the knee joint must necessarily be performed with both legs in all joints (including healthy)
- special exercises for contracture of the knee joint should be combined with general, respiratory and relaxation exercises, and also exercises should include attention, coordination, balance and m.
- Especially careful use of exercises that can have an adverse effect on regeneration processes
- Much attention should be paid to preventing muscle growth to the bones in the fracture region
- restoring the normal amplitude of movements, special attention should be paid to the phase of full extension in knee joint, which is very important for the prevention of deforming arthrosis in the damaged the joint.

Medical gymnastics with contracture of the knee jointit can be done at home.

So, the approximate complex of LH with contracture of the knee joint:
1. AND. P. Lying on his back or sitting. Grab a kneecap with your hand and passively move it aside, then up and down. Repeat 10-15 times.
2. AND. P. - sitting, legs stretched. To raise arms or hand under a thigh the relaxed sick leg, thus a heel from a bed to not tear off. Repeat 10-15 times.
3. AND. P. - lying (when stretching for the thigh). To bend and unbend the leg in the knee joint with the help of the LFK instructor.
4. AND. P. - sitting on the bed, legs almost straight. Supporting the thigh of the sick leg with both hands, raise the hip with your hands, while the heel should slide on the bed. Repeat 15-16 times.
5. AND. P. Lying on his stomach. The sick leg lies on the knee of a healthy one. With the help of a healthy leg, perform flexion and extension of the aching leg in the knee joint. Repeat 18-20 times.
6. AND. P. Lying on his back. With your hands, support the leg under the thigh, half bent in the knee joint, to do the treatment with the position.
7. AND. P. - sitting on the bed, legs bent. Supporting the painful leg under the thigh with both hands, perform flexion and extension in the knee joint, at the moment of flexion, put the leg on the bed. Repeat 6-8 times.
8. AND. P. - same. Supporting the aching leg with both hands under the thigh, raise it higher, so that the heel is on weight. Perform flexion and extension in the knee joint, while not lifting the foot from the support. Repeat 8-10 times.
9. AND. P. - lying on his side. The sick leg lies on the healthy one. Perform flexion and extension in the knee joint. Repeat 8-10 times.
10. AND. P. Lying on his stomach. Perform alternate active flexion and extension of the legs in the knee joints. Repeat 20-25 times.
11. AND. P. - same. Perform simultaneous bending of the legs in the knee joints. Repeat 10-15 times.
12. AND. P. Sitting on the bed. The legs are lowered down. Perform bending and unbending the aching leg in the knee joint, while helping yourself with a healthy foot:
a) a bad leg on a healthy
b) a sick leg under a healthy one, which, by pressing on the patient, increases the volume of movement. Repeat 10-15 times.
13. AND. P. Standing, with your back against the wall. Put a sick leg on a chair, which is gradually approaching you. Repeat 8-10 times.
14. AND. P. Standing, hands on the waist. Put a healthy leg back on the toe, the patient - bend at the knee, while the distance is gradually increased.
15. Perform exercises on an inclined plane.
16. Perform exercise near the gymnastic wall - remembrance.

Thus, subject to systematic training, medical gymnastics and physiotherapy exercises under contracture knee joint will help the damaged joint to restore its functions and will further promote it strengthening.

Contractures in the joints of the limbs. Treatment.

Fractures (injuries) of the lower limbs

LFK - Gymnastics with a patellar fracture (trauma)

LFK with a hip fracture (injury)

LFK - Gymnastics in case of a shin fracture (injury)

LFK at fracture (trauma) of foot

A source: http://lfk-gimnastika.com/lfk-v-ortopedii/114-lfk-pri-kontrakture-kolennogo-sustava

Treatment of contracture of the knee joint

The pathology of knee joints is a great social and economic problem all over the world. Complications that periodically occur during the course of the disease significantly worsen the prognosis for the patient.

One of the most severe of these is contracture.

In this condition, free movement of a person is difficult, pathological changes in the spine develop and signs of flat feet in a healthy leg develop.

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This pathological condition develops due to damage to adjacent tissues or the joint itself. Violation of the muscles, changing the elasticity of the ligament apparatus, dermatological problems - this all can affect the development of contractures.

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Traumatologists or orthopedists have a dilemma: on the one hand, the joint should be kept at rest for early relief of the patient's condition, and on the other - the early onset of motor activity prevents the emergence complications.

Epidemiology, symptoms and causes

The most common cause of contracture of the knee joint is mechanical damage. This pathology is accompanied by a prolonged immobilization, which contributes to the atrophy of muscle tissue, a violation of nerve conduction, a deterioration in the properties of the ligamentous apparatus.

In addition to the stiffness of the limb, the most frequently diagnosed symptoms include pain and swelling. The remaining symptoms may vary depending on the nature of the underlying disease.

Traumatic lesions - one of the possible causes of contracture of the knee joint, but not the only one. Limitation of mobility can also be influenced by:

  • congenital abnormalities of tissue development;
  • the transferred pathology of joints (arthrosis, arthritis);
  • diseases of the nervous system;
  • burns;
  • occupational hazards.

The timing of the development of contracture of the knee joint may vary considerably. Cases of almost instant progression of complication are described (Folkman contracture). At the same time, inflammatory processes can lead to contractures for several months or even years.

Diagnostics

The appointment of any treatment should be preceded by the fullest possible examination of the patient. After a detailed study of the history of the disease, a comparative examination of the symmetrical limbs is necessary. During it pay attention to the following criteria:

  • skin condition;
  • the presence and severity of muscle atrophy;
  • muscle tone;
  • limitation of mobility in the joints;
  • violation of peripheral sensitivity.

These data are compared with the results of instrumental diagnostic methods - radiography and electromyography.

The main technique that allows assessing the functional state of the joint is radiography.

Also, this study enables differential diagnosis with other joint diseases.

Electromyography can help determine the extent of neuromuscular transmission in the injured limb. The obtained results of studies in combination with the symptoms of the disease and physical methods allow you to make an accurate diagnosis and begin the necessary therapy.

Features of therapy

Treatment of contractures of the knee joint is performed in several stages depending on the severity of the pathology.

The choice of the method of therapy is influenced by the immobilization time of the limb.

The longer the joint is immobilized, the more effort it takes to restore normal functional activity to it. Two main methods in the treatment of contractures:

  • conservative;
  • surgical.

It is worth remembering that the therapy of this complication is a long and high degree of individualization. However, in neglected cases, even maximum efforts can not always cause the damaged joint to move.

Conservative therapy

Conservative methods of treatment are the starting methods for contractures of the knee joint. Depending on the type of contracture, the underlying disease and the timing of the initiation of therapy, various types of rehabilitation can be used. But they all have common principles:

  1. stretch the contracted tissues of the lower limb gradually, after a preliminary relaxation;
  2. In parallel, they try to strengthen the muscles that do not participate in the movement of the joint due to contracture;
  3. all procedures are carried out without increasing pain.

To increase the chances of a positive outcome of therapy, it is necessary for the patient to understand the importance of manipulation and to fully support their implementation in full.

Treatment by position

One of the main conservative ways of treating contractures of the knee joint is to treat treatment as a condition. This method allows to achieve effective stretching of tissues due to the use of special devices - tires and orthoses (orthopedic external devices).

A rough correction of contractures also leads to an increase in edema or a violation of tissue trophism.

In addition, pain intensifies, which can reflexively increase muscle tone.

Therefore, to avoid the above complications, manipulation is performed using a small corrective force.

This technique minimizes tissue trauma. At the same time, the minimum effort must be permanent. By adjusting the angle of dilution of the parts of the orthoses or tires, the corrective force gradually increases and a painless stretching of the affected muscle is achieved.

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This technique involves fixing the knee joint with a gradual decrease in the angle of dilution. With a positive response to therapy, you can completely unbend the lower limb.

Kinesitherapy

The second main method of conservative treatment is kinesitherapy - therapeutic gymnastics. It can be carried out in 2 ways:

During the performance of passive physical activity, you can gently stretch the contracted tissue and relax the muscular apparatus of the affected limb. Such exercises are performed several times a day (up to 5).

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The effect is enhanced if the muscles are warmed up before activity due to the use of paraffin or warm medical mud.

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To promote full relaxation can the physiological position of the limb, conducting exercises in warm water.

Exercises are performed with resistance, which can be adjusted by conducting exercises on special mechanotherapy devices or block simulators.

As the muscular apparatus strengthens, the amplitude of motion in the joint increases, the duration of activity and the magnitude of the load. It is important to monitor the correct performance of the exercises to avoid injury or aggravation of problems with the affected muscles.

Psychotherapy plays a major role in the complex treatment of contractures of the knee joint. The work performed can improve the patient's attitude to the therapy and achieve at least minimal voluntary motor activities.

Operative treatment

If there is no effect on the methods of conservative therapy, a surgical correction is recommended to the patient. Depending on the tissue involved in the pathological process, there are:

  • a variety of skin plastics;
  • myotenolysis (surgical intervention aimed at eliminating scars in contractures);
  • tenotomy (dissection of the tendon or affected muscle);
  • removal of part of the joint capsule;
  • replacing the affected joint with an artificial one.

The methods of therapy of contractures of the knee joint are determined by the orthopedist after a full examination. The patient should be observed in dynamics for the possibility of timely correction of treatment.

Prevention

Prophylaxis of contractures involves less physical and economic costs than treatment. Observing the recommended principles, it is possible to prevent the occurrence of this complication with a high percentage. These include:

  • ensuring the physiological position of the limb from the first days of immobilization;
  • timely correction of trophic tissue;
  • as soon as possible elimination of pain syndrome;
  • early onset of movements in the joint.

The correct location of the limb is achieved through the use of orthopedic devices.

Physiological for the knee joint is flexion by 40 degrees.

With this situation, blood circulation remains and the maximum possible relaxation of the muscular apparatus is observed.

It is important to ensure venous and lymphatic outflow from the lower limb, because edema provokes the development of contractures.

For this, in addition to proper immobilization, the foot is given an elevated position.

The early onset of motor activity in the joint refers to one of the most effective methods of prevention. Performing passive or active kinds of movements can improve the nutrition of tissues, reduce stagnant phenomena and thereby activate reparative processes.

Forecast

The prognosis in patients with knee joint contractures depends on many factors. Therefore, reliably determining the outcome of the disease is extremely problematic even for specialists. The forecast is affected by:

  • time elapsed since the onset of the onset of pathology;
  • type of contractures;
  • severity of underlying disease;
  • age of the patient;
  • the usefulness of the treatment and the timing of its inception and conduct.

It is worth remembering that early diagnosis and the beginning of complex therapy allow to count on positive results.

A source: http://MedOtvet.com/drugie-zabolevaniya-pozvonochnika/lechenie-kontraktury-kolennogo-sustava.html

Contracture of the knee joint: what is it, knee treatment

Contracture of the knee joint is, as a rule, an inborn defect or a consequence of an injury.

To restore the function of mobility and the removal of pain, there are various types of therapy. Timely adequate treatment leads to positive results.

Symptoms typical for contracture

The development of the pathological process, in which there is no flexion function of the knee, is called "contracture of the knee joint." This disease is caused by cicatricial contraction of tendons, skin or muscles. Translated from the Latin "contractura" means a contraction.

Contracture in the knee joint area is accompanied by several symptoms:

  1. acute pain syndrome;
  2. limitation of joint mobility (no flexion function);
  3. pathological changes in the adjacent tissues (contraction of tendons and muscles);
  4. deformity of the lower leg;
  5. limb shortening;
  6. complete loss of joint mobility (without appropriate treatment).

To make an accurate diagnosis, the doctor should be assigned a full examination of the patient. To date, the diagnostic technique is diverse:

  • CT scan;
  • X-ray examination;
  • magnetic resonance imaging (MRI).

Factors provoking the development of contracture

The causes of contracture are many. It can be various traumas, inflammatory processes, loss of elasticity of ligaments, deformation limbs with arthrosis or arthritis, shortening of the muscle tissue on which the motor mechanism depends the joint.

A variety of contracture, called "arthrogenic is due to bone fracture, stretching, bruising, or intra-articular dislocation.

Most often this type of disease affects people with chronic and acute joint diseases.

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In rare cases, arthrogenic contracture can develop in healthy joints.

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The contracture of the knee joint is not inherently a disease, as a rule, a consequence of congenital pathology, a transferred illness or a trauma. This complication accompanies almost all serious injuries.

The scar formed on the damaged tissue is not elastic, so it interferes with the normal functional activity of the joint.

Contracture of different degrees of gravity is present for any damage to the musculoskeletal system.

Arthroses, affecting people in old age and developing in the younger generation of arthritis, significantly deform the joints and entail a complication in the form of contracture.

This ailment can manifest itself against the background of diseases of the nervous system. But the most common cause is mechanical damage.

The rehabilitation period after trauma requires rest, but the longer the rest rest, the greater the risk of contracture and the process of getting rid of it becomes more complicated.

If the timely treatment does not begin, the contracture of the knee joint leads to complete immobility.

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The started disease is treated exclusively by the surgical method. To avoid surgery, you need to contact the doctor at the first manifestations of symptoms.

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Acquired or congenital contracture leads to sad consequences.

Treatment with conservative methods

Currently, in domestic and foreign clinics, there are two types of contracture treatment: operative and conservative.

Conservative therapy includes physical education, therapeutic gymnastics, various restorative exercises, massages. The complex physiotherapy includes:

  1. treatment with medicinal preparations;
  2. shock wave therapy (therapeutic technique using acoustic waves);
  3. thermal procedures;
  4. manual therapy (technique of influence on muscles and joints);
  5. electrophoresis.

A number of medications are presented by anesthetics for pain in the joints (lidocaine, novocaine) and hormonal injections. When they are injected into the affected joint, the pain sensations decrease significantly, the muscles relax and acquire a normal tone.

Such procedures significantly slow down the development of knee contracture.

When conducting a massage session, doctors are advised to intensively work on weakened muscles, and on muscle-antagonists - superficially.

Therapeutic exercises and physical exercises involve simple exercises, which should be done with great care.

For the beginning passive movements are carried out, gradually pass to active actions.

Consider some effective exercises for the treatment of contracture:

  1. alternately pull your legs to your stomach, bending your knees;
  2. lying on his back, bend his legs and straighten them up;
  3. standing, bend the leg in the knee and lift up, then straighten, lowering it to the floor;
  4. alternately one, and then the other foot perform movements that mimic cycling
  5. Perform bicycle exercises with two legs simultaneously;
  6. lift up the leg in a straightened state;
  7. do circular movements of the shin with the knee bent on the weight;
  8. Support the straightened leg on the gym ball and perform pressure actions;
  9. crouch with the ball between the knees;
  10. roll the ball to himself and from himself, putting his feet on him;
  11. Raise the ball up, clutching it between the shin and the seat;
  12. Put the ball under your knees and push hard on it with your heels;
  13. lying on his side, perform bicycle traffic;
  14. lie on your stomach and alternately bend your knees;
  15. in the same pose, raise your straightened leg;
  16. Lie down on his side and bent his leg to swing up, gradually straightening his knee;
  17. lie on your stomach and take your leg straight to the side;
  18. lying on the abdomen, bend the leg in the knee and shin in a circular motion (ten times in each direction).

All of the above exercises should be done 10 times. Therapeutic physical training should be regular, the minimum number of classes - 3 times a week. An obligatory condition is medical supervision.

Conservative treatment, physical exercises and other manipulations are necessary to restore the motor function of the limb. In complex treatment:

  • pain sensations disappear;
  • muscle tissue is strengthened;
  • the articulation acquires normal mobility;
  • nutritional intraarticular processes are normalized;
  • healthy blood circulation is restored;
  • Dissolves formed spikes.

In the process of rehabilitation, so-called mechanotherapy is used. It includes restorative medical exercises with the use of special equipment and simulators.

Surgery

In situations where physical exercises and medications do not lead to the desired results, the use of a surgical method of treatment is necessary.

With the help of surgery, doctors extend the muscles; restore tendons (release them from the healed tissues); conduct osteotomy, transplant and removal of skin scars.

When the tendon is seriously injured, the patient is implanted with tissues made of special plastic or canned, which are easy to take root in the body.

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Still spend various korrigirujushchie operations on bone fabrics.

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For example, when the length of the limbs does not match, the shortened bone can be lengthened or, alternatively, shortened.

Forecast

The main goals of contracture treatment are to remove pain syndrome, reduce inflammation and return the mobile function of the joint. To date, medicine quite successfully treats this disease in different degrees of its complexity.

The most important factor in successfully getting rid of an ailment is the time that has elapsed since the onset of the disease. The doctors attach great importance to the degree and type of damage, the age of the patient. It must be remembered that the sooner the treatment begins, the higher the probability of positive dynamics and full recovery.

A source: http://sustav.info/bolezni/drugie/kontraktura-kolennogo-sustava.html