Contracture of muscles and joints: causes, treatment

Content

  • 1Characteristics of joint contractures: causes, types, symptoms and treatment
    • 1.1Types of pathology
    • 1.2Common causes
    • 1.3Symptoms
    • 1.4Diagnostic Methods
    • 1.5Treatment
    • 1.6General scheme of conservative treatment
    • 1.7Operative intervention
    • 1.8Conclusion
  • 2Contracture of joints and muscles - causes of development, diagnosis and treatment
    • 2.1Classification of contractures
    • 2.2Dupuytren's Contraction
    • 2.3Diagnosis and treatment of contractures
    • 2.4Consequences of the disease
  • 3Contracture is what? Contracture of muscles: diagnosis, treatment
    • 3.1Contracture of muscles
    • 3.2Kinds
    • 3.3Palmar fibromatosis
    • 3.4Causes of pathology
    • 3.5Stages of
    • 3.6Possible complications
    • 3.7Diagnostics
    • 3.8Contracture: treatment
    • 3.9Conservative treatment
    • 3.10Surgical intervention
    • 3.11Natural methods of treatment
    • 3.12Conclusion
  • 4Contracture of joints
    • 4.1Mechanism of development of joint contractures
  • 5Contracture of the joint. Symptoms, treatment, prevention:
    • 5.1Types of joint contracture
    • instagram story viewer
    • 5.2How contractures of joints arise
    • 5.3Symptoms of having a joint contracture
    • 5.4The causes of elbow joint contracture
    • 5.5How does the condition of knee joint contracture develop?
    • 5.6Contracture of the joint: treatment
    • 5.7Prophylaxis of contracture

Characteristics of joint contractures: causes, types, symptoms and treatment

articles:

  • Types of pathology
  • Common causes
  • Symptoms
  • Diagnostic Methods
  • Treatment
  • Conclusion

Contractura (contractura) is a pathological limitation of movements in the joint, because of which the limb is unbent or bent not in full.

Develops due to mechanical obstruction in the joint itself, periarticular tissues (passive contracture) or changes in nervous regulation (active contracture).

With changes in nervous regulation, the tone of one muscle group predominates over the other, normal muscular balance is disrupted, joint stiffness is formed.

The initial active contracture is unstable and is successfully corrected. Elimination of neurological disorders leads to a reduction in the limitation of mobility or its complete disappearance.

In the absence of treatment and progression of the disease, secondary persistent changes in the joint elements develop - the active contracture passes into the passive, which is also treated, but much more difficult.

Contractures of the joints strongly affect the quality of life of the patient, causing the disability and disability. The group of disability is determined by the degree of stiffness, the number of affected joints and the general limitation of motor activity.

.

Depending on the reasons, the problem is dealt with by a traumatologist, arthrologist, orthopedist, rheumatologist or neurologist.

.

Further from the article you will learn about common causes of development, types, symptoms, methods of detection and ways to eliminate contractures.

Types of pathology

A large number of different types of pathology is due to a variety of causes, mechanisms of development of contractures, as well as structural changes in the joint itself and surrounding elements.

In the tables below - the classification of pathologies.

(if the table is not completely visible - turn it to the right)

In a separate category, contractures are given after gunshot wounds.

Given the causes of development, all structural contractures are divided into 7 types (structural - that is, damage to the articular joint itself):

(if the table is not completely visible - turn it to the right)

Stiffness of a neurogenic nature (that is, the cause of pathology - a violation of nervous regulation, and not joint damage) also has several types:

(if the table is not completely visible - turn it to the right)

Click on photo to enlarge

Common causes

Causes of contractures in a common list:

  • congenital disorders of development of osteoarticular structures,
  • various injuries,
  • inflammatory and (or) destructive processes in the joints,
  • severe pain syndrome,
  • scarring of the skin,
  • connective tissue bands of tendons or ligaments,
  • muscle diseases.

On the combined contracture, the doctor says, if it is difficult to establish the root cause: whether the local articular process first developed or whether there was a disturbance in the nervous regulation.

People with joint diseases often suffer from stiffness. At risk are athletes and people engaged in heavy physical labor - they are most susceptible to various injuries of muscles, bones or joints.

Contractors after burns are exposed to workers of harmful (chemical) productions.

Pianists, violinists tend to develop contractures of brushes and fingers, which develop due to strong tension during many hours of rehearsals or performances.

The table presents a generalized list of reasons for the appearance of contractures of various types:

(if the table is not completely visible - turn it to the right)

Symptoms

The main manifestation of pathology is the difficulty of extension, flexion of the joint.

Examples of specific contractures:

  • The knee stiffness develops against the background of its deformation, accompanied by edema, pain syndrome, violation of the supporting function, shortening and forced position of the leg.
  • The defeat of the elbow is characterized by the restriction of movements of different degrees in several directions: extension, bending, turning of the forearm. With a congenital form, the affected leg or arm lags behind in development.
  • With Dupuytren's contracture, a small compaction appears initially on the palm of the hand, increasing in size over time. A strand is formed, the skin around it is densified and soldered to the underlying tendon, which is gradually shortened - a persistent contracture develops. Usually this process is painless - only 10% of people experience mild pains, sometimes radiating in the forearm or shoulder. It can affect both one and several fingers. The consequence of Dupuytren's contracture may be ankylosis of the joint - its complete immobility. The course of this pathology is progressive and difficult to predict, the speed depends on external circumstances.

Diagnostic Methods

The diagnosis and type of pathology is established by the doctor on the basis of complaints, identified causes, visual changes of the affected part of the body. To determine the degree of stiffness, the doctor measures the volume of active and passive movements.

The main diagnostic method is radiography.

The purpose of additional research depends on the type and nature of the contracture.

With passive contracture, it is possible to perform MRI or CT of the joint, with neurogenic - a consultation of a neurologist is mandatory, with a hysterical advice - a psychotherapist.

Also, a doctor can prescribe electromyography - a diagnostic method for recording bioelectric activity muscles; Based on the results of this study, one can judge the functional state of the nerves that connect the damaged muscle.

If the cause is a specific or nonspecific inflammation, the main disease is treated by a phthisiatrist, a venereologist, a rheumatologist or an arthrologist.

Treatment

Treatment of contracture can be conservative or surgical. The doctor chooses the methods of treatment, starting from the cause, nature and severity of stiffness.

General scheme of conservative treatment

(if the table is not completely visible - turn it to the right)

Ilizarov's apparatus

  • Complex, conservative treatment is, first of all, subject to contractures that are amenable to correction. In addition to massage, with mild to moderate stiffness it is useful at home to perform in a bath with warm water simple exercises extension, flexion of the affected joint, and then go to exercise therapy with a gradual increase in load and mud and paraffin treatment.
  • Arthrogenous contracture (deformation and damage directly to the joint) is treated with / m injection of pyrogen, vitreous body, thermal procedures, massage of adhesions and scars.
  • Reduction of limb (i.e., stretching, forced correction of deformity) is rarely used, the greatest effect without complications is the gradual elimination of the articulation contracture.
  • With flaccid paralysis, galvanization is first shown (the method of physiotherapy), and after strengthening the muscles other physiotherapy procedures.

Operative intervention

Persistent contracture, which can not be treated conservatively, is removed surgically:

  • Dermatogenic and desmogenic contractures are treated by excising scars with subsequent dermatoplasty.
  • Apply fasciotomy - cutting of special connective tissue membranes (fascia) - is shown when the fascia is shortened.
  • Tenotomy or lengthening of the tendon is used for contraction of muscles and tendons (tendonous contracture).
  • Arthroplasty, arthrolysis, capsulotomy, osteotomy help get rid of persistent contractures, more often arthrogenic.
  • Sometimes in neglected cases of Dupuytren's chronic contracture, the situation can be corrected only by amputation of the finger or arthrodesis - creating an immovable joint with a permanent fixation of the finger in a functionally convenient position.

Conclusion

It is possible to eliminate stiffness of the joint, but it is better not to allow its occurrence.

Prevent development of stiffness can early and competent treatment of the disease, which can lead to its appearance (more about these diseases - later in the article).

If, for some reason, you have been plastered - after removing it, make sure that you do the gymnastics to develop the joint and restore muscle tone.

Observe safety measures to avoid personal injury.

The main thing - do not run the disease, on time contact your doctor and follow his recommendations.

If the contracture still appeared, modern methods of treatment can either completely rid it of it, or significantly improve the amplitude of limb movements.

Nadezhda Martynova

A source: http://SustavZdorov.ru/raznoe/kontraktura-286.html

Contracture of joints and muscles - causes of development, diagnosis and treatment

:

  • Classification
  • Dupuytren's Contraction
  • Diagnosis and treatment of the disease
  • Possible consequences

Contracture refers to the limited amplitude of movements in the joint, which is due to the shortening of extraarticular soft tissues caused by injuries or diseases.

Classification of contractures

There are contractures:

  1. Congenital, accompanying such malformations as arthrogryposis, clubfoot, muscular torticollis and other congenital diseases.
  2. Acquired, developed as a result of scarring, associated with infectious, traumatic and other lesions of tissues and joints, and after amputations, tendon injuries, muscular balance disorders associated with the installation of plastic surgery implants (capsular contracture).

Depending on the predominant tissue in the resulting contracture, they can be:

  • Dermatogenic (cutaneous), caused by scars, resulting from burns or inflammatory diseases;
  • desmogenic, resulting from the wrinkling of ligaments and fascia after extensive damage, and also after the development of certain diseases;
  • myogenic (muscle), associated with shortening of muscles because of their reflex reduction or because of the inflammatory processes occurring in them (for example, Volkmann's ischemic contracture);
  • tendonous (tendon), caused by shortening or difficulty sliding of tendons due to inflammation, damage, leading to the formation of adhesions;
  • arthrogenic (articular), developing as a result of changes in the ends of the joint and in its ligamentally-caspular apparatus.

Dupuytren's Contraction

Dupuytren's contracture refers to a disease accompanied by the degeneration and shortening of the palmar tendons, resulting in a partial loss of the functions of the brush, including a violation of the ability to unbend fingers.

The exact causes of its occurrence are still unknown.

However, there is an assumption that it can arise as a result of overload of the hands, inflammatory disease, metabolic disorders, smoking, genetic predisposition, diseases such as: diabetes, epilepsy, alcoholism.

You will be interested in:Comfrey gel-balm 911: instructions

Dupuytren's contracture is absolutely painless.

Suspicions can arise only in the case of detection under the skin of the palms of the nodules and seals, and tightened by them fingers, usually this ring finger or little finger, unbend with difficulty or not straighten out at all (in particularly heavy cases). The sensitivity of the fingers is sharply reduced.

This disease is a permanent, more or less progressive process, ultimately leading to the degeneration of the palmar aponeurosis. The process of degeneration begins, as a rule, with one brush, and then occurs on the second.

Conditionally distinguish four periods of the disease:

  1. Preclinical. He is characterized by such signs: a feeling of general fatigue, aching pain in the hands, morning stiffness of the hands, numbness of the fingers. Objective symptoms (flattening of skin folds, dry skin, tightening and deterioration of its displacement) at this stage are expressed indistinctly or not expressed at all.
  2. Elementary. The palms begin to appear nodes, the skin folds become denser, grooves are formed. This period lasts several years.
  3. The period of progression. The process of cicatricial degeneration begins to progress and spreads along the longitudinal rays of the palmar aponeurosis, starting from the palm and reaching the phalanges of the fingers. It is characterized by densification and shortening of the rays of the aponeurosis, which leads to the appearance of a contraction of metacarpophalangeal and later interphalangeal (proximal and distal) joints. On the skin of the palms and fingers, the entrainment is formed, the subcutaneous-fat tissue is atrophied, the skin becomes coarse and wrinkled.
  4. Late. Local symptoms stabilize, reaching an extreme degree. In the absence of surgical treatment of the brush, secondary deformations occur leading to subluxation of the nail or medium phalanx. The forecast for renewal of brush functions at this stage is quite unfavorable.

Diagnosis and treatment of contractures

To make an accurate diagnosis, first of all, the doctor must listen to the patient's complaints, learn about the way of his life, and also conduct palpation.

The treatment of contracture can not be dealt with on its own, since it includes a whole complex consisting not only of conservative measures, but also of operational ones. Those species that can be corrected can be treated with conservative methods. In this case, prescribe drugs that are designed to eliminate pain, as well as muscle relaxants.

The complex of therapeutic measures must include physiotherapy procedures: diadynamic currents and electrophoresis of novocaine, as well as physical exercises (active and passive), which should be performed in a bath with warm water. It is very useful for this disease, therapeutic exercise, aimed at relaxing the muscles.

.

For contractures more resistant, for example, arthrogenic, injections of pyrogenal or vitreous are prescribed, paraffin-ozocerite applications.

.

In addition, it is highly recommended to perform intensive massage of adhesions and scars, to perform exercises that stretch the abbreviated tissues.

In some cases, when there is an increased elastic resistance of tissues, to correct the position of the joints it is possible, having resorted to the help of stage plaster casts, and also to the method of forced straightening - one-stage Redress. An effective method of treatment is the use of hinge-distraction apparatus.

Mechanotherapy with the use of pendulum apparatus and block installations is also practiced.

To develop contracture of both the knee and elbow joint is very convenient, using blocks through which cords for thrust are thrown.

It is also good for knee joints to practice on special tires of Belera or on tires with elastic traction.

Eliminate the contracture of fingers and brushes with a special apparatus in the form of a lyre, which is attached to the forearm. To fix the fingers to this apparatus use rubber bands.

With fixed contractures, the treatment of which is useless with conservative methods and folk remedies, surgical intervention is indicated.

In the course of such operations, constricting skin scars are excised, lengthened and released from muscle and tendon scars, capsules of the joints are dissected.

Consequences of the disease

If you do not consult a doctor in a timely manner, contracture can lead to a complete immobility of the limb. The disease that has reached the final stage is treated only by surgery, so it is very important to consult a doctor at the very first symptoms.

Regardless of the type of disease, it can end very unfavorably for the patient.

For example, in the case of an advanced contracture of the knee joint, the patient will not be able to move normally, and The deformed limb will reduce the possibility of physical activity to a minimum and will not allow him to lead full life.

A source: https://vashaspina.ru/kontraktura-sustavov-i-myshc-prichiny-razvitiya-diagnostika-i-lechenie/

Contracture is what? Contracture of muscles: diagnosis, treatment

Contracture is a condition in which the mobility of the joint is limited. Causes such a phenomenon pathological scar scar tissue, surrounding the joint: muscles, skin, subcutaneous tissue.

Contracture of muscles

With muscle contracture, there is a pathological tone or rehydration of muscles, ligaments, tendons.

If this process progresses, muscle fibrosis is observed, that is, muscle tissue, capable of contraction, is transformed into a fibrous tissue that has lost such a function.

In other words, the joint is not able to fully bend or straighten up because the associated muscle bundles can not fully 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, and operations.

.

This is especially true when the affected limb has been fixed for a long time in a stationary position.

As a result of the pathological tone of the muscles, nervous signals change and contracture is formed.

In some cases, contracture (photos showing this state, are available in the article) develops when injury to the muscles and incomplete recovery of them, as a result of which to perform their functions in full muscle not in condition. An intensive pain syndrome further exacerbates the course of the pathological process, since the painful sensations in the joints or muscles somehow force the person to restrict movement.

Kinds

Symptoms and causes of structural changes in the joints and adjacent tissues are manifold, therefore it is rather difficult to classify contractures. The generally recognized system of division is based on the immediate cause of their development.

  • Structural (passive) contracture. It occurs as a result of structural changes in local tissues (tendons, joints, muscles, ligaments, fasciae or skin). Develops with gross violations of blood supply or long-term immobility of the joint.
  • Neurogenic (active) contracture. It causes a prolonged strain of certain muscles, as a result of which cicatrical and dystrophic changes develop in the capsule of the joint 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 innate character. Acquired, in turn, is divided into neurogenic and post-traumatic.

This ailment most often affects small joints.

For example, contracture can develop with a complete loss of mobility of the joints of the fingers for several months. It is called immobilization.

Of the conditions affecting large joints, hip contracture and shoulder contracture are highlighted.

Palmar fibromatosis

The contracture of the fingers of the hand, or Dupuytren, is the most common and at the same time dangerous kind of this pathology. Developing nodes on the palm are often mistaken for calluses. Gradually, the normal movement of the fingers is disturbed.

The thickening of the connective tissue at some point becomes so great 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 wrist is developing, today it is not known for certain. 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, the contracture of the hand more often develops in people suffering from diabetes mellitus, epileptic seizures. There is also a genetic predisposition.

That is, if someone from the family had a contracture of the hand, then the probability of the disease is significantly increased.

For the treatment of Dupuytren's contracture, a conservative method is used. At the initial stage, further development of the pathology will be assisted by massage and physiotherapy.

.

But with a strong restriction of the mobility of the fingers, special enzyme preparations are used (for example, injections of the Lidase drug), which help soften the tissues.

.

Some clinics use the method of shock wave therapy, which allows you to achieve fairly good results. Contracture of the fingers in severe form 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 are engaged in heavy physical labor, since in this case the risk of damage to the joints, bones, muscles is increased.

People who work in chemical production are predisposed to the appearance of burn contractures.

The violinists, pianists and other musicians can develop a contracture of the fingers, since during long training the fingers experience a lot of stress.

Passive contracture develops as a result of mechanical obstructions both in the joint itself, and in the tendons, muscles, fasciae or skin. People with active contractures have no mechanical obstruction in the joint or surrounding tissues.

Instead, there is a violation or restriction of motor activity. In this case, a long tonic tension is observed in individual muscle groups. The balance between the muscles-antagonists is broken, as a result of the joints "jammed".

This is the mechanism of development of active contractures. At the initial stage of existence, they are still unstable and lend themselves to a relatively simple correction. Active contractures disappear after normal motor activity.

However, over time, they become more resistant.

There are also mixed forms, when the root cause of the restriction of movements is difficult to determine. This happens in the case when at the first examination of the patient there are signs of both mechanical damage and damage to the nervous system.

You will be interested in:Polyneuropathy of the lower and upper extremities: symptoms, treatment, drugs

Stages of

  • Neurogenic. Inactivity of the damaged limb provokes persistent centers of excitation in the central nervous system. These pockets send impulses to the periphery, thus forming a pathological tone. At the same time, biochemical changes develop in the limb tissues.
  • Myogenic. Due to biochemical changes and neurogenic reaction, changes occur in muscle tissue (degeneration and atrophy).
  • Miodesmogenic. The weight and volume of the limb sharply decrease, the muscles develop degenerative changes. There is hypertrophy of the muscles, which, progressing, grows into an atrophy.
  • Atrogenic. There is thickening and wrinkling of the joint capsule, articular cartilage becomes less durable and elastic. Appear scars, soldering capsule and cartilage. There is a wrinkling of the fascia, the intermuscular connective tissue grows and partially replaces the muscular tissue. Soft tissues and bones are soldered. Third points of fixation that impede the movement of the joint develop.

Possible complications

Contracture is a serious pathology, and if it is not treated, complications such as stiffness and even ankylosis (complete immobility with degeneration of the joint tissues) can develop. Often the ailment also covers adjacent joints.

So, for example, if the normal functioning of the ankle joint is disturbed, the foot is involved in the pathological process over time, knee, hip joint (develops hip contracture), lumbar, and then thoracic and cervical spine.

Pathologies of the upper extremities are no less dangerous. So, the ulnar contracture leads to a decrease in the functionality of the hand. This makes it difficult to self-service at the household level and elementary work.

Diagnostics

Preliminary diagnosis includes a questioning of the patient and his examination. Also, the doctor will find out whether there were cases of this pathology in close relatives. After the specialist will determine whether the limb is able to perform the actions and what 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 in additional studies there is no need.

In some cases, an X-ray may be required in order to accurately determine the location of the abnormal area.

Contracture: treatment

Before starting treatment, it is necessary to completely eliminate the cause that triggered 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

Typically, with contracture appoint conservative therapy, aimed at restoring the normal amplitude of limb movements. It includes:

  • medicamentous therapy (non-steroidal anti-inflammatory drugs, hormones, analgesics, muscle relaxants);
  • therapeutic blockades - drugs injected into the joint cavity that have a resolving effect;
  • manual therapy and massage;
  • mechanotherapy;
  • Physiotherapy (electrophoresis, UHF);
  • orthopedic methods (elastic pull, twist, orthoses);
  • traction (traction);
  • stage gypsum dressings.

Surgical intervention

The main goal of the above measures is to eliminate the symptoms of inflammation, relieve swelling, restore joint mobility.

However, all these methods do not involve the work of muscles in the process. But it is the muscles - the main "engine" of the joints.

Therefore, in some cases, if a contracture is found, an operation is a necessity.

Surgical treatment includes:

  • excision of scars and skin plasty;
  • fasciotomy;
  • tenotomy;
  • fibrotyomy;
  • capsulotomy;
  • arthrolysis;
  • arthroplasty;
  • osteotomy.

In some cases, you can not do without surgery. But for tissues this is a traumatic process. With the help of surgery, you can get rid of the mechanical cause of the contracture, but the pathological tone and pain will not disappear.

Restoration of normal muscle activity in any case is necessary, because, having eliminated only the mechanical an obstruction, a contracture will disappear only partially, and normal movement in a joint will be restored not in the full volume.

Natural methods of treatment

Contracture is a pathology that needs to be treated systematically. Natural methods help not to fight the symptoms, but to eliminate the causes of the development of the disease. If the contracture has developed, the treatment includes:

  • power kinesitherapy;
  • manual therapy, mechanotherapy, physiotherapy;
  • balneotherapy, medical baths;
  • physiotherapy;
  • phytotherapy;

Conclusion

To prevent the emergence of contracture, it is important not to allow 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 is to be kept in a bent state for a long time, then bend it should be 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 is such a nuisance as a bone fracture or a joint dislocation, and a prolonged immobilization is necessary, do not despair.

.

The risk of muscle contracture can be minimized, provided that active muscular work is performed from the first day.

.

If there was a fracture of the bones of one limb, exercise can be performed with a healthy arm or leg.

Restorative processes after muscle activity, except for the worked muscles, will affect the muscles in the problem area. And the process of regeneration will be more pronounced, if you work out the large muscles. Take care of yourself and be well!

A source: http://.ru/article/161832/kontrakturaeto-chto-kontraktura-myishts-diagnostika-lechenie

Contracture of joints

Contracture of the joint- Stable limitation of movements in the joint.

It can be caused by various causes: violation of the joint configuration, cicatricial changes, pain syndrome, muscle diseases, disorders of nervous regulation, etc. Perhaps the defeat of any joint.

The importance of pathology depends on the location of the contracture and the degree of restriction of movement.

The greatest clinical significance is contracture of large and medium joints of the extremities: ankle, knee, hip, elbow and shoulder.

In this case, the most common are contractures of the ankle, knee and elbow joints. Diagnosis is made on the basis of symptoms, measurement of movement volume, joint radiography and other studies. Treatment can be both conservative and operative. The prognosis depends on the prescription and the cause of the development of pathology, fresh contractures are amenable to treatment better than the chronic ones.

Contracture joints - pathological conditions, accompanied by a persistent restriction of movements. They are widely used in practical traumatology and orthopedics.

They can develop due to inflammatory and degenerative-dystrophic processes, congenital developmental disorders, innervation disorders, etc. Often occur in the long-term after a skeletal injury, especially severe.

Often become the reason for disability and access to disability. Treatment of joint contractures is usually handled by traumatologists and orthopedists.

Depending on the cause of the development of pathology, neurologists, surgeons, rheumatologists and other specialists can also take part in treatment.

Mechanism of development of joint contractures

Depending on the mechanism of origin, two large groups of joint contractures are distinguished: passive and active.

The cause of the formation of passive contractures are mechanical obstacles in the joint itself or in surrounding tissues (fasciae, skin, tendons, muscles, etc.).

With neurogenic (active) contractures, there is no mechanical obstruction, restriction of movements develops due to irritation of certain parts of the nervous system, or due to the loss of its functions.

.

Due to the violation of nervous regulation, muscle tone of one group begins to predominate, the muscular balance between the antagonists is broken, the joint is in the position of contracture.

.

In the initial stage, the restriction of movements in such cases is unstable, with the elimination of neurologic violations of contracture significantly reduced or even disappear.

With prolonged existence, secondary changes in the joint and periarticular tissues gradually develop, the active contracture acquires passive components.

Along with passive and active, in some cases, there are combined joint contractures, with which can not be established, which originated in the beginning - the pathology of the nervous system or the local process in the joint. In addition, there are congenital joint contractures, in which both a mechanical obstacle to movement or a violation of nervous regulation, and a combination of both of these mechanisms are possible. So, for example, with congenital dislocation of the knee joint, the underdevelopment and vicious position of the tibia is sometimes combined with underdevelopment of the muscles and nerves of the thigh and lower leg.

Significant heterogeneity of this pathology, both in the etiological aspect, and in terms of the diversity of structural changes in the joint and periarticular tissues cause a large number of classifications of contractures joints. Along with the active (neurogenic) and passive (structural) allocate congenital and acquired contractures. Given the cause of development, all structural joint contractures are divided into:

  • Arthrogenic- the cause of the limitation of movements is the pathology of the joint itself, for example, the disruption of the configuration of articular surfaces as a result of a fracture, purulent arthritis or deforming arthrosis.
  • Myogenic- movements in the joint are limited due to the pathology of the muscles.
  • Dermatogenic- the cause of the limitation of movements are scars on the skin, usually after extensive burns, less often - after purulent processes (abscess, phlegmon), ruptured and wound-bruised wounds in the region of the joint and the nearest segments extremities.
  • Desmogenic- movements are limited due to connective tissue scars. Such contractures are often combined with dermatogenic, however, can develop and in isolation.
  • Ischemic- usually occur in fractures, accompanied by a prolonged and significant, but not complete restriction of the arterial blood supply to the extremity. More often they are formed in childhood with fractures of the forearm, condylar and supracondylar fractures of the shoulder.
  • Immobilization- arise due to prolonged immobilization. They are usually caused by a combination of several factors: a decrease in the elasticity of the soft tissue structures of the joint, a shortening of the muscles,

Some specialists single out joint contractures arising after gunshot wounds in a separate group.

Neurogenic joint contractures are also divided into several forms, taking into account the cause:

  • Central neurogenic: cerebral - joint contractures arising from injuries and brain diseases (ischemic and hemorrhagic stroke, encephalitis, severe TBI, cerebral palsy), spinal - developing with spinal cord injury (tumors, vertebral-spinal trauma, spinal cord blood flow disorders).
  • Peripheral neurogenic: painful - due to the forced position of the limb, developed due to pain syndrome; reflex-conditioned prolonged irritation of the nerve, leading to an increase in muscle tone; Irritation-paretic and due to violation of autonomic innervation.
  • Psychogenic- arising from hysteria.

Taking into account the peculiarities of the movement limitation, the flexion, extensor, diverting, leading, supination and pronational contractures are distinguished. In clinical practice, it is also important to divide joint contractures into functionally beneficial and functionally unprofitable ones.

You will be interested in:Shingles in the lower back and back: causes

The diagnosis of joint contracture is set based on measuring the volume of active and passive movements.

An X-ray examination of the corresponding segment is mandatory: for contracture knee - x-ray of the knee joint, with elbow contracture - x-ray of the elbow joint and and so forth.

.

In the rest, the volume of additional studies depends on the nature of the pathology that caused the limitation of movements. With passive contractures, the patient can be sent to the MRI or CT of the joint.

.

With neurogenic contractures, a consultation of a neurologist is necessary (with hysterical psychiatrists), electromyography and various tests are possible. If a nonspecific or specific inflammation is suspected, consultations of the appropriate specialists are appointed: surgeon, rheumatologist, phthisiatrician, etc.

Treatment of joint contractures should be comprehensive, conducted taking into account the cause of development and the nature of pathological changes.

Conservative therapy of structural contractures includes massage, physiotherapy (Novocain electrophoresis and diadynamic currents), complex exercise therapy with the implementation of active and passive exercises, as well as exercises for muscle relaxation. With more stable restriction of motion, paraffin, ozocerite, vitreous injection or pyrogenal are prescribed. If the tissues have retained sufficient elasticity, stage gypsum dressings or a one-stage redression (forcible straightening of the limb) are used.

Practice mechanotherapy with the use of block installations and pendulum devices. To reduce inflammation and relieve the pain caused by a significant load on the affected joint, prescribe analgesics and NSAIDs.

Sometimes Ilizarov's apparatus and hinged-distraction apparatuses are used to restore movements.

The drawback of this method is the massiveness of external structures - the devices have to be superimposed on two neighboring segments (for example, the shoulder and forearm), the advantages include the "smoothness" of development the joint.

If conservative therapy does not give the desired effect, surgery is performed. With dermatogenic and desmogenic joint contractures, scars are excised and skin plasty is performed.

When the fascia is wrinkled, fasciotomy is performed, with shortening of the muscles and tendons - tenotomy and lengthening of the tendons.

With arthrogenic contractures, depending on the nature of the pathological changes, dissection of the joint capsule (capsulotomy), dissection of adhesions in the joint (arthrolysis), restoration of articular surfaces (arthroplasty) or bone dissection (osteotomy).

.

Treatment of neurogenic joint contractures is also complex, combining general and local measures, more often - conservative. When psychogenic (hysterical) contractures require psychiatric or psychotherapeutic treatment.

.

Treatment of central neurogenic contractures is carried out in close connection with the therapy of the underlying disease. Patients are prescribed massage, exercise therapy and rhythmic galvanization.

If necessary, impose gypsum dressings to prevent the limb from being set in a vicious position.

With spinal contractures of the joints, the main disease is treated, and the joints are prevented and treated.

Widely used various orthopedic devices: tires, cuff and glue traction, designs with cargoes, intended for gradual straightening of bent joints, etc. Prescribe exercise therapy, massage and warm baths.

With old contractures that impede standing and walking, use orthopedic devices and banded gypsum dressings. In some cases, surgical operations are performed.

With peripheral neurogenic contractures, the main disease is also treated.

To restore the movement apply LFK, massage, stage dressings, electrostimulation, mud therapy and balneotherapy.

.

If necessary, surgical interventions are performed to restore nerve conduction and eliminate secondary adhesions in the joint region.

.

The prognosis for joint contractures depends on the cause and duration of the pathology.

With fresh joint dilution and the absence of gross anatomical changes (eg, significant destruction of the articular surface) in most cases it is possible to achieve partial or complete restoration of movements.

With old contractures, there is a degeneration and reorganization of all joint structures, including cartilage, capsule, ligament, etc., therefore the prognosis in such cases is less favorable, in most cases, to restore the movements (even partial), a surgical correction.

A source: http://www.krasotaimedicina.ru/diseases/traumatology/joint-contractures

Contracture of the joint. Symptoms, treatment, prevention:

Due to the inflammatory diseases or injuries of the tendons, muscles, nerves and vessels, the patient may develop a condition in which the mobility of the joints is limited. In medicine, it is defined as the contracture of the joint. About what this pathology represents and how it is treated, we'll talk further in the article.

Types of joint contracture

The stiffness of the joints, depending on the surviving possibilities of functioning, is divided into several types:

  • flexion (the patient can not unbend the limb or fingers);
  • extensor (the process of flexion is broken);
  • leading (the patient can not take the limb aside);
  • The diverting one (can not press a limb);
  • Rotational (the possibility of any movement is impaired).

And depending on the area of ​​the lesion that caused the problem, the joint contracture is divided into arthrogenic (caused by fractures and dislocations of bones), desmogenic (which is a consequence of the transferred inflammatory process), dermatogenic (developed after skin burns), myogenic (which arose in result of muscle damage), tendon (after injury of tendons) and neurogenic (consequence of paralysis, CNS diseases and hemorrhages in the brain).

How contractures of joints arise

Contractures can be both congenital and acquired. Congenital contracture of the joint arises as a result of underdevelopment of muscle tissue or defects in the structure of the joint itself.

And acquired appears either as a result of pathologies of the nervous system (then it is referred to as neurogenic), or as a result of traumatic damage to the soft tissues or bones of the joint (then it is considered traumatic).

But in most cases, contractures are of a mixed nature, because, due to the change in one type of tissue, contracture often leads to secondary changes in the joint, which, in turn, also supports violations of it mobility.

Symptoms of having a joint contracture

As it is already clear from the above, the contracture is the limitation of the motor abilities of the joint.

And the symptoms of the presence of this pathology directly depend on what caused the stiffness, as well as the stage of the disease.

The patient, as a rule, discovers that the motion of the limb has deteriorated noticeably:

  • the joint became swollen;
  • its deformation is noticeable;
  • it is difficult to lean on a sick limb;
  • movements in the damaged joint became painful;
  • the limb became somewhat shorter.

All these signs should be perceived as the need for urgent consultation with the surgeon, to establish a diagnosis and prescribe a course of treatment, since contracture at early stages is well amenable to correction, and a neglected disease often requires surgical intervention, up to replacement the joint.

The causes of elbow joint contracture

The most common types of this disease are contractures of the elbow, knee and ankle joints.

In the elbow joint, the most frequent cause of development of his stiffness is pathological changes in soft tissues associated with the joint functionally. That is, the mobility of the arm at the elbow is severely limited by the change in the adjacent soft tissues.

The reasons that caused contracture include:

1) inflammation and trauma;

2) deformation of the joint bones under the influence of the transferred arthritis or arthrosis;

3) loss of joint elasticity;

4) reducing the length of those muscles that support movement in the elbow joint.

There is also a contracture of the elbow joint caused by purulent arthritis, as well as extensive burns or lacerations of the soft tissues of the hand.

How does the condition of knee joint contracture develop?

After fractures of the lower extremities, it is often possible to observe the development of stiffness in the knee joint.

This is due most often to the fact that the foot is stationary for a long time in order to create favorable conditions for the fusion of bone fragments.

Therefore, in the rehabilitation of patients with leg injuries, one of the directions is contracture of the knee joint, or rather, the fight against its manifestations.

Therapy, as a rule, is aimed at reducing painful sensations and eliminating the existing inflammatory process. By the way, physicians insist that early treatment of the pathology of any joint gives the highest chances of getting rid of contracture.

Contracture of the joint: treatment

Treatment of contracture has two directions: conservative and surgical.

In the first case, the patient is offered a course of drug treatment with pain medications ("Lidocaine "Novocaine etc.), which are injected into the affected joint.

With the disappearance of pain, the muscles acquire a previous tone, and the pathological process slows down. So does the treatment with hormonal drugs.

Physiotherapy, physiotherapy and massage are always included in medical therapy.

.

If conservative methods do not bring the expected result for any reason, the contracture of the joint is treated with a surgical intervention.

.

With its help, scars are scraped, muscle length is increased, tendons are removed, spikes are cut, and the need to carry out and osteotomy - an operation that can delay the replacement of the destroyed joint artificial.

Prophylaxis of contracture

Contracture, like any disease, is, of course, easier to prevent. For this you should use absolutely simple methods:

  • if necessary, hold your hand for a long time, try to make the angle of the bend straight;
  • and the best position for the legs - straightened;
  • the fingers of the hands "love" to be in a half-bent position;
  • trauma and inflammation must be treated on time and to the end;
  • If the limb should be fixed, then it must be placed in a functionally correct position.

In addition, it is important to remember that in the absence of adequate treatment, any contracture is the risk of the patient developing complete immobility of the joint (ankylosis) and disability. So, do not delay visiting a surgeon or orthopedic surgeon if you suspect a contracture, as this can directly affect your physical abilities.

A source: https://www.syl.ru/article/202476/new_kontraktura-sustava-simptomyi-lechenie-profilaktika

Sign Up To Our Newsletter

Pellentesque Dui, Non Felis. Maecenas Male