Contracture (Latin contractura narrowing, reduction, tightening) — the restriction of normal mobility in a joint caused by cicatricial tightening of skin, tendons, diseases of muscles, a joint, a pain reflex, etc. Often a contracture call permanent reduction of extensibility of a muscle as a result of fibrosis or the steady activization of the mechanism of reduction of muscle fibers arising without action potentials of motor-neurons. These states define as a muscle contracture.
Classification of contractures
There is a large number of classification schemes of contractures. Difficulties of creation of such schemes are caused by a polietiologichnost of these morbid conditions, a big variety of structural changes in a joint and the fabrics surrounding it.
Except the division of contractures into passive (structural) and active (neurogenic) mentioned above, it is also accepted to allocate group of congenital contractures which in many respects differ from acquired in clinical and structural aspect.
Classification of passive contractures is usually made taking into account that fabric which plays a primary role in their origin. By this principle the passive contractures divide into artrogenny, myogenetic, dermatogenny and desmogenny. As separate forms of contractures are distinguished ischemic, immobilized. Some authors fairly consider that the contractures developing after gunshot wounds demand special consideration.
The group of neurogenic contractures includes the following forms:
I. Psychogenic contractures: a) hysterical.
II. Central neurogenic contractures: a) cerebral, b) spinal.
III. Peripheral neurogenic contractures: a) irritatsionno-paretic, b) painful, c) reflex, d) contractures at disturbances of a vegetative innervation.
Depending on restriction of any given sort of movements in a joint it is possible to allocate flexion, extensive, bringing, taking away, rotational (supinatsionny, pro-national ionic) and so forth. On function distinguish contractures in functionally favorable and it is functional an extremity disadvantage.
Reasons of contractures
Passive contractures which are called sometimes also local are caused by the mechanical obstacles arising both in the joint and in the fabrics surrounding it or located near a joint (in muscles, tendons, skin, fastion and so forth).
Patients with neurogenic contractures in a joint in which there was a restriction of movements in the fabrics surrounding a joint have no local mechanical reasons with which it would be possible to explain this restriction of movements. Such patients usually have phenomena of loss or irritation from nervous system causing the long tonic tension of separate muscular groups. At the same time there comes disturbance of normal muscular balance between antagonists, as leads already again to data of joints.
Originally neurogenic contractures are unstable, corrections give in, and at elimination of neurologic disturbances and restoration of normal function of nervous system can even disappear.
Gradually, eventually, neurogenic contractures gain firmness because in them components of a passive contracture appear.
Sometimes the combined forms of contractures at which it is difficult to differentiate initial mechanogenesis of the developed permanent restriction of movements in a joint meet, that is it is difficult to establish what was the prime cause of restriction of movements — local process or damage of nervous system.
The clinical value of contractures is very high. This most frequent complication of intra articulate and circumarticular fractures, dislocations, bruises of joints, fire injuries of extremities, inflammatory and degenerative dystrophic processes in joints, damages and diseases of nervous system and so forth. Meet a contracture and congenital origin.
Treatment of a contracture
Early and complex treatment: use of remedial gymnastics, physical therapy, massage, sanatorium treatment, according to indications operational.
Passive and active remedial gymnastics in injuries or diseases of nervous system, in burns and imposing of devices of chreskostny fixing.
Contractures are flexion and extensive. Contractures are subdivided into artrogenny, myogenetic and artromiogenny. The arthroscopy allows to solve all problems of artrogenny contractures. By means of arthroscopic tools the removal of commissures, intra articulate hems which are the reason of a contracture that allows to restore the normal volume of a cavity of a joint with the minimum injury is made.
Arthroscopic treatment allows to reduce, and in certain cases completely to eliminate a contracture of joints and provides early postoperative rehabilitation.
Prevention of a contracture
Prevention of a contracture consists in the correct and timely treatment of a disease which can cause it. At injuries of bones and joints the extremity has to be fixed in the correct situation, and at certain indications treatment of changes during the period, an immobilization has to be carried out by constant skeletal traction. The last allows to combine rest of the place of a change with movements in the next joints. After removal of plaster bandages carry vigorously out the subsequent treatment: appoint remedial gymnastics, massage, bathtubs, physical therapy, etc. It is especially important to warn artrogenny contractures in the intra articulate and circumarticular fractures demanding for the treatment of a long immobilization. At inflammatory and paralytic defeats the immobilization has to be made taking into account functionally advantageous position of an extremity. So, for example, when fixing a shoulder joint it is necessary to take away a shoulder on the 60th, for an elbow joint the most favorable is its bending at an angle 90 °, for brush fingers — halfbent situation them and assignment of a thumb, for knee and a hip joint — the straightened position of a leg, etc.
The Dermatogenny contracture can be warned by early skin plasticity in extensive burns or injuries of skin of other character. At injuries of tendons it is necessary to achieve timely recovery of their integrity and the subsequent performing the correct treatment. Functional contractures can be warned by wearing orthopedic footwear (when shortening a leg), etc.