A 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 muscle bundles associated with it can not fully relax and allow the joint bones to take one of the extreme physiological positions.

Most often, muscle contracture develops as a result of injuries, inflammatory diseases, and operations. Especially it concerns those cases when for a long time the affected limb was fixed 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 such a state, there are in the article) develops when the muscles are injured and their recovery is incomplete, as a result of which the muscles are unable to perform their functions in full. 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 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). It develops with gross violations of blood supply or prolonged 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 the 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 disease. 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 one of the relatives had a contracture of the hand, 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. The contracture of the fingers in severe form requires surgical intervention.

Causes of pathology

Contracture is the most common complication of damage to joints, such as dislocations, bruises, fractures, gunshot wounds, inflammation, diseases of the nervous system, etc.

At risk are athletes and people who are engaged in heavy physical labor, as in this case, the risk of damage to joints, bones, muscles is increased. People who work in chemical production are predisposed to the appearance of burn contractures. For violinists, pianists and other musicians, the contracture of the fingers can develop, as during long training the fingers experience strong tension.

Passive contracture develops as a result of mechanical obstructions both in the joint itself, in the tendons, muscles, fasciae or skin. People with active contractures do not have mechanical obstructions in the joint area or in 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 is the case, if at the first examination of the patient there are signs of both mechanical damage and damage to the nervous system.

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 the size of the limb sharply decrease, the muscles develop degenerative changes. There is hypertrophy of the muscles, which, progressing, grows into 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, intermuscular connective tissue grows and partially replaces the muscular. 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 disrupted, the foot, knee, hip joint (hip contracture), lumbar and then thoracic and cervical spine are involved in the pathological process over time.

Pathologies of the upper extremities are no less dangerous. Thus, 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 expert 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 the need does not arise. 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 blockade - drugs injected into the joint cavity that have a resolving effect;

• Manual therapy and massage;

• Mechanotherapy;

• Physiotherapy (electrophoresis, UHF);

• Orthopedic methods (elastic traction, twisting, 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 that are the main "motor" 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;

• Fibrobotomy;

• 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 obstacle, the contracture will disappear only partially, and the normal movement in the joint will not be restored in full.

Natural methods of treatment

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

• Power kinesitherapy;

• Manual therapy, mechanotherapy, physiotherapy;

• Balneotherapy, medical baths;

• Physiotherapy;

• Phytotherapy;

• Balanced diet.

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 for a long time in a bent state, then it should be bent at right angles, the best position for the fingers of the hand is a semi-bent one, for the legs, the most optimal position is straightened.

If there is such a nuisance as a bone fracture or dislocation of the joint, 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!