Sarcomeres are basic muscle units that cause muscle fibers to contract. In muscle contractures, the sarcomeres lengthen too much as the muscle fibers tighten. This increase in the length of the sarcomere prevents the muscle from contracting normally, which leads to muscle weakness. Muscle contracture makes muscles tense and difficult to move and stretch. The causes of muscle contracture are not always preventable, but a wide range of treatment options are available to relax tense muscles and maintain or restore the range of motion of your muscles. Common risk factors for the development of contractures are motor dysfunction (hemiplegia or tetraplegia), hypoxic ischemic lesions (e.B. Stroke), spinal cord injuries and age.13 Muscles that are flexors, those that bend joints to bring body parts closer to the body, are most affected by contractures. The stiffening and tightening of these muscles prevents parts of the body from being moved out of the body and away. The PIP joint is most often contracted by the central cord, followed by the spiral cord and the lateral cord, in descending order. The three cords are attached to the base of the middle phalanx and can be involved alone or together. Your doctor may use one or more of the following measures to treat your contracture: Most joint contractures are successfully treated by stretching and splinting. Few require surgical release. Contractures from 15° to 50° generally have favorable results.
Adults and adolescents with long-term contractures of more than 70° bending are best treated with arthrodesis. The results of soft tissue release are inversely proportional to the severity of the contracture. Often, initial tight contractures can be improved by conscientious stretching, but must be operated on later in childhood to achieve complete correction. Surgery can be difficult and must be followed by a strict stretching and night train program. Surgical release of contracted muscle tissue may be necessary in severe cases where muscle contractures limit the range of functions required for activities of daily living (ADLs). This type of surgery can also improve functional movements such as walking and getting in and out of the bed and chairs. Tense muscles can be surgically cut and tendons lengthened to allow for more mobility. Injections of obese stem cells have been proposed as an accelerator for wound healing with a better range of motion in patients with radiation-induced cervical burn contractures and as an alternative to surgical procedures.30 Treatments vary depending on the child`s age, type of contracture, and current health status. Treatments may include: Shoulder stiffness often develops in the hemiplegic patient after a stroke, and this is often followed by shoulder-hand syndrome, which is considered a variant of regional pain syndrome (reflex-sympathetic dystrophy). The joints of the hand become stiff and flexion contractures begin to develop. Pain, edema and vasomotor changes are important.
The patient protects the hand with vigilance and can withstand ROM exercises. The key to solving this problem is to reduce edema and stiffness of the hand and stiffness of the shoulder. Edema is best controlled by elevation, gloves reducing edema or graduated wrapping of the fingers and hand, ROM exercises and massage. Hot or cold compresses on the hand and shoulder can make ROM movements less painful. A course of an NSAID can reduce pain and inflammation, although a short course of a corticosteroid is more effective in more severe shoulder-hand syndrome. A low dose of a tricyclic antidepressant can also help relieve pain. Other pharmacological options include anticonvulsants, especially gabapentin. Star node blocks may be needed if other procedures have failed. If spasticity causes pain and restricts the ROM on the shoulder, nerve blocks that affect the shoulder adductors and internal rotators can be helpful. The best treatment is to slow down or prevent the formation of contracture. Clinically, this mainly involves daily PROM and stretching exercises.
However, some evidence-based research has made these interventions controversial for a long time. Cochrane Review articles have suggested that passive movements are not effective in preventing and treating contractures,19 and that stretching does not prevent or reverse joint contractures in people with neurological diseases.20 However, many argue that these clinical trials did not provide a sufficient dose or did not combine modalities. Therefore, PROM, proper positioning and stretching remain the main clinical stays of treatment and prevention. Muscle contractures, or muscle tissue that is stiffer than normal and difficult to stretch, is caused by a permanent shortening of muscle fibers and a change in normal muscle structure. A contracture occurs when non-stretchy, fiber-like tissue replaces the normally stretchy elastic connective tissue of a joint, such as the hip or knee. .
