Contracture

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Classification according to ICD-10
M24.5 Joint contracture
ICD-10 online (WHO version 2019)
Difficulty getting up and walking. A senior citizen is supported with mobility by a carer

A contracture ( Latin: contrahere "to pull together") is a restriction of the function and movement of joints . It is caused by the shortening of the surrounding soft tissues such as muscles , tendons , ligaments and fasciae . The affected joints cannot be moved actively or passively, or can only be moved with difficulty and to a small extent; the movement can be painful. The extent of the restriction can range up to complete stiffening. The treatment of contractures that have occurred is predominantly physiotherapeutic , with particular importance being given to avoiding restricted mobility through contracture prophylaxis .

Occurrence

Joint contractures can occur in the following diseases:

Clinical appearance and diagnostics

Knee as sole of foot - knee flexion contracture

Contractures are characterized by active and passive, sometimes painful, restricted movement, which also limits the function of the joint. All planes of movement of a joint can be affected; the movement appears inharmonious. The restriction can range from a slight functional restriction to complete rigidity with forced posture of the joint. The transitions are fluid. In principle, all joints can be affected by contractures, but they mostly occur on the large joints such as the shoulders, elbows, hip and knee joints.

Contractures have a very typical clinical appearance and the diagnosis is accordingly easy. Further diagnostic measures are therefore not usually necessary.

Types of contractures

Classification according to joint position

Contractures can be described by the misalignment of the affected joint; the most common contracture is the flexor contracture , since the flexor muscles are often more pronounced than the counteracting extensor muscles, but extensor contractures also occur. A typical example of flexion contractures of the hand is camptodactyly, which can occur sporadically, in families or as a syndromic form (contracture in the proximal interphalangeal joint of the little finger).

If limbs are spread apart or drawn in from the center of the body as a result of the contracture, these are referred to as abduction or adduction contractures . Other forms are internal or external rotation contractures as well as pronation and supination contractures .

Classification according to tissue damage

Contractures are differentiated according to their cause and development :

  • Ontogenetic contracture - The contracture is innate, such as a congenital clubfoot.
  • Neurogenic contracture - The contracture is caused by nerve damage, such as polio or spastic paralysis .
  • Dologene contracture - cause of this pain is where the person concerned a posture assumes, for example as part of a sciatica .
  • Dermatogenic contracture - The contracture occurs when the skin contracts, for example when scarring after burns.
  • Arthrogenic contracture - A joint-related contracture, such as in rheumatism .
  • Tendomyogenic contracture - joint stiffness is caused by shrinkage of the tendons, an example of which is Volkmann's contractures .
  • Psychogenic contracture - the affected person consciously or unconsciously does not move a joint. The cause can be a traumatic experience .
  • Fasciogenic contractures - The aponeuroses or fasciae contract as a result of inflammation, injury or immobilization , a typical example is the Dupuytren's contracture .
  • Positioning deformity - The contracture is caused by the incorrect positioning of immobile patients, a known care mistake in this context is the equinus .

treatment

The contractures that occur most frequently are due to the position, so efforts are made to avoid them through good prophylaxis. The most important treatment method for contractures that have already occurred are active and passive movement exercises as part of physiotherapy or occupational therapy . As a complement to physiotherapy or occupational therapy training in a can exerciser or an exercise therapy device reduce or prevent contractures. In addition, massages and heat treatments can be used, during breaks in treatment positioning rails, stretch bandages or motor-driven movement rails can be used. If these measures do not work, surgical interventions can be considered to eliminate the contracture.

Contracture prophylaxis

In order to avoid movement and functional restrictions, the contracture prophylaxis should be started after determining the contract risk, for example through a nursing history . Depending on the cause of the risk, this includes, for example, early mobilization after surgical interventions as well as active, assisting or passive movement of the joints. Pain medication can be used to avoid relieving postures. Activating care , for example the continuation of the day and night rhythm with dressing and undressing, also contributes to the avoidance of a sedentary lifestyle that promotes contractures. Patients who are unable to move and who are impaired of consciousness, who also need decubitus prophylaxis , should be positioned in a physiological position and not too soft, as this inhibits their own movements.

literature

  • Rüdiger Döhler : Lexicon Orthopedic Surgery . Springer, Berlin / Heidelberg 2003, ISBN 3-540-41317-0 , pp. 107-108.
  • Ulrich Kamphausen: Prophylaxis in nursing - suggestions for creative action. Kohlhammer Verlag, 2009, ISBN 978-3-17-020829-2 .
  • Siegfried Huhn: Strategies of contracture prophylaxis for residents of nursing homes with restricted mobility . Grin Verlag, 2011, ISBN 978-3-640-98700-9 .
  • A. Macfarlane, H. Thornton: Solving the problem of contractures - throw out the recipe book? In: Physiotherapy Research International. 2, 1997, pp. 1-6.

Individual evidence

  1. ↑ F. Hefti: Pediatric Orthopedics in Practice. Springer, 1998, ISBN 3-540-61480-X , p. 648.
  2. ↑ a b Jürgen Krämer, Joachim Grifka: Orthopädie. Springer, 2004, ISBN 3-540-21970-6 , p. 23.
  3. ↑ a b Bernhard Weigel: Praxisbuch Unfallchirurgie. Springer, 2005, ISBN 3-540-41115-1 , pp. 1066-1067.
  4. ↑ Bernd-Dietrich Katthagen , I. Scheuer: The post-traumatic "Psychogenic Clubfoot". In: Arch. Orth. Trauma. Surg. 97 (1980), pp. 193-195, doi: 10.1007 / BF00389726 .
  5. ↑ a b Jürgen Krämer, Joachim Grifka: Orthopädie. Springer, 2004, ISBN 3-540-21970-6 , p. 24.
  6. ^ Ulrich Kamphausen: Prophylaxis in Nursing: Suggestions for creative action. Kohlhammer Verlag, 2009, ISBN 978-3-17-020829-2 , pp. 89-101.
  7. ↑ Axel Berning: Prophylaxis in nursing practice: assessing risks reliably - applying nursing standards competently. Elsevier, Urban & Fischer, 2006, ISBN 3-437-27740-5 , pp. 72-76.