What is the treatment for contracture?
The treatment of contractures includes different rehabilitation and positioning. If a contracture does not respond to conservative management and affects the quality of life, medical professionals may consider surgical intervention.
When is surgical intervention indicated in the treatment of contracture?
If a contracture does not respond to conservative management and affects the quality of life, medical professionals may consider surgical intervention. The treatment approaches include PROM or AAROM, Stretching, Proper Positioning and heat modalities.
How can i Improve my contracture recovery efforts?
To boost your contracture recovery efforts, you can try spasticity-reducing treatments like Botox . This drug is a nerve-blocker that temporarily relieves spasticity and contractures. Although the treatment is temporary and requires repeat treatments, you can use the relief as a “window of opportunity” to get rehab exercises done.
What should be included in patient education about joint contracture?
Discussions are necessary about the sequelae of a joint contracture and treatment options available. Patient goals are discussed with the rehabilitation team and concerns addressed. Prevention is key. Appropriate positioning in bed is a simple yet effective preventative measure.
How is physical therapy contracture treated?
Stretch is one of the most widely used techniques for treatment and prevention of contractures. Its aim is to increase joint mobility and it can be self-administered or applied manually by therapists. Splints, positioning programs or casts changed at regular intervals (serial casting) can also be used.
What is the best way to manage a contracture?
Nonsurgical options include:wearing open-back shoes, such as clogs.taking nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (Advil, Motrin IB) or aspirin (Bufferin)icing the bump for 20 to 40 minutes per day to reduce swelling.getting ultrasound treatments.getting a soft tissue massage.wearing orthotics.More items...
How can occupational therapy prevent contractures?
In addition, range-of-motion exercises are the best way to reverse and prevent contracture. These exercises provide stimulation of the muscles and joints, creating more blood flow to the affected area, reducing the risk of blood clots.
What are contractures and how can they be prevented?
Contractures occur when the burn scar matures, thickens, and tightens. This can prevent movement. It usually occurs when a burn occurs over a joint.
How do you treat contracted muscles?
How are muscle spasms (muscle cramps) treated?Stretch the affected area.Massage the affected area with your hands or a massage roller.Stand up and walk around.Apply heat or ice. Put an ice pack together or apply a heating pad, or take a nice warm bath.Take painkillers such as ibuprofen and acetaminophen.
How can you prevent contractures in a bedridden patient?
Are contractures preventable?EXERCISE. Range of motion exercises are arguably the most important weapon in preventing contractures. ... POSITIONING. The position of nursing home residents is crucial. ... SPLINTING. Splinting devices can be very useful in helping prevent painful and debilitating contractures.
What kind of exercises can be used to prevent contractures and muscle atrophy?
Swimming This is an excellent aerobic exercise for people with type 4 SMA, since it can help maintain range of motion and prevent contractures, says Sumner.
How can you prevent hand contractures?
One way to prevent contracture would be to wear a hand splint (orthosis) for a few hours every day or even while you are sleeping in order to passively stretch the muscles and maintain a unclenched hand state for an extended period of time.
Is stretching good for contracture?
Conclusion: stretch is not effective for the treatment and prevention of contractures and does not have short‐term effects on quality of life and pain in people with non‐neurological conditions.
How do you release contractures?
There are a number of therapies to reduce contractures including intra-lesional corticosteroid injection, antihistamines, hydrotherapy, dynamic or static splinting, laser therapy, compression therapy, and surgical excision and reconstruction; yet, it is still unknown which therapy should be chosen for which contracture ...
What is contracture management?
Neurological physiotherapy treatment will help manage contractures (soft tissue shortening) in order to limit and correct contraction of limbs. Contractures can occur when the hands, feet leg or arms slowly start to pull in towards the body and stiffen up.
Why does paralysis cause contractures?
The development of contractures may also occur due to muscle weakness and spasticity (increased muscle tone) .
What is the best way to reduce muscle shortening?
Positioning – this will be continually assessed in lying, sitting and standing making it as functional as possible to prevent muscle shortening and decrease pain. Heat – to decrease muscle pain and assist tissue lengthening before stretching.
What is the best way to stretch a joint?
Stretching – this may involve the use of splints or casts for prolonged stretch of the soft tissue surrounding a joint. Massage – helps maintain tissue mobility and nutrition. Manual techniques - joint mobilization may be used to increase joint flexibility and decrease pain.
What is the treatment for a contracture?
Treatment of Contractures: The treatment of contractures includes different rehabilitation and positioning. If a contracture does not respond to conservative management and affects the quality of life, medical professionals may consider surgical intervention.
What is a contracture in a joint?
A Contracture is a fixed loss of range of motion of a joint. It is usually due to any pathology of soft tissues like muscles, tendons, ligaments, cartilages, or connective tissues.
Can a brain injury cause contractures?
For example, brain injury leads to spasticity (high tone in muscles) causing immobility of muscles or joints that leads to contractures. Conversely, orthopedic conditions which require casting or bracing the joints for long period of time (treatment of fractures with an immobilizer) can cause contractures as well.
Do contractures occur in upper extremities?
These kinds of contractures seem to be more common in upper extremities than lower extremities. Few contractures, in early stages, respond well to treatment. Consequently, clinicians, mainly rehabilitation professionals are able to gain either full or near-normal range of motion back. This also helps to gain a functional activity.
Abstract
Contractures are a common complication of neurological and non‐neurological conditions, and are characterised by a reduction in joint mobility. Stretch is widely used for the treatment and prevention of contractures. However, it is not clear whether stretch is effective. This review is an update of the original 2010 version of this review.
Plain language summary
Review question: we reviewed the evidence about the effect of stretch in people who had or were vulnerable to joint deformities.
Background
Contractures are common in people with neurological conditions including stroke, spinal cord injury, acquired brain injury and cerebral palsy ( Diong 2012; Fergusson 2007; Kwah 2012 ).
Objectives
The aim of this review was to determine the effects of stretch on contractures in people with, or at risk of developing, contractures.The outcomes of interest were joint mobility, quality of life, pain, activity limitations, participation restrictions, spasticity and adverse events.
Discussion
The primary objective of this systematic review was to determine whether stretch increases joint mobility in people with existing contractures or those at risk of developing contractures.
Authors' conclusions
The results of this systematic review are sufficiently robust to indicate that stretch, as typically provided by physiotherapists, does not produce clinically meaningful effects on severity of contractures in people with neurological or non‐neurological conditions.
History
Methods were updated in accordance with current recommendations of The Cochrane Collaboration: 'Risk of bias' assessment and 'Summary of findings' tables were added.
How to prevent contractures from forming?
Gently stretching the affected muscles and taking them through their range of motion can help prevent contractures from forming. Most of all, massed practice of rehabilitation exercise can help manage spasticity, reduce contractures, and improve mobility.
What is a contracture in a stroke?
Contractures are a form of spasticity, a condition where muscles become stiff and tight after stroke. When spasticity is left unmanaged, contractures can develop. For example, if you had spasticity in your hand ...
What is orthosis for a therapist?
Orthoses include splints and props that are custom-fitted to support and gently stretch open the affected muscles and joints. They might be recommended by your therapist and will be adjusted to best suit your needs.
How to stretch your hand after a stroke?
When splints aren’t feasible, you can try using a basketball or other object to stretch your hand on. 2. Range of Motion Exercises. Next you’ll want to move your affected muscles through gentle range of motion exercises.
How to reverse a stroke?
You can reverse contractures after stroke by participating in daily, consistent rehabilitation using the following methods: 1. Stretching. To help reduce contractures after stroke, start by gently stretching the affected muscles.
What is contracture management?
Contractures are a complex problem involving multiple contributors, such as spasticity and muscle weakness. Existing evidence has suggested that sole interventions focusing on either reversing soft tissue shortening or addressing the underlying causes of contractures have limited effectiveness. Combining passive stretch with treatments that address the contributors appears a logical and worthwhile approach to consider for contracture management.
What are the factors that contribute to contractures?
Combined Factors. Spasticity and muscle weakness are both common primary motor impairments and often co-exist after an acquired brain injury. One study identifies spasticity as the main contributor to contractures in the first 4 months after stroke and thereafter muscle weakness.
Why are contractures common?
Contractures are common following acquired brain injury. Up to 84% of patients with craniocerebral trauma and about 50% of patients with cerebrovascular accident develop contractures. However, reports of incidence vary substantially. Contractures are undesirable because of their potentially serious implications on motor recovery, functional outcomes and care needs.
How does spasticity affect contractures?
Spasticity. Spasticity, like muscle weakness, can induce contractures by immobilising a limb in a fixed position but the remodelling process is likely accelerated by the chronic tonic contractile activity associated with spasticity.
Can muscle weakness cause contractures?
Another study reports that up to 20% of variation in contracture development can be explained by strength , spasticity, age, pre-morbid function and pain; of all these factors muscle weakness is the most significant predictor for contractures after stroke.
What is contracture in care homes?
Contractures are an increasing problem in care homes and affect health and wellbeing. Many care home staff receive no training in contracture management. Using a contracture risk assessment tool improves early identification and early intervention.
What is a CRAT in nursing?
Nursing staff in residential homes, along with community nurses, need to be aware of contractures and their negative impact on residents. The CRAT provides evidence to request early intervention from other NHS professionals, who can give advice on treatment and equipment. This supports better contracture management.
Do care home staff have to be trained?
Many care home staff have no training in preventing and managing contractures. This article describes the implementation of a contracture risk assessment tool and a training programme to improve staff awareness of contractures and aid decision-making to ensure appropriate, timely interventions. Our evaluation suggests the risk assessment supported by training has the potential to improve quality of care by increasing the knowledge, skills and confidence of care home staff.
Can a lower limb contracture cause pain?
They can cause pain, interfere with sleep (Harvey et al, 2017) and increase the risk of pressure ulcers (Wagner et al, 2008). Lower-limb contractures may impair balance and gait, and can lead to a loss of mobility.
Disease/Disorder
Essentials of Assessment
- Stretching the affected muscle (eg. for a calf cramp, use a hand to pull the foot and toes upward)
- Light massage
Preventive measures-
- Not exercising immediately after eating
- Gently stretching the muscles before exercising or going to bed
- Drinking plenty of fluids (especially beverages that contain potassium) after exercise
- Avoiding caffeine
- Not smoking
- Avoiding stimulant medicines, such as ephedrine, pseudoephedrine (OTC cold and flu medicines)
- It occurs frequently or if the frequency keeps increasing
- It causes severe pain
- Interferes in daily activities or work repeatedly
- It causes leg swelling, redness or skin changes
- It causes muscle weakness
- It does not improve with self- care
See a doctor immediately if you notice:
- Cramps in the arms or trunk
- Muscle twitching
- Alcoholism
- Cramps occur after loss of body fluids (dehydration) or use of diuretics
- Loss of sensation or pain
Cutting Edge/Emerging and Unique Concepts and Practice
Gaps in The Evidence-Based Knowledge
- Definition
Contractures are the chronic loss of joint mobility caused by structural changes in non-bony tissue, including muscles, ligaments, and tendons. They develop when these normally elastic tissues are replaced by inelastic tissues. This results in the shortening and hardening of these ti…
References
- History
History should include the etiology of the contracture, its natural course, and its impact on the patient’s functionality. This includes pain, difficulties in mobility and transfers, activities of daily living (ADLs), and hygiene. Details regarding caregiver burden should also be explored. - Physical examination
Ideally, the patient should be free from pain that may interfere with the examination. Inspect the patient for joint size, symmetry, and resting position compared with the contralateral side. A goniometer can measure residual range of motion and document changes over time. Joint defor…