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Contractures of joints

Joint contracture – steady restriction of movements in a joint. Can be caused by various reasons: violation of a configuration of a joint, cicatricial changes, pain syndrome, diseases of muscles, violations of nervous regulation etc. Damage of any joint is possible. The importance of pathology depends on localization of a contracture and extent of restriction of movements. Contractures of large and average joints of extremities have the greatest clinical value: talocrural, knee, coxofemoral, elbow and humeral. At the same time contractures of talocrural, knee and elbow joints are the most widespread. The diagnosis is exposed on the basis of the symptoms given measurements of volume of movements, a X-ray analysis of a joint and other researches. Treatment can be both conservative, and quick. The forecast depends on prescription and the reason of development of pathology, fresh contractures will respond to treatment better than old.

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Contractures of joints

Contractures of joints (Latin of contractio – I connect) the Source: /diseases/traumatology/knee-contracture – the pathological states which are followed by permanent restriction of movements. Are rather widespread in practical traumatology and orthopedics. Can develop owing to inflammatory and degenerate and dystrophic processes, congenital violations of development, violations of an innervation etc. Often arise in the remote period after a skeletal trauma, especially heavy. Quite often become the reason of restriction of working capacity and an exit to disability. Traumatologists and orthopedists usually are engaged in treatment of contractures of joints. Depending on the reason of development of pathology neurologists, surgeons, rheumatologists and other experts can also take part in treatment.

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Pathogenesis

Depending on the mechanism of emergence allocate two big groups of contractures of joints: passive and active. Mechanical obstacles in the joint or in surrounding fabrics (fastion, skin, sinews, muscles etc.) are the reason of formation of passive contractures. At nevrogenny (active) contractures the mechanical obstacle is absent, restriction of movements develops owing to irritation of certain sites of nervous system or owing to loss of its functions.

Because of violation of nervous regulation the tone of muscles of one group begins to prevail, muscular balance between antagonists is broken, the joint falls into a contracture state. In an initial stage restriction of movements in such cases unstable, at elimination of neurologic violations of a contracture considerably decrease or even disappear. At long existence secondary changes in a joint and circumarticular fabrics gradually develop, the active contracture gets components of passive.

Along with passive and active, the combined contractures of joints at which it is impossible to establish what arose in the beginning – pathology from nervous system or local process in a joint in some cases meet. Besides, there are congenital contractures of joints at which it is possible as a mechanical obstacle to the movements or violation of nervous regulation, and a combination of both listed mechanisms. So, for example, at congenital dislocation of a knee joint the underdevelopment and vicious position of a tibial bone is sometimes combined with an underdevelopment of muscles and nerves of a hip and shin.

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Classification

Considerable heterogeneity of this pathology, both in the etiologichesky plan, and in respect of a variety of structural changes in area of a joint and circumarticular fabrics causes existence of a large number of classifications of contractures of joints. Along with active (nevrogenny) and passive (structural) allocate the congenital and acquired contractures. Taking into account the development reason all structural contractures of joints divide on:

  • Artrogennye – is the reason of restriction of movements pathology of the joint, for example, violation of a configuration of articulate surfaces as a result of a change, purulent arthritis or the deforming arthrosis.
  • Miogennye – the movements in a joint are limited owing to pathology of muscles.
  • Hems on skin, usually after extensive burns become Dermatogennye – the reason of restriction of movements, is more rare – after purulent processes (abscess, phlegmon), fragmentary and rvanoushiblenny wounds in a joint and the closest segments of an extremity.
  • Desmogennye – the movements are limited owing to soyedinitelnotkanny hems. Such contractures are often combined with dermatogenny, however, can develop and separately.
  • Ischemic – usually arise at the changes which are followed by long and essential, but not full restriction of arterial blood supply of an extremity. Are more often formed at children's age at forearm fractures, myshchelkovy and nadmyshchelkovy fractures of a shoulder.
  • Immobilized – arise owing to a long immobilization. Are usually caused by a combination of several factors: reduction of elasticity of myagkotkanny structures of a joint, shortening of muscles etc.

Some experts allocate in separate group of a contracture of joints, arising after gunshot wounds.

Nevrogenny contractures of joints are also divided into several forms taking into account the cause:

  • Central nevrogenny: cerebral – the contractures of joints arising at injuries and diseases of a brain (an ischemic and hemorrhagic stroke, encephalitis, heavy ChMT, DTsP), spinal – developing at damage of a spinal cord (tumors, a vertebral and spinal trauma, violations of spinal blood circulation).
  • Peripheral nevrogenny: painful – are caused by the compelled position of an extremity which developed owing to a pain syndrome; reflex – caused by the long irritation of a nerve leading to increase in a tone of muscles; irritatsionno-paretic and caused by violation of a vegetative innervation.
  • Psychogenic – arising at hysteria.

Taking into account features of restriction of movements allocate the sgibatelny, razgibatelny, taking-away, bringing, supinatsionny and pro-national ionic contractures. In clinical practice division of contractures of joints on functionally favorable and functionally unprofitable also matters.

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Diagnostics

The diagnosis of a contracture of a joint is exposed on the basis of measurement of volume of active and passive movements. The radiological research of the corresponding segment is surely appointed: at a knee contracture – a X-ray analysis of a knee joint, at an elbow contracture – a X-ray analysis of an elbow joint etc. For the rest the volume of additional researches depends on the nature of the pathology causing restriction of movements. At passive contractures of the patient can direct to joint MPT or KT. At neurogenetic contractures consultation of the neurologist (is necessary at hysterical – the psychiatrist), carrying out an electromyography and various tests is possible. At suspicion appoint consultations of the corresponding experts to a nonspecific or specific inflammation: surgeon, rheumatologist, phthisiatrician etc.

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treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

Treatment of contractures of joints has to be complex, carried out taking into account the reason of development and the nature of pathological changes. Conservative therapy of structural contractures includes massage, physiotreatment (an electrophoresis of novocaine and diadynamic currents), the LFK complex with performance of active and passive exercises, and also exercises on relaxation of muscles. At more permanent restriction of movements appoint paraffin, ozokerite, injections of a vitreous body or pirogenat. If fabrics kept sufficient elasticity, apply landmark plaster bandages or a one-stage redressation (violent straightening of an extremity).

Practice mechanotherapy with application of block installations and pendular devices. For reduction of an inflammation and removal of the pain syndrome arising owing to considerable load of the affected joint appoint analgetics and NPVP. Sometimes for restoration of movements use Ilizarov's devices and pivotally-distraktsionnye devices. A lack of this method is massiveness of external designs – devices should be imposed on two next segments (for example, a shoulder and a forearm), "smoothness" of development of a joint is among advantages.

If conservative therapy does not give desirable effect, perform surgeries. At dermatogenny and desmogenny contractures of joints excise hems and carry out skin plasticity. When wrinkling fastion carry out a fastsiotomiya, when shortening muscles and sinews – a tenotomiya and lengthening of sinews. At artrogenny contractures depending on the nature of pathological changes the joint capsule section (kapsulotomiya), a section of solderings in a joint (), restoration of articulate surfaces (artroplastik) or a section of a bone (osteotomiya) can be shown.

Treatment of nevrogenny contractures of joints also complex, combining general and local actions, is more often – conservative. At psychogenic (hysterical) contractures psychiatric or psychotherapeutic treatment is necessary. Treatment of the central nevrogenny contractures is performed in close connection with therapy of the main disease. To patients appoint massage, LFK and rhythmic galvanization. If necessary apply plaster bandages to prevent installation of an extremity in vicious situation.

At spinal contractures of joints carry out treatment of the main disease, perform prevention and treatment of the data of joints. Widely use various orthopedic devices: tires, manzhetochny and glue extension, the designs with freights intended for gradual straightening of the bent joints etc. Appoint LFK, massage and heat baths. At the old contractures interfering standing and walking use orthopedic devices and landmark plaster bandages. In some cases perform surgeries.

At peripheral nevrogenny contractures also perform therapy of the main disease. Apply LFK, massage, landmark bandages, electrostimulation, mud cure and a balneoterapiya to restoration of movements. If necessary carry out surgeries for restoration of nervous conductivity and elimination of secondary adhesive processes in a joint.

The forecast at contractures of joints depends on the reason and prescription of existence of pathology. At fresh data of joints and lack of rough anatomic changes (for example, considerable destruction of an articulate surface) in most cases it is possible to achieve a partial or complete recovery of movements. At old contractures there is a regeneration and reorganization of all structures of a joint, including cartilages, the capsule, sheaves etc. therefore the forecast in such cases is less favorable, in most cases for restoration of movements (even partial) surgical correction is required.

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Contractures of joints - treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!

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