Joint contracture is an ailment that limits mobility. It has many causes. Contracture is not limited to the appearance in any one joint. In this case, the degree of restriction of mobility may be different. Most common in the knee, ankle and elbow joints.
Concept
Joint contracture may occur due to the dynamics of adjacent soft tissues, as well as other causes, including the passage of inflammatory processes. A person's movements become limited, which can contribute to his disability. Most of the treatment is carried out by orthopedic traumatologists. As the disease progresses, neurologists, psychologists, rheumatologists, and surgeons may be involved.
Classification
Joint contracture can be acquired or congenital. In addition, it is divided into active (neurogenic) and passive (structural). The latter, in turn, is divided into several varieties:
- myogenic - appearing with impaired muscle function;
- immobilization - arising from specially carried out measures to limit the mobility of the joints (casting, tight bandages, etc.);
- dermatogenic - appearing after lacerations, burns, purulent processes against the background of epidermal scars;
- ischemic - occurring after fractures, typical mainly for children;
- arthrogenic - consequences of joint pathologies;
- desmogenic - appearing as a result of movement limitation due to scars formed by connective tissue;
- tendogenic - associated with traumatic or inflammatory dynamics of the ligaments.
Restrictions that appear after injuries received from firearms are a separate group.
Active contractures of the joints are divided into the following forms for reasons of occurrence:
- psychogenic - occur with hysteria;
- neurogenic - pain (with a fixed position of the limb, formed due to illness), reflex (appearing with prolonged irritation of the nerves), irritative-paretic (arising from a violation of autonomic innervation);
- central cerebral - appearing with injuries or ailments of the brain;
- spinal - developing with diseases of the spinal cord.
Each contracture is characterized by its own characteristics, in connection with which the following varieties are distinguished:
- pronation;
- leading;
- extensor;
- flexion;
- supination;
- diverting.
In addition, the classification can be carried out according to the preservation of the he alth of the limb. If the restrictions are functionally beneficial, then the person serves himself, since his movements are purposeful and specific.
With functionally unfavorable restrictions, work cannot be done by a person independently, since the resulting restrictions create serious obstacles. Sometimes different types combine signs of both active and passive contractures. The greatest pain syndromes are observed with the development of temporary diseases. The development of their resistant varieties occurs in the first stages inconspicuously and painlessly.
Joint contracture according to ICD
The International Classification of Diseases is a single systematization used by physicians in the world. It is reviewed once a decade. The next revision is scheduled for 2018. Here, verbal diagnoses are converted into digital form in order to facilitate analysis, storage and retrieval of data. All diseases are divided into 21 classes, and diagnosis codes include Latin letters and numbers.
Contracture of the joint according to ICD-10 belongs to the XIII class "Diseases of the musculoskeletal system and connective tissue", it is assigned the code M24.5.
Reasons
Congenital contractures appear due to genetic or chromosomal mutations or develop due to fetal defects. Children in this case may experience curvature ortorticollis.
Acquired contractures have a long list of causes:
- prolonged immobilization;
- burns;
- gunshot wounds;
- adaptation of the body to various deformations;
- trauma and inflammation in the nervous system;
- stroke;
- prolonged fixation with plaster, tight bandages and tourniquets;
- autoimmune lesions;
- inflammatory processes in the joints;
- degenerative-dystrophic diseases;
- ischemia;
- inflammation of adipose tissue;
- joint fractures;
- soft tissue injury.
Contractures can occur as a result of surgical operations, spastic or flaccid paralysis. Sometimes they develop for unknown reasons.
Development stages
There are three of them. On the first one, there is a limitation of the amplitude of movements, however, some mobility is preserved.
The second stage is called stiffness, while the joint retains limited mobility, which is not detected during a simple examination, but is measured using special techniques.
Ankylosis - the third stage - is characterized by the absence of any movement in the joints.
Restriction of movement in the knee
The reasons for this phenomenon may be a decrease in the elasticity of muscle tissue, disruption of the nervous system, genetic predisposition. Contracture of the knee joint may appear as a result of the passage of inflammatoryprocesses, various injuries and leg injuries.
A symptom of the disease is the inability to perform flexion-extension of the legs at the knee or their implementation with great difficulty. In addition, the following phenomena are observed:
- shin curvature;
- support violation;
- joint deformity;
- edema;
- pain in the area of injury.
When the contracture of the knee joint progresses for a long time, processes characteristic of arthrosis are detected. Diagnosis is carried out by a general examination, CT and MRI, as well as an x-ray of the damaged area.
Restricted movement at the elbow
Elbow contracture occurs for the following reasons:
- erroneous comparison of bone fragments resulting from fractures;
- brain diseases;
- burns;
- congenital anomalies of the elbow joints;
- purulent arthritis;
- hemorrhages in the articular cavity;
- deformity or shortening of a limb;
- prolonged fixation of a certain position of the hand;
- edema.
Restricted movement in the shoulder
Causes of shoulder contracture can be:
- diseases and injuries of the rotator cuff;
- mental disorders;
- articular ischemia;
- pathologies of the nervous system;
- incorrectly applied cast;
- shoulder, neck, chest surgery;
- burns resulting inscars;
- cervical osteochondrosis and its complications.
The disease can develop as a result of congenital anomalies or age-related changes. Sometimes the range of motion does not exceed ten degrees, which makes the shoulder joint incapacitated. With any movement, aching pains are provoked in it. The patient has difficulty flexing and extending his arms, he cannot bring them back or raise them.
Restricted hip movement
With such an ailment, the patient puts his legs in an uncomfortable position. Contracture of the hip joint is mainly due to hip dysplasia, Perthes disease, which are congenital pathologies, or develops after deforming coxarthrosis or injuries.
Symptoms of this disease:
- limb shortening;
- beginning atrophy of the gluteal and femoral muscles;
- pain syndromes;
- limiting hip movement.
If conservative treatment does not help, endoprosthesis replacement of this joint is done. Diagnosing this disease in a child can lead to the development of arthrosis and the appearance of pain in the operated area. The girl may face problems during childbirth in the future.
Ankle restriction
He is the most mobile in humans and the most prone to sprains and injuries. There is a lot of pressure on the foot. The leg often tucks into a dislocation, resulting intendon damage and the onset of the inflammatory process. The contracture of the ankle joint mostly develops after injuries of the ankles, feet and lower leg. As a result, functional lengthening of the foot, curvature of the spine, flat feet can be observed.
The causes of such contracture are:
- tendon injury;
- rheumatoid arthritis;
- prolonged immobilization;
- incorrectly applied cast;
- arthritis lesions.
Pain, swelling, deformity of the joint, impossibility of its flexion are noted. If the disease is not treated, the motor function is disturbed, and the leg ceases to act as a support.
Contracture of the wrist
It is marked by wrinkling of the articular capsule, after which pathological dynamics is observed at the articular ends of the bones.
In this case, the movements of the fingers are insignificant. The movement of neighboring fingers is also limited. The second of them fixed in the unbent state has the greatest obstacle to their bending. The contracture interferes with the movement of other fingers. For the purpose of prevention, they need to be given a functionally correct position. Improvement with treatment may be marginal.
Treatment
For all types of the disease in question, it follows the same pattern. Treatment of joint contracture is first performed by conservative methods, and if they are useless, surgical intervention is prescribed.
The first type is based on a complex effect on the affected area with physiotherapy procedures (novacoin electrophoresis and diadynamic currents) and drugs. The patient is prescribed exercise therapy, in which passive and active exercises are performed under the supervision of a doctor.
In case of a more persistent disease, injections of the vitreous body, "Pyrogenal", are treated with paraffin, ozocerite. With elastic tissues, they can forcefully straighten the limbs or apply plaster casts. Limit mobility with orthopedic bandages. In addition, a set of exercises on simulators can be prescribed.
The operation can be performed in various ways:
- osteotomy - cutting the bone to correct the deformity;
- capsulotomy - opening the internal articular part to access the site that is needed;
- fibrotomy - muscle dissection;
- tenotomy - an operation with an incision and lengthening of the tendons, used for arthrogenic contractures;
- arthroscopic arthrolysis - dissection of fibrous adhesions;
- arthroplasty and arthroplasty - replacement of the affected joint with an implant.
The type of operation is selected depending on the degree of damage to the joints, the severity of the disease, the form of contracture. Rehabilitation consists of exercise therapy and massage.
Treatment of contracture of the elbow joint involves arthrolytic arthrolysis in the presence of additional ties and restraints in order to increasestrength of the injury site. To increase mobility and reduce pain, thermal procedures are performed. For passive development of the elbow, traction is prescribed using a special apparatus. Fix the limb in the correct position using fixing bandages and plaster. In addition, intra-articular oxygen and hydrocartisone can be used to reduce muscle retraction. Painkillers are also prescribed.
Contracture present in a mild form can be cured completely. But this will require a large time interval. Protracted contracture has a less favorable prognosis. With untimely medical procedures, secondary arthrosis may develop, motor functions may be lost, deformation of he althy tissues may occur, and flat feet may develop.
It must be remembered that the disease is characterized by relapses. They usually occur after 5 years, so the patient must be prepared for the fact that the disease may return. Therefore, it is necessary to monitor the condition of the joints and muscles. It is better to identify the disease in the early stages, which will allow you to fully restore the normal functioning of the joints, ligaments and muscles.
In closing
Joint contracture is a serious disease that can completely immobilize a person, making him an invalid. It is difficult to treat, especially in the later stages of development. Basically, conservative and surgical intervention is carried out. As the first, drug treatment, physiotherapy, exercise therapy and exercise equipment are used. Viewsurgery is selected depending on the form and severity of the disease. Pathology is characterized by relapses, so a person who has had this ailment should be ready for his return after a while. To prevent this, take care of your he alth from a young age.
