Contractures
Description:
Contracture (Latin contractura — tightening, narrowing) — restriction of passive movements in a joint, that is such state at which the extremity cannot be completely bent or unbent in one or several joints, caused by cicatricial tightening of skin, sinews, diseases of muscles, a joint, a pain reflex and other reasons. Contractures can be divided into two main groups: a) passive (structural) and b) active (neurogenic).
Symptoms of Contractures:
There is a large number of classification schemes of contractures. Difficulties of creation of such schemes are caused by a polietiologichnost of these morbid conditions, a big variety of structural changes in a joint and the fabrics surrounding it.
Except the division of contractures into passive (structural) and active (neurogenic) mentioned above, it is also accepted to allocate group of inborn contractures which in many respects differ from acquired in clinical and structural aspect.
Classification of passive contractures is usually made taking into account that fabric which plays a preferential role in their origin. By this principle passive contractures divide on artrogenny, myogenetic, dermatogenny and desmogenny. As separate forms of contractures are distinguished ischemic, immobilized. Some authors fairly consider that the contractures developing after gunshot wounds demand special consideration.
The group of neurogenic contractures includes the following forms:
I. Psychogenic contractures: a) hysterical.
II. Central neurogenic contractures: a) cerebral, b) spinal.
III. Peripheral neurogenic contractures: a) irritatsionno-paretic, b) painful, c) reflex, d) contractures at disturbances of a vegetative innervation.
Depending on restriction of this or that sort of movements in a joint it is possible to allocate flexion, extensive, bringing, taking away, rotational (supinatsionny, pro-national ionic) and so forth. On function distinguish contractures in functionally favorable and it is functional an extremity disadvantage.
Reasons of Contractures:
Passive contractures which sometimes call also local are caused by the mechanical obstacles arising both in the joint and in the fabrics surrounding it or located near a joint (in muscles, sinews, skin, fastion and so forth).
Patients with neurogenic contractures in a joint in which there was a restriction of movements in the fabrics surrounding a joint have no local mechanical reasons with which it would be possible to explain this restriction of movements. Such patients usually have phenomena of loss or irritation from a nervous system causing the long tonic tension of separate muscular groups. At the same time there comes disturbance of normal muscular balance between antagonists, as brings already for the second time note joints.
Originally neurogenic contractures are unstable, corrections give in, and at elimination of neurologic disturbances and recovery of normal function of a nervous system can even disappear.
Gradually, eventually, neurogenic contractures gain firmness because in them components of a passive contracture appear.
Sometimes the combined forms of contractures at which it is difficult to differentiate initial mechanogenesis of the developed permanent restriction of movements in a joint meet, that is it is difficult to establish what was the prime cause of restriction of movements — local process or defeat of a nervous system.
Clinical value of contractures is very big. This most frequent complication of intra joint and circumarticular changes, dislocations, bruises of joints, fire injuries of extremities, inflammatory and degenerative and dystrophic processes in joints, damages and diseases of a nervous system and so forth. Meet a contracture and an inborn origin.
Treatment of Contractures:
Treatment of contractures, especially active, has to consist of impacts of the general order on all organism of the patient and local medical actions.
Psychogenic (hysterical) contracture.
Treatment of this form of a contracture — psychotherapeutic.
Central neurogenic contractures.
a) Cerebral contractures can arise after damage of a brain owing to various reasons. Treatment of such cerebral contractures needs to be carried out in close connection with the general plan of treatment of a basic disease. Apply massage, passive gymnastics, the active movements. Also sessions of rhythmic galvanization of the paretichny or paralyzed muscles are useful. Sometimes for the prevention of data of joints impose plaster tires on an extremity.
b) Spinal contractures very often accompany and complicate various diseases and injuries of a spinal cord. When developing the medical plan such patients with the main thing have to have a treatment of a basic disease. Orthopedic measures have to be applied to prevention and treatment of contractures at spinal patients widely: tires for extremities, glue or, better, manzhetochny extension, different devices with loads imposed on the bent joint for the purpose of its gradual straightening, etc. If there are no contraindications from the main process, appoint massage, the passive movements in joints of extremities, remedial gymnastics. Well heat water baths affect kontragirovanny muscles. During later periods, at the resistant contractures disturbing the patient's raising on legs and complicating standing and walking apply stage plaster bandages, orthoses, and sometimes and operational treatment (lengthening of sinews, corrective osteotomies, artificial ankyloses).
Peripheral neurogenic contractures.
Peripheral neurogenic contractures arise usually at damages of peripheral nerves. Undoubtedly, as well as at other types of active contractures, treatment of a basic disease or damage of a nervous trunk has to be on the first place (surgical, drug treatment, physical therapy). With the medical purpose stage plaster bandages, massage, the passive movements are applied. Exercises on recovery of active movements in joints are important. From the electrostimulating procedures it is possible to recommend rhythmical galvanization of the affected muscles. The balneoterapiya and mud cure are shown. The operative measure which is carried out in a zone of the injured nerve is frequent, improving function of a nervous trunk, eliminates or reduces a kontraktutra in this or that joint.
Painful contractures.
Pain is one of the frequent reasons of a contracture. The main objective of treatment at a painful contracture is removal of pain as the main source supporting a muscular spasm. At treatment of a painful contracture widely apply various analgetic means: physical therapy, suggestion, drug treatment, surgical interventions.
Passive contractures.
Passive (structural) contractures are characterized by emergence of obstacles for movements directly in a zone of a joint or in the fabrics surrounding it. At the same time seldom only one any fabric (muscles, skin, the joint capsule) is involved in pathological process. Therefore when scheduling treatment of the patient with a passive form of a contracture it is necessary to make in each separate case the correct idea of localization and the amount of damage, of the nature of changes in fabrics, their depth and reversibility, of extent of involvement of a nervous system in pathological process.
The medical actions applied at passive contractures can be divided into two big groups: conservative and operational methods.
