A contracture is a tightening or shortening that causes a deformity. It usually affects the skin and the tissues underneath or the tendons, ligaments, and muscles around a joint. Specific symptoms and the location of the contracture depend on the cause, of which there are many. Some are mild, but they can also be quite severe.
Types of Contracture
Contractures are divided into three categories according to their location and the changes that occur. Atherogenic contractures affect connective tissue, and many include adhesions. Periarticular contractures involve joint and connective tissue stiffness. The third classification, myogenic contracture, is divided into two types: myostatic and pseudomyostatic. The former involves a structural change, usually muscle-shortening, to accommodate a change in the joint, generally from the restriction of movement from a cast, brace, or prolonged bedrest. Pseudomyostatic contracture is similar but is not accompanied by any true structural changes.
Burn Contractures
One of the most serious complications of a burn is burn contracture. This occurs when the burn scar matures, getting thicker, tighter, and restricting or preventing movement. The burned area may not move normally, which can impact the quality of life significantly, depending on where the contracture is located on the body.
Arthrogryposis
Arthrogryposis is congential contracture of two or more joints. It is usually found in utero or at birth and usually affects both the arms and legs. Contractures often occur at the shoulder, elbow, wrist, and hand in the upper extremities and the hips, knees, and ankles in the lower. The cause of arthrogryposis is unknown, but it is typically linked to underlying genetic conditions.
Capsular Contracture
Capsular contracture is caused by the hardening of breast tissue around an implant. This type is graded using the Baker Grading Scale. At grade I, the breast is soft and looks normal. By grade IV, the breast looks abnormal and is hard and painful. Higher grades may require the removal of the implant as there are no approved methods to prevent or treat this type of contracture.
Dupuytren’s Contracture
Dupuytren’s contracture specifically affects the hands. One of the most common symptoms is being unable to lay the palm flat against a table. This condition causes small nodules to form in the palm. These lumps may be painful at first, but pain generally eases over time. The nodules thicken and tighten, which causes thick bands of tissue to form under the skin, pulling the fingers forward. The exact cause is unknown, but Dupuytren’s contracture is believed to be hereditary, particularly in those with Northern European heritage. It usually starts in middle age and affects men more than women.
Freeman Sheldon Syndrome
Freeman-Sheldon syndrome is a rare genetic disorder involving multiple congenital contractures as well as defects in the hand, feet, and skeleton, including the head and face. Children with this condition have a small, puckered mouth, and prominent cheeks and forehead. The fingers and toes are permanently bent, and the child may have club foot or scoliosis.
Marden-Walker Syndrome
Another rare condition that causes contractures is Marden-Walker syndrome, a genetic disease affecting the connective tissue. People with this condition often have frozen joints with bones held in a fixed position, but these contractures may improve with time. A curvature of the spine is a common finding, as are facial deformities.
Stroke
A more common health condition that may cause contractures is stroke. Strokes often cause weakness or paralysis in one or more arm or shoulder muscles. Shoulders are a significant problem area, as the joint can dislocate due to the other changes in the arm, causing the shoulder to droop. The muscles and tissues surrounding the joint can stretch or shorten, leading to contracture.
Rheumatoid Arthritis
Another disease that can lead to contracture is rheumatoid arthritis or RA, an inflammatory and autoimmune disease that causes swelling in the joints. The symptoms lead to joint damage, which causes deformities and contractures. RA usually affects the joints in the wrists and hands or knees.
Treatment
Treatment for contracture depends on the severity and the cause. The approach also differs depending on whether or not the contracture is due to a genetic disorder. Some nonsurgical interventions include medicine to relax the muscles and joints, nerve blocks, physical therapy, casts, and splints. In some cases, doctors recommend surgery to lengthen the muscles or repair damaged bones, tendons, or ligaments.