Contracture
Last reviewed: 23.04.2024
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Contracture - restriction of mobility of the joint, but with a clear presence in it of the volume of movements; complete immobility of the joint is defined as ankylosis of the joint; and the possibility of only punitive movements in the joint is called rigidity of the joint.
The working classification includes several positions, the contracture is divided into: congenital and acquired; active (with restriction of active movements); passive (with the restriction of passive movements) and active-passive; primary, when the cause of the restriction of movements is the pathology in the joint, and secondary, when the restriction of movements is caused by the pathology of the surrounding tissues; by the form of restriction of movement, the contracture is divided into flexion, extensor, leading or retracting, rotational, mixed type. In accordance with the localization of primary changes, the contracture is divided into dermatogenic, desmogenic, tendogenous, myogenic and arthrogenic. According to the etiopathogenetic trait, they distinguish: posttraumatic, post-burn, neurogenic, reflex, immobilization, occupational, ischemic.
Congenital contracture: torticollis, clubfoot, slanting; arthrogryposis, etc. - are referred to the category of orthopedic pathology. Acquired contracture occurs as a result of local changes in the joint or surrounding tissues or under the influence of common factors leading to muscle atrophy or disruption of their elasticity (hysterical contractures, lead poisoning: etc.). Dermatogenic contracture occurs with keloid changes in the skin with wounds, burns, chronic infections, especially specific. Desmogenic contracture develops when the fascia, aponeuroses and ligaments wrinkle, more often with their constant traumatization, for example, Dupuytren's contracture on the wrist. Tendogenic and myogenic contracture develops with cicatricial changes in the tendons, their vaginas, muscles and surrounding tissues. But there may be other reasons: damage to the posterior muscle group or peripheral nerve can cause hyperfunction of the antagonist muscles; with neuralgia and myositis, a persistent spastic contraction of muscles can form; with prolonged immobilization in a vicious position, a redistribution of muscle traction can develop, etc.
Arthrogenic contracture develops after intraarticular fractures, with chronic inflammatory or degenerative diseases of the joint and capsule. The most complex pathogenesis is neurogenic contracture, their diagnosis belongs to the competence of neuropathologists.
Restriction of movements in the joint is a fairly vivid demonstration symptom.
The process, as a rule, develops slowly, sometimes for years. The surgeon is important to establish the orthopedic etiology of the process and refer the patient to a specialist - orthopedic traumatologist, konboustiologist or plastic surgery department. For diagnosis, radiograph the joint, preferably in different phases of motion (X-ray film). The volume of movements is determined by a goniometer. In all cases, the patient should be consulted by a neurologist.
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