Contracture (convergence, unification) - restriction or lack of mobility in the joints caused by pathological changes of soft tissues associated with this joint. When flexion contracture limited extension in the replacement, extension - flexing. Contracture may also be leading, discharge, and rotary.
Origin contracture divided into innate, for example due to the underdevelopment of the muscles (torticollis), joints and bones (club foot), and acquired. The latter arise from changes bags and ligaments, joints (atrogenna contracture), from the shortening of the muscle (muscle contraction), tightening skin scars (dermatologie contracture), from wrinkling of fascia and ligaments and cartilage (desmodenia contracture). The reason for such contractures often - injury and inflammation, causing cicatricial changes in the ligaments, muscles, etc. and long stiffness of joints in such a situation, in which a group of muscles, ligaments, fascia is relaxed and gradually shortened. An example of the fixation contracture is flexion contracture of the foot (horse's foot), due to the shortening of the calf muscles as a result of incorrect (with protruding foot) plaster immobilization or long lying on her back with her foot. Cicatricial changes in muscles may occur when insufficient blood supply - ischemia, caused by compression of the plaster cast (ischemic contracture of Volkmann). Tendinous contracture often develops after purulent tendowaginita (see), especially on the brush. Professional cicatricial contracture overload of muscles or repeated trauma occur in athletes, hairdressers, carpenters, such as Dupuytren's contracture (see the Brush). Special neurogenic origin have contracture - paralysis and spastic. Paralytic contracture occurs when the lesion of the peripheral nerves or the Central nervous system.
To spastic contractures include, for example, reflex arising from protective muscle contractions in response to painful stimuli. This is the contracture of the jaws (lockjaw) in the inflammatory process (osteomyelitis and others). Spastic contractures may eventually progress to persistent scar or fixation.
Psychogenic contractures occur mainly in hysteria, occur suddenly and can suddenly disappear.
The severity of the contraction depends on the amount of surviving mobility, and the main thing - the situation brought joint. So, flexion contracture of the knee joint makes a person disabled, and the elbow is only partially violates the ability to work. When extensor contracture elbow to use the hand is almost impossible, while the total absence of bending the knee, breaking gait, does not exclude walk.
Prevention of contractures is correct and timely treatment of the disease, which can cause contracture. In injuries of bones and joints limb should be secured in the correct position. Treatment of fractures extension allows very early start a movement in the neighboring joints that prevents contracture. After removal of plaster bandages necessary medical gymnastics, massage, bathtubs, etc., it is Important to warn the latter contractures in intra-articular and periarticular fractures requiring treatment prolonged immobilization. In inflammatory processes and paralysis immobilization spend functionally advantageous position of the limb. For example, when fixing the shoulder joint to take his shoulder at 60 degrees, immobilization of the elbow joint is carried out in the position of the bending it at an angle slightly less than 90 degrees, fingers - half-bent position of the diverting of the thumb. Extensor contracture fingers makes hand functionally useless. When you commit the knee and hip joints leg attach upright position.
Germinoguenne contracture can be warned early skin plasty with extensive burns or other skin damage. In injuries to tendons, you must timely restore their entirety followed by the correct treatment.
Treatment. Conservative treatment is the use of physiotherapy, medical gymnastics, massage, mechanotherapy and bloodless redress joint with the help of a landmark plaster bandages (see Plaster technique). Simultaneously enforced Redressal (straightening) are completely unacceptable. Therapeutic exercises should be undertaken with caution, especially with the sharp weakening of the muscles. First by passive movements within preserved mobility, gradually transition to active, gradually overcoming the resistance of tissues. This massage vigorously massaged weakened muscle group and very superficial muscles-antagonists. With flaccid paralysis originally used galvanizationand then after some muscle strengthening transferred to other procedures. The use of thermal procedures should start with a warm water bath (temperature of 36 degrees). Then with great caution move to paraffin and mud therapy. To develop the movement in the joints conveniently using blocks through which throw cords for thrust, or tires Capitol records, as well as to fit the tyres with elastic rod.
In high elastic resistance of tissues can be achieved stretching them by constant stretching (see). To correct contraction and hand fingers I use the device, which is attached to the forearm and has the shape of a lyre. To the last recorded fingers with rubber cords.
For contractures, not amenable to correction by conservative methods, showing surgery - excision of skin scars from skin grafting (see), lengthening of the muscles, tendons, the release of the tendons of the scars, transplantation tendons, osteotomy , etc.