Contracture

As contracture (Latin contra here " contract ", see also contraction) is called a function and restriction of movement of joints. It is caused by the shortening of surrounding soft tissues such as muscles, tendons, ligaments and fascia. The joints can be affected both active as well as passive not move or only with difficulty and in a small degree, besides the movement can be painful. The extent of the limitation may range up to a full stiffening. The treatment occurred contracture is predominantly physiotherapy, special importance is the avoidance of restrictions on movement by the Kontrakturenprophylaxe to.

Clinical features and diagnosis

Contractures are characterized by active and passive, sometimes painful movement restrictions, whereby the function of the joint is restricted. It all planes of movement of a joint can be affected; the movement appears this inharmonious. The restriction can range from mild impairment to a complete rigidity with positive attitude of the joint. The transitions are fluid. Basically, all joints can be affected by contractures, however, they occur mostly on the large joints such as the shoulders, elbows, hips and knees.

Contractures have a very typical clinical picture, the diagnosis is correspondingly simple. Other diagnostic measures are therefore not usually necessary.

Kontrakturarten

Classification according to joint position

Contractures can be described by the deformity of the affected joint; the most common contracture is the flexion contracture because the flexor muscles is often more pronounced than the opposing extensor muscles, but also Streckkontrakturen occur. If the contracture limb abducted or attracted by the middle of the body, these are referred to as abduction or adduction. Other forms are inside or Außenrotationskontrakturen as well as pronation and Supinationskontrakturen.

Classification by tissue damage

Contractures are distinguished according to their cause and origin:

• Ontogenetic contracture - The contracture is innate, such as a congenital clubfoot.
• Neurogenic contracture - The contracture is caused by nerve damage, for example by polio or spastic paralysis.
• Dologene contracture - This is due to pain in which the person takes a posture, for example in the context of sciatica.
• Dermatogene contracture - The contracture is caused by a contraction of the skin, such as scarring after burns.
• Arthrogenic contracture - A related to the joint contracture, such as rheumatism.
• Tendomyogene contracture - The joint stiffness is caused by a contraction of the tendons, example of this are Volkmann's contracture.
• Psychogenic contracture - The person concerned does not move consciously or unconsciously a joint. Cause for example, can be a traumatic experience.
• Fasziogene contractures - It is due to inflammation, injury or immobilization to shrinkage of the aponeurosis or fascia, a typical example is Dupuytren's contracture.
• Lagerungsdeformität - The contracture produced by the non Unprofessional storage of immobile patients, a well-known therapeutic errors in this context is the equinus.

Treatment

The contractures most frequently encountered are due to storage conditions, therefore it is proposed especially to avoid this by a good prophylaxis. Most important method of treatment was already forming contractures are active and passive motion exercises as part of a physiotherapy or occupational therapy. As a complement to physiotherapy or occupational therapy training on a movement coach or a motion device can reduce or prevent contractures. Moreover, massage and heat treatments can be applied in treatment breaks splints, extension bandages or motor-driven movement rails can be used. Reaching these measures do not, surgery may be considered to eliminate the contracture.

Kontrakturenprophylaxe

Should avoid motion and functional limitations after determining the Kontrakturrisikos, for example by a maintenance history, to begin with the Kontrakturenprophylaxe. These include, depending on the cause of the risk, for example, the early mobilization after surgery and active assistive forming or passive movement of the joints. To avoid relieving postures can be a pain medication can be used. Activating care, for example, the continuation of the day and night rhythm with dressing and undressing, also contributes to the prevention of kontrakturbegünstigenden lack of exercise. Motion Disabled and bewußtseinsgetrübte patients in whom a pressure ulcer prevention is also necessary should be stored in a physiological position and not too soft, as this inhibits proper motions.