Description • Tissue contractures are commonly caused by the shortening or stiffening of muscles and/or other connective tissues. When a contracture occurs in muscles, tendons, or ligaments around a joint, the range of motion (ROM) of the joint will be restricted. • Can occur at any joint of the body. This joint dysfunction may be a result of : immobilization from injury or disease nerve injury (spinal cord damage & stroke) or muscle, tendon, or ligament disease. Causes Contractures may be caused by abnormalities of the structures surrounding a joint. These include: • Deformity • Immobility Injury • Chronic inflammation • Certain disorders that affect nerves and muscles almost always lead to contractures. For example: Muscular dystrophy, Cerebral palsy • Contractures are often also associated with spasticity resulting from injuries to the central Diagnosis • Manual testing of joint mobility • Measuring the motion of the joint with a device termed a "goniometer“ • X rays • physical examination involving physical and manual testing of the joint motion Mc Cauley classification Risk • A risk factor is something that increases your chances of getting a disease or condition. • Each of these conditions increases the risk for contractures: a. Rheumatoid arthritis b. Tenosynovitis (inflammation of a tendon and its sheath) c. Polio and other diseases of nerves and muscles d. Trauma ◦ Burns ◦ Scarring e. Prolonged inactivity Symptom • The primary symptom is loss of motion in a joint. • Pain can also be a major symptom Treatment Manual techniques • Joint mobilization and stretching of soft tissues Mechanical techniques • continuous passive motion machines • following surgery of joints. • administered within the first 24-72 hours after the injury or surgery. • The joint is mechanically moved through the patient's tolerable motion. • CPM machines have been proved to accelerate the return motion process, allowing patients more function in less time Treatment Casting or splinting • used to provide a constant stretch to the soft tissues surrounding a joint. • initial holding cast is applied for 7 to 10 days, a series of positional casts are applied at weekly intervals. Surgery • manipulation of the joint under a general anesthesia Alternative treatment • Massage therapy can be beneficial by promoting additional circulation to joint structures, causing better elasticity. Yoga can help prevent as well as rehabilitate a contracture and can facilitate the return of joint mobility. Hand splinting Surgery
Fasciotomy Tendon repair
Flap Z dan flap interpolasi Prevention Prevention of contractures depends on the cause. After acute injuries or orthopedic surgery, contractures may be prevented by: • Early movement • Physical therapy • Continuous passive motion (CPM) machines, which mechanically keep joints in motion • Aggressive medical treatment of inflammatory conditions such as rheumatoid arthritis may also delay or prevent contractures • program of positioning, splinting if appropriate, and range-of-motion exercises either manually or mechanically aided. These activities should be started as early as possible for optimal results Prognosis • Depend upon the cause of the contracture. • In general, the earlier the treatment for the contracture begins, the better the prognosis.