The medical term contracture goes back to the Latin word “contrahere” and means “to contract”. A contracture occurs when a tissue, for example muscles, ligaments and tendons, contracts. Shrunken skin from burns and scarring near joints can also affect joint mobility. These conditions may be irreversible (incurable) or reversible (curable).
What is contracture?
Contracture is a shortening of tendons, muscles, ligaments, and fascia (soft tissue sheath) that occurs as part of wound healing. A contracture is a shortening of tendons, muscles, ligaments, and fascia (soft tissue sheath) that occurs as part of wound healing. Individual areas of tissue near the joint, such as shrunken skin after burns and scarring, may be affected by a contracture. People with a contracture may have difficulty moving the affected joints. Movement may be limited, both passively and actively, and sometimes causes pain. In the worst cases, these restrictions and discomfort can lead to stiffening of the joints. Contractures are classified according to joint position and tissue damage. Compulsive restraint postures due to persistent pain are also possible.
Function and task
Contractures occur when joints are permanently restricted in their range of motion due to shortened or shrunken muscles, tendons, ligaments, joint capsules, and adhesions near the joint surfaces. The symptoms can be mild to severe. If the contraction is counteracted at an early stage, it is reversible (curable) with appropriate therapeutic measures, for example physiotherapy. In the worst case, however, it is irreversible, i.e. cannot be reversed. The affected joint remains stiff. The most common causes are prolonged bed rest in long-term illnesses, incorrect positioning, neurotic (compulsive) protective posture in chronic pain, joint inflammation, rheumatism and nerve diseases. The leading complaints are pain, immobility, inharmonious movements and general inability to move the contracted body part. Most often, joint contractures occur in a “forced position” that the patient cannot control. This situation occurs in many cases during prolonged immobility in long-term illnesses that cause paralysis (e.g., stroke) or after surgery. The most common nursing error is the wrong positioning of the patient when he is fixed. Elderly people are also affected by contractions when they are unable to move sufficiently in hospital after surgery or in a nursing home and spend long periods of time in bed. Shrunken tissue, for example extensive skin burns and subsequent scarring, can also cause contraction. Many patients suffer from flexion contracture. One example is knee flexion contracture. In healthy people, flexor and extensor muscles are in a harmonious relationship. In patients with flexion contracture, the flexor muscles dominate the extensor muscles. It is no longer able to counteract the flexor muscles in a compensatory manner. The joint remains partially or completely in the flexed position. Camptodactyly (hyperextension of a finger) is a common example of flexion contracture. The symptoms can also occur the other way around, when the extensor muscles dominate the flexor muscles. It permanently cramps and causes loss of motion or stiffness of the contracted joint due to the perpetual extensor posture. Adduction contractures often occur as a sports injury. The patient is unable to bring the contracted body part closer to his or her body. With an abduction contracture, the patient is no longer able to move the affected body part laterally away from the body.
Diseases and conditions
The clinical appearance of contractures is accompanied by typical complaints and symptoms. Accordingly, the diagnosis is simple and leads through the active and passive movement restrictions, which often cause pain and limit joint function. Often all planes of motion of the joint are affected, and the entire functional picture appears inharmonious. The complaints and symptoms can vary in severity.Some patients suffer only from a slight functional disorder, others are affected by stiff joints with associated forced posture. Contractures can affect all joints, but mainly occur in the large joint groups such as shoulders, hips, knee joints and elbows. After diagnosis, a nursing history is taken and contracture prophylaxis is directed accordingly. It is particularly necessary for patients who are immobilized in bed for a long period of time, for example in the case of a stroke or after an accident. They must be positioned in a physiological position to prevent bedsores, pressure ulcers and skin inflammation. If the patient is positioned too softly, this prevents the patient’s own movements from proceeding in an orderly manner. In this case, additional decubitus prophylaxis is necessary. Prompt mobilization is also necessary for patients after surgery to prevent contractions. In addition to nursing staff, relatives can also assist with active or passive joint movements. Gentle postures can be avoided by pain medication. For patients with mild contracture symptoms, physical therapy is helpful.
