Contracture

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Contracture
Diseases of infancy and childhood (1914) (14771754012).jpg
Specialty Orthopedics
Hand contractures as seen in Freeman-Sheldon syndrome Freeman-Sheldon syndrome.JPG
Hand contractures as seen in Freeman–Sheldon syndrome

In pathology, a contracture is a shortening of muscles, tendons, skin, and nearby soft tissues that causes the joints to shorten and become very stiff, preventing normal movement. [1] [2] A contracture is usually permanent, but less commonly can be temporary (such as in McArdle disease), [3] or resolve over time but reoccur later in life (such as in Bethlem myopathy 1). [4]

Contents

It is usually in response to prolonged hypertonic spasticity in a concentrated muscle area, such as is seen in the tightest muscles of people with conditions like spastic cerebral palsy, but can also be due to the congenital abnormal development of muscles and connective tissue in the womb.

Contractures develop usually when normally elastic tissues such as muscles or tendons are replaced by inelastic tissues (fibrosis). This results in the shortening and hardening of these tissues, ultimately causing rigidity, joint deformities and a total loss of movement around the joint.

Most of the physical therapy, occupational therapy and other exercise regimens targeted towards people with spasticity focuses on trying to prevent contractures from happening in the first place. However, research on sustained traction of connective tissue in approaches such as adaptive yoga has demonstrated that contracture can be reduced, [5] at the same time that tendency toward spasticity is addressed.

Causes of muscle contracture

Contractures can have a variety of causes other than spasticity. In regards to muscle, these include (but not limited to):

Skin contracture

Wound contraction, where the edges of the skin are pulled together to close the wound, is a normal part of wound healing. However, large wounds and abnormal wound healing cause skin contractures by excessively tightening the skin and limiting movement. [6] [7] [8] A skin contracture due to a burn is known as a burn scar contracture.

Large areas of missing skin (such as large burns, grazes, and gouges) drastically reduce the area of skin causing it to become tight when pulled together during wound healing. [6] [7] Scars initially lack elasticity with synthesis of elastic tissue fibres (elastogenesis) being a function of duration and site of the scar. [9] Deep wounds and abnormal wound healing causes abnormal scarring such as hypertrophic scars. [8] Studies on hypertrophic scars have shown a lack of improvement to both elasticity and stiffness suggesting a prolonged healing phase without amelioration seen in a normal wound-healing curve. [10] [11]

Surgery can help alleviate skin contractures in the form of skin grafts and removal of hypertrophic scars. [8] [6] For hypertrophic scars, timing is important when considering surgery, as over time scars will mature and may show decreased contractures along with flattening, softening, and repigmentation without surgical intervention. [8]

See also

Related Research Articles

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<span class="mw-page-title-main">Scar</span> Area of fibrous tissue that replaces normal skin after an injury

A scar is an area of fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other organs, and tissues of the body. Thus, scarring is a natural part of the healing process. With the exception of very minor lesions, every wound results in some degree of scarring. An exception to this are animals with complete regeneration, which regrow tissue without scar formation.

<span class="mw-page-title-main">Ehlers–Danlos syndromes</span> Group of genetic connective tissues disorders

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<span class="mw-page-title-main">Keloid</span> Medical condition

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<span class="mw-page-title-main">Arthrogryposis</span> Medical condition

Arthrogryposis (AMC) describes congenital joint contracture in two or more areas of the body. It derives its name from Greek, literally meaning 'curving of joints'.

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<span class="mw-page-title-main">Muscle contracture</span> Permanent shortening of a muscle

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Hoffmann syndrome is a rare form of hypothyroid myopathy and is not to be confused with Werdnig-Hoffmann disease.

<span class="mw-page-title-main">Wound contracture</span>

Wound contracture is a process that may occur during wound healing when an excess of wound contraction, a normal healing process, leads to physical deformity characterized by skin constriction and functional limitations. Wound contractures may be seen after serious burns and may occur on the palms, the soles, and the anterior thorax. For example, scars that prevent joints from extending or scars that cause an ectropion are considered wound contractures.

Regeneration in humans is the regrowth of lost tissues or organs in response to injury. This is in contrast to wound healing, or partial regeneration, which involves closing up the injury site with some gradation of scar tissue. Some tissues such as skin, the vas deferens, and large organs including the liver can regrow quite readily, while others have been thought to have little or no capacity for regeneration following an injury.

Scar free healing is the process by which significant injuries can heal without permanent damage to the tissue the injury has affected. In most healing, scars form due to the fibrosis and wound contraction, however in scar free healing, tissue is completely regenerated. During the 1990s, published research on the subject increased; it is a relatively recent term in the literature. Scar free healing occurs in foetal life but the ability progressively diminishes into adulthood. In other animals such as amphibians, however, tissue regeneration occurs, for example as skin regeneration in the adult axolotl.

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References

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  2. "Definition of contracture". www.cancer.gov. 2011-02-02. Retrieved 2023-05-06.
  3. Lucia, Alejandro; Martinuzzi, Andrea; Nogales-Gadea, Gisela; Quinlivan, Ros; Reason, Stacey; International Association for Muscle Glycogen Storage Disease study group (December 2021). "Clinical practice guidelines for glycogen storage disease V & VII (McArdle disease and Tarui disease) from an international study group". Neuromuscular Disorders. 31 (12): 1296–1310. doi: 10.1016/j.nmd.2021.10.006 . ISSN   1873-2364. PMID   34848128. S2CID   240123241.
  4. Bönnemann, Carsten G. (2011-06-21). "The collagen VI-related myopathies: muscle meets its matrix". Nature Reviews. Neurology. 7 (7): 379–390. doi:10.1038/nrneurol.2011.81. ISSN   1759-4758. PMC   5210181 . PMID   21691338.
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  6. 1 2 3 "Contractures". stanfordhealthcare.org. Retrieved 2023-05-07.
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  8. 1 2 3 4 Gauglitz, Gerd G; Korting, Hans C; Pavicic, Tatiana; Ruzicka, Thomas; Jeschke, Marc G (2011). "Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies". Molecular Medicine. 17 (1–2): 113–125. doi:10.2119/molmed.2009.00153. ISSN   1076-1551. PMC   3022978 . PMID   20927486.
  9. Roten, S. V.; Bhat, S.; Bhawan, J. (February 1996). "Elastic fibers in scar tissue". Journal of Cutaneous Pathology. 23 (1): 37–42. doi:10.1111/j.1600-0560.1996.tb00775.x. ISSN   0303-6987. PMID   8720985. S2CID   37823718.
  10. Rapp, Scott J.; Rumberg, Aaron; Visscher, Marty; Billmire, David A.; Schwentker, Ann S.; Pan, Brian S. (February 2015). "Establishing a Reproducible Hypertrophic Scar following Thermal Injury: A Porcine Model". Plastic and Reconstructive Surgery – Global Open. 3 (2): e309. doi:10.1097/GOX.0000000000000277. PMC   4350315 . PMID   25750848.
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