A contracture is a medical condition defined by the chronic loss of motion in a joint. This occurs when the soft tissues surrounding the joint tighten and shorten, preventing the joint from moving through its normal arc of movement. The resulting fixed position can significantly impair a person’s mobility and independence.
The Mechanics of Tissue Shortening
A contracture represents a profound structural change within the body’s soft tissues. It is the result of normally elastic tissues being replaced by inelastic, fibrous material through a process known as fibrosis. This replacement affects components surrounding a joint, including the muscles, tendons, ligaments, and the joint capsule itself. The loss of elasticity causes the tissue to become denser and more rigid, leading to shortening. When tissues are held in a shortened position, the body remodels them to that length, creating a fixed deformity that prevents the joint from achieving its full range of motion.
Common Conditions That Lead to Contractures
Prolonged Immobility
Prolonged immobility is the single most frequent cause of contractures. Lack of movement triggers rapid changes in muscle tissue, including decreased protein synthesis and increased collagen infiltration, which is a sign of fibrosis. This disuse atrophy and stiffening often occurs in patients who are critically ill, on long-term bed rest, or recovering from an injury in a cast or splint.
Neurological Disorders
Neurological disorders are a major cause due to their impact on muscle control. Conditions such as stroke, cerebral palsy, and spinal cord injuries can lead to muscle imbalance and spasticity, where muscles are involuntarily over-contracted. This constant contraction, or the paralysis that causes a limb to be unused, results in the permanent shortening of the affected tissues.
Trauma and Inflammatory Diseases
Musculoskeletal trauma and inflammatory diseases also lead to contractures. Severe thermal injuries, like third-degree burns, cause significant scarring that pulls the adjacent joint into a fixed position as the scar tissue matures and tightens. Inflammatory conditions like rheumatoid arthritis cause pain and joint damage, which limits movement and encourages soft tissue shortening around the joint capsule.
Identifying the Physical Manifestations
The defining observable sign of a contracture is a severely limited range of motion in the affected joint. The joint cannot be moved through its full arc, a limitation that persists even when a clinician attempts passive movement. The affected limb often adopts a fixed, bent, or abnormal posture, known as a flexion deformity. A contracture in a common site, such as the elbow or knee, may hold the joint in a permanently bent position, making daily tasks difficult. Hands and fingers can also be affected, resulting in an inability to fully straighten the digits. Attempts to move the fixed joint beyond its restricted range can cause significant pain or discomfort.
Strategies for Treatment and Prevention
Prevention and Conservative Therapy
Preventative measures are the primary strategy against contractures, especially for at-risk individuals facing prolonged hospitalization or neurological conditions. Maintaining proper positioning and implementing passive range-of-motion exercises reduce the risk of tissue shortening. Early intervention with physical and occupational therapy prevents mild stiffness from progressing into a severe contracture. Treatment focuses on physically lengthening the shortened tissues and restoring joint mobility through intensive stretching and manual therapy. Assistive devices, such as splints, braces, and serial casting, provide a prolonged, low-load stretch to gradually adjust the joint toward a more functional position.
Advanced Treatment Options
For contractures resistant to conservative therapy, medical and surgical options are considered. Botulinum toxin injections temporarily relax spastic muscles, allowing for more effective stretching and bracing. When a contracture is severely fixed, surgical procedures such as tenotomy (lengthening the tendon) or joint capsule release may be necessary to structurally restore the joint’s range of motion.