In this article we will look at joint contracture as a complication after prolonged immobilization due to trauma. In order to avoid joint contractures in physiotherapy worldwide, rehabilitation protocols are “individualized”, in practice accelerating the process of movement. This is possible only with good cooperation between specialists and in practice is difficult to achieve for most patients. They often do not have a recommendation for preoperative movement. And movement after immobilization or surgery often starts late. This poses a risk of joint contracture and significantly increases the rehabilitation time. It is possible to get a contracture in case of inadequate rehabilitation.
Etiology, nature and symptoms
The etiology of joint contracture is associated with prolonged immobilization. Lack of movement leads to a number of changes in the soft tissues around the affected joint.
The contracture structurally affects the joint, and this directly affects its function. It is characterized by limited joint mobility with a rigid final sensation and stop. The joint capsule, ligaments and surrounding muscles are affected. There is reduced tissue slipperiness and fibrous passions. Adaptive shortening is observed in the flexor and adductor muscles, which keeps the joint in a permanent pathological position. The extensor and extensor muscles are stretched and weak. Normal atrokinematics are disturbed and over time this leads to compensatory movements and adjacent joints, negatively affecting the entire affected limb.
The main distinguishing feature of joint contracture is the limited volume of movement with a firm final sensation and a painful stop sensation. Another sign is the unnatural position of the joint.
Prevention and treatment
Prevention should be aimed at early inclusion of rehabilitation measures such as passive movement of equipment and light exercises for the structures adjacent to the traumatic site. A consultation with a physiotherapist in the early period could give you enough clarity on what should be the adequate care at home and in specialized centers and when to start.
Aggressive kinesitherapy is of paramount importance in the treatment of joint construction. The specialist occupies a central place in it. Manual therapy consisting of joint mobilizations, postisometric relaxations, positional therapy, active gymnastics are the main means of influencing the construction. Apparatus physiotherapy is not excluded, but it does not matter. During medical interventions, the patient is unable to maintain the volume of movement achieved by the specialist, even when conscientiously performing the exercises to maintain it at home. This should not discourage patients. They should be informed about the long course of treatment and the anatomical and physiological changes that have occurred during the period of immobilization. Unfortunately, the procedures are painful, as a result of the stretching of the adaptively shortened soft tissues and the microrupting of fibrous adhesions.
Another option for affecting contracture is a one-time forced extraction of the volume of movement in the joint in the operating room under anesthesia. Or arthroscopic entry and cleaning of the joint. In both cases, prolonged aggressive rehabilitation follows again.