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PubMed2000

Contractures secondary to immobility: is the restriction articular or muscular? An experimental longitudinal study in the rat knee.

OBJECTIVES: To measure articular structures' contribution to the limitation of range of motion after joint immobility. STUDY DESIGN: Experimental, controlled study involving 40 adult rats that had one knee joint immobilized in flexion for durations of 2, 4, 8, 16, and 32 weeks; 20 rats underwent a sham procedure. The angular displacement was measured both in flexion and extension at three different torques. Myotomy of transarticular muscles allowed isolation of the arthrogenic component of the contracture. RESULTS: A contracture developed in all immobilized knees. The articular structures were incrementally responsible for the limitation in range of motion (from 12.6 degrees +/-6.7 degrees at 2 weeks to 51.4 degrees +/-5.4 degrees at 32 weeks). The myogenic restriction proportionately decreased over time (from 20.1 degrees +/-8.4 degrees at 2 weeks to only 0.8 degrees +/-7.2 degrees at 32 weeks). The increase in the arthrogenic component of contracture was predominant in extension. CONCLUSION: This study quantified the increasing role of arthrogenic changes in limiting the range of motion of joints after immobility, especially as the period of immobility extended past 2 weeks. These data provide a better understanding of joint contracture development and can be used to guide therapeutic approaches.

Animals↗
PubMed1987

Prevention of post-prostatectomy vesical neck contracture by prophylactic vesical neck incision.

Most vesical neck contractures occur after resection of adenomas weighing less than 20 gm. This complication is believed to be secondary to excessive resection or fulguration of an undilated bladder neck. Prophylactic bladder neck incision was performed in conjunction with transurethral resection of the prostate on 114 patients with prostatic adenomas weighing less than 20 gm. Vesical neck contracture occurred in 1 patient (0.87 per cent), compared to 12 contractures in 161 patients who underwent transurethral resection of the prostate alone (7.5 per cent). Increasing bladder neck diameter by incision appears to be protective against formation of vesical neck contractures in patients with small obstructing prostatic adenomas.

Contracture↗
PubMed2001

Is 20 years of immobilization, not sufficient to render metacarpophalangeal joints completely useless?--Correction of a 20-year old post-burn palmar contracture: a case report.

This report presents a case of post-burn palmar contracture with flexion contracture of thumb of 20-year duration. The contracture was released and the raw area was covered with split thickness skin graft. Only one 'K' wire in soft tissue was needed to keep all the fingers straight and immobilized, suggestive of intermetacarpal ligamentous contracture. A static night splint was given to maintain the correction. Complete range of movement was achieved in a month with the combination of dynamic splinting and physiotherapy. It was interesting to note that even 20 years of contracted position did not render the metacarpophalangeal joints completely stiff and useless. Probable reasons are discussed.

Adult↗
PubMed2002

Treatment modalities for post-burn axillary contractures and the versatility of the scapular flap.

Inappropriate treatment of axillary burns frequently results in adduction contractures. In this clinical study we have reviewed 32 patients with different types of axillary post-burn adduction contractures. We have used a variety of surgical treatments for reconstruction of axillary contracture releasing defects such as simple grafting, Z-plasties and locally pedicled flaps. Among these alternatives, we preferred to use scapular island flap most frequently. In addition to conventional harvest of this flap, extension of its pedicle up to the subscapular ramification by passing it through the triangular space allowed its transfer even to the anterior axillary line defects in a vertical orientation without pedicle kinking. In conclusion, the island scapular flap is a good choice for reconstruction of all types of axillary contracture, releasing defects with satisfactory results in terms of function and cosmesis.

Adult↗
PubMed2003

An evaluation of functional improvement following surgical corrections of severe burn scar contracture in the axilla.

This report present an evaluation 13 consecutive cases of severe burn scar contracture of the axilla and investigates the factors that influence functional improvement. The operation was performed at various times during the period from 3 months to 63 years after the initial burn wound healed. The active range of shoulder abduction before the operation in these patients was restricted to 30-90 degrees. The scar contractures in the axilla were released in all cases and the defects of the axillary region were covered with musculocutaneous flaps or fasciocutaneous flaps. Following operation rehabilitation was performed with the range of shoulder abduction had reached a plateau. The relations between the improved range of shoulder abduction, time to reach a stable range of abduction, patient age and duration of illness in each patient are discussed. Patient with long post-injury periods required a longer time to reach a stable range of abduction. Furthermore, the patients with an extremely long period before operation had difficulties such as nerve injury or stiff joint which restricted improvement. In conclusion, adequate surgical treatment in early period after occurrence of contracture is desirable for burn scar contracture of the axilla.

Adolescent↗
PubMed2002

Androgen receptors in Dupuytren's contracture.

Palmar fascia tissue and cultured cells from patients with Dupuytren's contracture and from normal subjects were characterized and analyzed for androgen receptor expression. Androgen receptors have never been studied in Dupuytren's myofibroblasts and may have a role in its high male predominance. Surgical samples were collected from eight patients undergoing surgery for Dupuytren's contracture and from four patients with carpal tunnel syndrome, used as control tissue. Immunohistochemical analysis was performed on tissue samples and on cell cultures with anti-androgen receptor, anti-alpha-smooth muscle actin, anti-fibronectin, and anti-type I and III collagen antibodies using the biotin avidin peroxidase method as revelatory system. Immunostaining for androgen receptors in tissue samples and cultured cells revealed nuclear reaction in many Dupuytren's myofibroblasts, but in few fibroblasts of the normal palmar fascia. In a double-labeling study, androgen receptors were seen to co-localize with alpha-actin in both cell cultures and tissue samples. We present the first evidence that the palmar fascia is a target tissue for androgen action and that the expression of androgen receptors in Dupuytren's contracture is considerably higher than in the normal palmar fascia. Further studies will need to evaluate whether the androgen-responsive state of the tissue is related to the high incidence of Dupuytren's contracture in the male sex.

Actins↗
PubMed1988

[Tests of contracture and sensitivity to malignant hyperthermia in 27 patients].

Twenty-seven patients, four of whom had presented with a crisis of malignant hyperthermia and the 23 other being close relatives of such patients, underwent a muscle biopsy so as to determine their susceptibility to malignant hyperthermia. Halothane-caffeine contracture tests, interpreted in accordance with the criteria of the European Group on Malignant Hyperthermia, yielded the following results: 13 positive (MHS), 10 negative (MHN), 4 equivocal (MHE). The history, clinical examination, CPK level, histoenzymatic morphology and electron microscopic study did not provide information sensitive enough to use for the detection of susceptibility to malignant hyperthermia. This confirmed the literature: the halothane-caffeine contracture test remains the only reliable diagnostic test to detect this susceptibility, despite the search for non invasive tests. If the mechanism of triggering a contracture to increasing doses of caffeine is well known in normal muscle, it is the smaller concentrations required which suggests malignant hyperthermia abnormality. The halothane effect is less well understood. A concentration less than or equal to 2 vol % yields a contracture only in MHS muscle. Differences in protocols used by American authors emphasize the importance of standardization as used by the European Group, which is the only way of collecting and comparing results on well over a thousand patients. This confrontation should reduce the number of equivocal diagnoses and allow a correct classification of patients at risk or their relatives as MHS or MHN.

Adolescent↗
PubMed1999

Therapeutic options in the management of articular contractures in haemophiliacs.

Haemophilic contracture is seen most commonly as an equinus deformity of the ankle, or at the knee or elbow in the form of a flexion deformity. Treatment options are varied, and decision-making is based on the degree of the contracture, its chronicity, the presence of articular subluxation, the patient's ability to participate in treatment, and the available medical facilities. The treatments available fall into four categories: physiotherapy, orthotics, corrective devices, and surgical procedures. Treatment should be primarily by physiotherapy, splintage, and corrective devices. The late or severe case may require surgical correction in the form of soft-tissue procedures. Soft-tissue correction of muscle shorthening may be performed such as lengthening of the Achilles tendon for equinus deformity of the ankle, or hamstring release of the flexor muscles of the knee. Lower femoral osteotomy has been used for correction of flexion deformity at the knee joint. Mechanical distraction using external fixators for treatment of severe knee flexion contractures has been recently reported with satisfactory results. The main principle underlying the treatment of haemophilic contracture is the restoration of the patient's lifestyle and mobility, rather than anatomic or radiographic normality.

Contracture↗
PubMed2001

Treatment of upper motoneuron plantarflexion contractures by using an adjustable ankle-foot orthosis.

OBJECTIVE: To assess the effectiveness of an adjustable ankle-foot orthosis in the treatment of plantarflexion contractures after central nervous system injury or disease. DESIGN: Prospective, nonrandomized, interventional trial. SETTING: University medical center's acute inpatient rehabilitation hospital. PARTICIPANTS: Nine ankles with plantarflexion contractures that could not be passively reduced to less than neutral position occurring in 6 patients with stroke or other acquired brain injury. INTERVENTION: To assure differentiation between spastic deformity and true contracture, patients received a 2% lidocaine block of the posterior tibial nerve. The adjustable ankle-foot orthosis was then applied on the affected ankle for 23 hours per day for 14 days. Adjustments to increase dorsiflexion passive range of motion (PROM) ranged from 0 degrees to 4.5 degrees and were attempted every 48 to 72 hours. MAIN OUTCOME MEASURES: Dorsiflexion PROM at the ankle with the knee extended. RESULTS: Increased PROM (average, 20.1 degrees; range, 6 degrees--36 degrees ) was statistically significant (p =.0078). Complications related to pressure with erythema or blister formation associated with pain occurred in 44% of treated ankles at some time during the 2-week trial period. CONCLUSION: Plantarflexion contractures can be significantly reduced by using the adjustable ankle-foot orthosis with minimal complications.

Adult↗
PubMed2001

Bone growth increases the knee flexion contracture angle: A study using rats.

OBJECTIVES: To assess the impact of bone growth on the flexion contracture angle at the knee, to measure the bone growth pattern in rats, and to assess the impact of immobility on bone growth. DESIGN: Experimental, controlled study. SETTING: Bone and joint laboratory. ANIMALS: Sixty Sprague-Dawley rats. INTERVENTIONS: Knee joints of 40 rats were immobilized unilaterally in flexion. Sham-operated animals (n = 20) were controls. MAIN OUTCOME MEASURES: The contracture angle and the femur and tibia lengths on radiographs. RESULTS: The angle of flexion increased over time and was largely explained by bone growth (r =.725, p <.01). Femur and tibia grew in rats until they were 11 months old. Immobility enhanced growth in bone length, especially of the femur, after 16 and 32 weeks of immobility (p <.05). CONCLUSIONS: Knee flexion contracture angle increased as a consequence of normal bone growth, a situation that is also encountered in skeletally immature children. The continued growth in length of bones in children may influence the progression of contractures and add to the therapeutic challenge. Ongoing bone growth should be considered when interpreting reports that use animal models for bone and joint diseases.

Aging↗
PubMedDate not supplied

The effect of corrective splinting on flexion contracture of rheumatoid fingers.

This paper reports a matched-pair experimental study to investigate the effect of corrective splinting on flexion contracture of rheumatoid fingers. Twenty-four patients with rheumatoid arthritis and finger flexion contracture participated in the study. After a 6-week baseline measurement of hand function-including measurement of grip strength and range of motion and administration of the Jebsen Hand Function Test-the patients were randomly placed into two groups. Patients in the first group were given dynamic (Capener) splints, and those in the second group were given static (belly gutter) splints. Hand function was re-assessed 6 weeks after the splinting program. Results indicated significant improvement in both groups, not only in the correction of the finger flexion contracture (p < 0.0005) but also in grip strength (p = 0.001) and hand function (p < 0.0005). Patients with dynamic finger extension splints did not differ from those with static splints in extension gains, but they did have better flexion than patients with static splints. Both types of splints can be recommended for flexion contracture of rheumatoid fingers, depending on patients' preferences and comfort.

Adolescent↗
PubMed2000

Cancer incidence in patients treated surgically for Dupuytren's contracture.

Our aim was to study risk factors for Dupuytren's contracture (DC) by assessing cancer morbidity in a group of Swedish patients treated surgically for Dupuytren's contracture. The risk of cancer was determined in 15,212 patients operated on for Dupuytren's contracture, identified in the nationwide Swedish Inpatient Register during the period 1965 to 1994 by means of record linkage to the Swedish Cancer Register. Standardized incidence ratios (SIRs) were computed using age-, sex- and period-specific incidence rates derived from the entire Swedish population. The overall relative risk of cancer was increased by 24%. There were significantly increased risks for malignancies related to smoking such as buccal, oesophageal, gastric, lung and pancreatic cancers. Significantly increased risks were present for both prostate and rectal cancer in men and an increase risk for breast cancer in women was noted 1 year or more after surgery for Dupuytren's contracture. The present study confirms smoking and alcohol abuse as probable risk factors for DC. There are characteristics in patients with DC that alter the risks for other malignancies compared with the general population.

Aged↗
PubMed2001

Langerhans cells in Dupuytren's contracture.

We have examined biopsies of Dupuytren's contracture palmar fascia, overlying subcutis and skin, and have correlated the distribution of gross macroscopic changes in the hand, mapped pre- and intraoperatively, with light microscopic immunohistochemical findings. We report increased numbers of S100 positive Langerhans cells (an epidermal cell of dendritic lineage) and CD45 positive cells, both in "nodules" and at dermo-epidermal junctions, in the biopsied tissues. This suggests that Langerhans cells migrate from the epidermis into Dupuytren's contracture tissue, possibly in response to local changes in levels of inflammatory cytokines within the tissue. Our findings, together with other reports of increased numbers of dermal dendrocytes and inflammatory cells in Dupuytren's contracture tissue, lend circumstantial support to the "extrinsic theory" of the pathogenesis of Dupuytren's contracture. However, the earliest stages of the disease process have not been defined, and therefore the events which ultimately produce fibrosis in the palmar fascial complex in susceptible individuals could begin in the skin and/or within deeper tissues, especially where there is dysregulation of the immune system.

Aged↗
PubMed2000

[Preoperative intermittent pneumatic extension treatment stage III and IV Dupuytren contracture].

BACKGROUND: The purpose of this study was the development of a non-invasive preoperative soft-tissue extension device for the treatment of patients with Dupuytren's contracture grade III and IV according to the classification of Tubiana, based on the experience of continuous extension treatment using the external fixator of Messina. METHODS: Intermittent pneumatic distraction (IPD) of soft tissue using a pneumatic extension device was employed for three weeks preoperatively on ten patients. RESULTS: After three weeks the active and passive extension deficit was reduced by 30.02% and 44.64% respectively. Eight months postoperatively an increase of extension on average of 110 degrees was attained. In contrast, a second group of ten patients with Dupuytren's contracture grade III and IV (Tubiana) without preliminary treatment was listed. In these patients, three times a skin graft was needed; in addition, the stay in hospital and time of rehabilitation was longer. CONCLUSIONS: The preoperative reduction of contracture simplifies the surgical treatment and reduces the complication rate. We present a new non-invasive technique for preoperative continuous extension of Dupuytren's contracture yielding at least equal results to the method introduced by Messina. Comparing the two groups of patients, the patients with preliminary treatment had a shorter stay in the hospital and a shorter time of rehabilitation.

Aged↗
PubMed2004

Successful correction of severe contracture of the palm using arterialized venous flaps.

Severe contracture of the palm causes great difficulty in the performance of the tasks required in daily life. Resurfacing with skin grafts may be sufficient for treating mild and small contractures; but severe and extensive contractures involving the joints, tendons, and neurovascular bundles should be covered with thin flaps. The authors present four cases of successful reconstruction of severe and extensive contractures of the palm using large arterialized venous flaps.

Adult↗
PubMedDate not supplied

[Results of surgical therapy of knee flexion contractures in patients with myelomeningocele].

This study reports the results of 98 operations for correcting knee-flexion-contractures, which were performed between 1972 and 1989 in 60 patients with myelomeningocele. 13 knees had hamstring lengthening and 85 knees had radical flexor release. In 4 patients, who had flexion-contractures of more than 50 degrees, the soft tissue release was combined with supracondylar extension osteotomy. 58 patients had additional hip-flexion-contractures and 39 patients had feet deformities. The average age at time of surgery was 8 years, 3 months. The average follow-up-period was 65 months with a minimum of 1 year and a maximum of 13 years. In 92 knees a permanent extension ability could be achieved. In 6 knees a recurrence of flexion-contracture occurred making a second surgery necessary. The main problem in the postoperative period were 13 skin necroses, which were seen mainly after an s-shaped incision. As a conclusion a perpendicular midline incision is recommended. After surgery 11 patients could be provided for the first time with an orthoses. In the remaining the upright body position or the erection of the orthoses could be improved.

Adolescent↗
PubMed1971

Biphasic potassium contractures in frog muscle fibers.

Potassium-induced contractures were studied in single fibers from the semitendinosus muscle of Rana pipiens. Contractures elicited by solutions containing 60-117 mM potassium and 120 mM chloride were biphasic, consisting of a rapid initial contraction with a duration at 23 degrees C of less than 1 sec followed by a slow response with a duration of many seconds. At 13 degrees C, the initial response was greatly prolonged so that the two responses virtually fused into a single smooth contracture. Membrane potential in high potassium, high chloride solutions underwent a transient peak depolarization, probably as a result of time-dependent changes in membrane conductance during depolarization. It is proposed that this complex time course of depolarization gives rise to the biphasic contracture response.

Animals↗
PubMed1986

Continuous passive motion in the treatment of knee flexion contractures. A case report.

Joint contractures are a problem frequently encountered by therapists. Methods of treating joint contractures traditionally have consisted of range-of-motion and stretching exercises. The medical literature suggests that, to be effective, ROM and stretching exercises must be performed with well-controlled speed, force, and duration. The patient in our case study used continuous passive motion machines after conventional methods of exercise failed. He subsequently demonstrated a 55-degree, bilateral reduction in knee flexion contractures. The purpose of this case report is to illustrate the use of continuous passive motion machines in the treatment of severe knee flexion contractures.

Contracture↗