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PubMed1984

A long-term retrospective study of proximal hamstring release for hamstring contracture in cerebral palsy.

Proximal hamstring release was used exclusively for hamstring contracture in patients with spastic cerebral palsy. Average follow-up was 9 years 5 months. Thirty-two of 78 patients were examined retrospectively. Straight leg raising increased from 30 to 68 degrees. Knee flexion contracture decreased from 16 to 9 degrees. Knee flexion contractures of greater than 10 degrees were not permanently corrected. Only four of 64 knees were in mild (5-10 degrees) recurvatum at follow-up. Lumbar lordosis averaged 53 degrees at follow-up, and hip flexion contracture release apparently had little effect on lumbar lordosis. Proximal hamstring release can be used by this described technique without severe lumbar lordosis or devastating genu recurvatum.

Adolescent↗
PubMedDate not supplied

Natural history of knee contractures in myelomeningocele.

The natural history of knee contracture was determined in a prospective study of 850 myelomeningocele (MM) patients, ranging in age from neonate to 23 years, excluding patients after knee surgery. Fixed flexion contracture of 10 degrees at birth decreased by age 9 months but increased thereafter if the patient's MM level was higher than L3. In the thoracic/L1-L3 level patients, the mean fixed flexion contracture was 18 degrees with and 17 degrees without knee flexor spasticity. Range of knee flexion remained at 126 degrees until age 3 years, and decreased thereafter if the patient's MM was higher that L3. This study demonstrates that muscle imbalance and spasticity play a minimal role in development of knee contracture.

Adolescent↗
PubMed1988

For how long must the soleus muscle be stretched each day to prevent contracture?

The extent to which treatment of passive muscle contracture could be minimised without loss of efficiency was studied. Soleus muscle contracture was measured by the difference between the ankle angles at which minimal and maximal resistance occurred during slow dorsiflexion of the ankle. This examination was done twice, at the beginning and end of a seven-month observation period. During the observation period, also, the ankle angles were measured throughout a 24-hour period in the ordinary life of the child. The number of hours per 24-hour period during which the soleus muscle was stretched above a minimal threshold length was calculated. The major finding was that there was no progressive contracture when the soleus was stretched for at least six hours a day (the same time as in non-handicapped children). On the other hand, there was progressive contracture when the stretching time was as short as two hours. Two of the cases examined illustrated the possible causes of success or failure of night splints. These results provide new guidelines for the continuous treatment of children with cerebral palsy.

Adolescent↗
PubMed1983

Dupuytren's contracture, chronic liver disease and IgA immune complexes.

Contrary to previous reports, Dupuytren's contracture was found to be equally common in patients with alcoholic and non-alcoholic biopsy-proven liver disease (25% v 28%). Furthermore, in 69 patients with Dupuytren's contracture referred for surgical correction, there was no significant increase in either history of alcohol abuse or abnormality of liver function compared to a matched control group. Patients with Dupuytren's contracture were found to have increased levels of circulating IgA immune complexes compared to those without (p less than 0.05 for those with liver disease; p less than 0.001 for those awaiting surgical correction). Circulating immunoglobulins and immune complexes of other classes were similar between the groups with and without Dupuytren's contracture. These results suggest that the importance of alcohol has previously been exaggerated but that IgA immune complexes may be involved in the pathogenesis of the condition.

Adult↗
PubMed1975

Value of 17beta-oestradiol in prevention of contracture formation.

Male and female rabbits were treated with 17beta-oestradiol during the 9-week development of a contracture in the left hind limb. The right hind limb served as the paired control. Untreated (absolute control) animals received saline injections. After 9 weeks biochemical analyses of water, hexosamine, soluble and total collagen, as well as biomechanical measurements of joint stiffness, were performed on the dissected knees. In all cases 17beta-oestradiol reduced the measured stiffness in the contractures by approximately 50% as compared to the contractures of the untreated animals. 17beta-oestradiol, in addition, partially prevented the loss of water and hexosamine which occurs in untreated contractures. 17beta-oestradiol administration also decreased the content of soluble collagen fractions in the periarticular connective tissue of both the control and experimental knees. The relationship of these biochemical findings to their mechanical consequences is discussed, and the results are related to a working hypothesis of stress- and motion-dependent homoeostasis within periarticular connective tissue.

Animals↗
PubMed1993

Abnormal growth factor and cytokine expression in Dupuytren's contracture.

AIM: To analyse patterns of gene expression for peptide regulatory factors in patients with Dupuytren's contracture. METHODS: Tissue samples (palmer fascia) from 12 patients with Dupuytren's contracture and 12 controls were studied using the reverse transcription/polymerase chain reaction (RT/PCR) technique. RESULTS: Tissue from patients with Dupuytren's contracture expressed a higher percentage of peptide regulatory factors than that of controls: interleukin-1 alpha (83% v 16%; p < 0.01); interleukin-1 beta (66% v 8%; p < 0.01); transforming growth factor beta (75% v 25%; p < 0.02); and basic fibroblast growth factor (66% v 25%; p < 0.05). Platelet derived growth factors alpha and beta were also expressed more commonly (66% v 33% and 25% v 16%, respectively), but these differences were not significant. CONCLUSIONS: The increased prevalence of expression for the above mRNAs in Dupuytren's tissue is relevant as interleukin-1, basic fibroblast growth factor, and transforming growth factor beta stimulate the growth of fibroblasts and transforming growth factor beta also enhances production of collagen and other extracellular matrix proteins. Excessive local release of these peptide regulatory factors may have an important role in the pathogenesis of Dupuytren's contracture.

Adult↗
PubMed1979

Mechanical and structural correlates of contracture induced by metabolic blockade in cardiac muscle from the rat.

We performed morphological studies of myocardial contracture to define its nature and relationship to mechanical changes occurring during metabolic blockade. Isolated rat papillary and trabecular muscles were stretched to the apices of their length-tension curves and stimulated to contract isometrically 12 times a minute at a temperature of 28 degrees C. Incomplete and total metabolic blockade were induced by 1 hour of hypoxia (95% N2, 5% CO2) or by hypoxia plus glycolytic blockade with iodoacetic acid, 10-4M, respectively. In oxygenated control preparations, mechanical performance was stable for the 60-minute experimental period. In preparations exposed to hypoxia, developed tension fell to 7 +/- 2% of prehypoxia values at 60 minutes. Contracture tension increased progressively to 2.5 +/- 0.4 g/mm2. With total metabolic blockade, developed tension declined to zero by 10 minutes, contracture tension rose to an average peak value of 5.3 +/- 0.4 g/mm2 by 15 minutes, and subsequently slowly declined. All preparations were fixed at Lmax in the muscle bath. Light and electron microscopic studies revealed focal irregularities of A, I, and Z bands with sarcomere malalignment, hypercontraction, and fiber disruption, which increased in severity with increasing metabolic blockade. Linear densities appeared in mitochondria following total metabolic blockade, but mitochondria appeared normal otherwise. Thus, myocardial contracture after metabolic blockade is a focal process beginning within the sarcomere; morphological alterations in the contractile apparatus correlate with mechanical changes and are more severe than those in the mitochondria.

Animals↗
PubMed1984

Post-burn contractures in Ibadan.

A review of our experience with post-burn contractures over a ten-year-period at the University of Ibadan is reported. Fifty-two patients (32 males, 20 females) were treated; 52% were under the age of 5 years. In 25% the contractures were due to therapeutic burns. Sixty-two per cent of the contractures occurred in the upper limbs. Best results were obtained by release of contracture, application of split-thickness skin grafts, and splinting for up to six months.

Adolescent↗
PubMed2006

Contracture preventive positioning of the hemiplegic arm in subacute stroke patients: a pilot randomized controlled trial.

OBJECTIVE: To investigate the effectiveness of a contracture preventive positioning procedure for the hemiplegic arm in subacute stroke patients in addition to conventional physio- and occupational therapy. DESIGN: A single-blind pilot randomized controlled trial. SETTING: Inpatient neurological units from three rehabilitation centres in the Netherlands. SUBJECTS: Nineteen subacute stroke patients (minus two drop-outs) with a severe motor deficit of the arm. INTERVENTIONS: All subjects underwent conventional rehabilitation care. Nine subjects additionally received a positioning procedure for two 30-min sessions a day, five days a week, for five weeks. MAIN MEASURES: Passive range of motion of five arm movements using a hydrogoniometer and resistance to passive movement at the elbow using the Ashworth Scale. Secondary outcome measures were pain at the end range of passive motions, the arm section of the Fugl-Meyer Assessment and Barthel Index scores for ADL-independence. Outcome measures were taken after five weeks and additional measurements after 10 weeks by two assessors blinded to group allocation. RESULTS: Comparison of the experimental (n = 9) with the control subjects (n = 8) after five weeks showed that additional positioning significantly slowed down development of shoulder abduction contracture (P = 0.042, -5.3 degrees versus -23 degrees). No other differences were found between the groups. CONCLUSIONS: Applying a contracture preventive positioning procedure for the hemiplegic arm slowed down the development of shoulder abduction contracture. Positioning did not show significant additional value on other outcome measures. Since the sample size was small, results of this study need future verification.

Adult↗
PubMed1977

The treatment of flexion contracture of the knee in myelomeningocele.

A follow-up study, on average four years after operation, of seventy-six cildren with myelomeningocele who had surgical treatment for flexion contracture of the knee, is reported. After a single operation sixty-eight knees (55 per cent) had a contracture of less than 20 degrees, which was the main criterion of success. About half of the cases of transplantation of the hamstrings to the femur, division or elongation of the hamstrings, or supracondylar osteotomy had successful results. Transfer of the hamstring tendons to the patella was successful in nine of twelve instances, so giving the lowest rate of failure. Forty-five patients were active walkers at follow-up as compared to eighteen before operation. However, only one of the eleven patients over twelve years of age with a motor level above T.12 was an active walker at review. Several conclusions are drawn. A flexion contracture of the hip greater than 30 degress should be corrected before operation of the knee. Supracondylar osteotomy as a primary procedure should only be used to correct flexion contracture of the knee secondary to malunited fractures. Faradic stimulation is useful in the evaluation of muslce function before operation. An intelligence quotient below 65 and weakness of the arms are relative contraindications for correction of the deformity of the knee.

Adolescent↗
PubMed1997

Smoking, alcohol and the risk of Dupuytren's contracture.

We investigated the association of Dupuytren's contracture with smoking and with alcohol by a case-control study in which 222 patients having an operation for this condition were matched for age, operation date and gender with control patients having other orthopaedic operations. Fifty of the cases were also each matched with four community controls. Data were collected by postal questionnaire. Dupuytren's contracture needing operation was strongly associated with current cigarette smoking (adjusted odds ratio 2.8 (95% confidence interval (CI) 1.5 to 5.2)). The mean lifetime cigarette consumption was 16.7 pack-years for the cases compared with 12.0 pack-years for the controls (p = 0.016). Dupuytren's contracture was also associated with an Alcohol Use Disorders Test score greater than 7 (adjusted odds ratio 1.9 (95% CI 1.02 to 3.57)). Mean weekly alcohol consumption was 7.3 units for cases and 5.4 units for controls (p = 0.016). The excess risk associated with alcohol did not appear to be due to a confounding effect of smoking, or vice versa. Smoking increases the risk of developing Dupuytren's contracture and may contribute to its prevalence in alcoholics, who tend to smoke heavily.

Alcohol Drinking↗
PubMed1995

The expression of platelet-derived growth-factor gene in Dupuytren contracture.

Dupuytren contracture is a disease of the palmar fascia characterized by nodular fibroblastic proliferation; its etiology and pathogenesis are poorly understood. Growth factors are polypeptides that regulate cell growth and differentiation and extracellular matrix production. Platelet-derived growth factor is known to cause fibroblastic proliferation, and it may be involved in the pathogenesis of Dupuytren contracture. The purpose of this study was to determine if the gene for the B chain of platelet-derived growth factor is expressed in Dupuytren contracture. Tissue from patients who had Dupuytren disease was examined immunohistochemically with the 5B5 antibody, which is a marker for fibroblasts. Polymerase chain reaction, gel electrophoresis, Southern blotting, and in situ hybridization were also used to study gene expression in the tissue as well as in normal fascia, A172 cells, and MRC5 cells. Total cellular RNA was extracted from tissue and cells. Polymerase chain reaction was done with oligonucleotide primers complementary to a portion of the platelet-derived growth-factor-B and platelet-derived growth-factor-receptor genes. The platelet-derived growth-factor-B gene was expressed in all six specimens from the patients who had Dupuytren contracture as well as in the A172 cells, but not in the normal fascia lata or the MRC5 cells. These results were confirmed with Southern blotting of the products of the reaction with a platelet-derived growth-factor-B probe. The gene for the platelet-derived growth-factor receptor was expressed by all tissues and cells studied.(ABSTRACT TRUNCATED AT 250 WORDS)

Blotting, Southern↗
PubMed1994

Adaptations during the stance phase of gait for simulated flexion contractures at the knee.

Adaptations in the stance phase of gait to knee flexion contractures simulated by a knee-ankle-foot orthosis were studied in 20 healthy women (mean age: 25 +/- 3.6 years). Stride characteristics, joint postures, floor reactions, and indwelling electromyographic activity of the lower gluteus maximus, vastus lateralis, long head of the biceps femoris, and soleus muscles were measured during walking with the orthosis, with and without contracture simulation. Simulated knee flexion contracture resulted in decreased stride length and velocity and increased forefoot weight bearing and flexion posture in stance. Increases were also seen in magnitude and/or duration of flexion floor reaction torques and gluteus maximus, vastus lateralis, and soleus muscle activity. The addition of a restriction of plantar flexion resulted in a further decrease in velocity and stride length and a small increase in hip extension posture. These results show that knee flexion contractures, simulated in healthy subjects, cause a decrease in gait function with a simultaneous increase in muscular demand.

Adaptation, Physiological↗
PubMed1997

[Total knee replacement of severe flexion contracture deformities greater than 60 degree].

The technique of total knee arthroplasty for the patients with severe flexion contractures of more than 60 degrees is not clear. Recently, We have performed 37 total knee arthroplasties in 23 patients with flexion contracture of more than 60 degrees (average 77.97 degrees). Among them, 14 knees (37.9%) with flexion contracture of more than 90 degrees, and 7 knees (18.0%) with 90 degrees flexion fusion deformities. Significant improvements occurred after averaged 4.3-year follow-up. Complications occurred in four patients: three had transient peroneal-nerve palsy, and one had temporary circulatory disturbance of the lower extremity. They recovered after conservative therapy. We consider that severe flexion contracture of more than 60 degrees is not a contraindication of TKR. Staged bone resection and thoroughly soft-tissue release of the posterior capsule and collateral ligament balance were the critical procedure. If necessary, additional distal femoral condyle resection with posterior cruciate ligment sacrifice can be considered.

Adult↗
PubMedDate not supplied

Congenital contractural arachnodactyly (Beals syndrome).

Congenital contractural arachnodactyly (CCA, Beals syndrome) is an autosomal dominant disorder that is phenotypically similar to Marfan syndrome. CCA is characterized by arachnodactyly, dolichostenomelia, scoliosis, multiple congenital contractures and abnormalities of the external ears. We report here 28 patients with CCA, in whom a wide range of phenotypic expression is observed. These individuals usually have abnormally formed ears, limited extension of fingers and toes, arachnodactyly, clinodactyly, delay of developmental milestones and psychomotor retardation. Limited extensions of elbows, knees and hips are not constant features. With time, those affected individuals experience spontaneous improvement of their contractures but the kyphosis, unlike the joint contractures, tends to be progressive. No ocular problems were found in all patients, but congenital heart defects were detected in 32.2% of them. Atrial septal defect and ventricular septal defect are common components in our patients. Within the only one family with two multiply affected siblings there is little phenotypic variation between the patients.

Adolescent↗
PubMed1999

[Potentiation of caffeine-induced contracture by raising extracellular potassium in frog skeletal muscle].

The effect of raising extracellular potassium ([K+]o) on caffeine contracture was investigated, using small bundles dissected from frog anterior tibialis muscle. Elevating [K+]o from the control of 2 mmol/L to 10 or 25 mmol/L significantly potentiated the contracture induced by 3 mmol/L caffeine. The potentiation represented by PKC/PC, where PKC and PC are the peak tension of the caffeine contracture evoked in high and normal [K+]o respectively, was dependent on [K+]o and the duration of conditioning high K+ exposure. With 10 mmol/L [K+]o, the potentiation was gradually increased by prolonging conditioning exposure up to 10 min. On the contrary, with 25 mmol/L [K+]o the potentiation reached a maximum within only 1 min, and then subsided to the control. These different time courses of PKC/PC could not be accounted for by high K+ induced depolarization, but were in general consistence with the time courses of the change in myoplasmic free calcium induced by corresponding high [K+]o. It is suggested that, at least in frog skeletal muscle, the high [K+]o induced potentiation of caffeine contracture is mainly due to an increase of myoplasmic free calcium.

Animals↗
PubMed2001

[Design of Z-shaped Achilles tendon scar composite flaps to correct the tendon-scar contracture].

OBJECTIVE: To modify the design of the Achilles tendon-scar composite flap into the Z-shape and to apply it into clinic situations to correct the tendon-scar contracture after burn and other injures. METHODS: According to degree of contracture and strephenopedia, the central limb of Z-shaped design lay in contracture line of posterior ankle area just over the Achilles tendon and extended 8 to 12 cm in length. Lateral limbs extended 5 to 8 cm and usual angles of the Z-shape was 60 degrees. The two tendon-scar composite flaps were made and slipped along the central limb between them. From March 1994 to August 1999, seven patients with Achilles tendon scar contracture were operated with this method. RESULTS: Excellent relieving of the Achilles tendon-scar contractue was achieved. No such complications happened as ischemia and necrosis of the flaps. CONCLUSION: The Z-shaped tendon-scar composite flap is practical in clinics. It is characterized by abundant blood supply, easily procedure and reliable result.

Achilles Tendon↗
PubMed2002

Use of a static adjustable ankle-foot orthosis following tibial nerve block to reduce plantar-flexion contracture in an individual with brain injury.

BACKGROUND AND PURPOSE: Ankle plantar-flexion contractures are a common complication of brain injuries and can lead to secondary limitations in mobility. CASE DESCRIPTION: The patient was a 44-year-old woman with left hemiplegia following a right frontal arteriovenous malformation resection. She had a left ankle plantar-flexion contracture of -31 degrees from neutral. After a tibial nerve block, an adjustable ankle-foot orthosis was applied 23 hours a day for 27 days. Adjustments of the orthosis were made as the contracture was reduced. The patient received physical therapy during the 27-day period for functional mobility activities and stretching the plantar flexors outside of the orthosis. OUTCOMES: The patient's dorsiflexion passive range of motion increased from -31 degrees to +10 degrees. DISCUSSION: The application of an adjustable ankle-foot orthosis following a tibial nerve block, as an addition to a physical therapy regimen of stretching and mobility training, may reduce plantar-flexion contractures in patients with brain injury.

Adult↗