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PubMed1984

Low-load prolonged stretch vs. high-load brief stretch in treating knee contractures.

This study was designed to compare the results of a traditional method of stretching knee flexion contractures by high-load brief stretch (HLBS) with the results of an experimental method of prolonged knee extension by skin traction, low-load prolonged stretch (LLPS). End range of passive knee extension was measured by standard goniometry. Subjects were 11 nonambulatory residents of a nursing home who had demonstrated gradually progressive bilateral knee contractures. Each subject served as his or her own control with one lower limb receiving LLPS and the other limb receiving HLBS and passive range of motion (PROM). Sequential medical trials were used as the clinical research design. Whether comparing the LLPS limb PROM measurements pretreatment and posttreatment (p less than or equal to .05) or the HLBS to the LLPS limb PROM recordings posttreatment (p less than or equal to .05), the results demonstrated a preference for LLPS in the treatment of knee contractures in the immobile nursing home resident.

Aged↗
PubMed1989

Low-load, prolonged stretch in treatment of elbow flexion contractures secondary to head trauma: a case report.

Joint contractures are a frequent complication of head trauma and often require extensive physical therapy intervention. Traditional methods of treatment, including passive stretching and range-of-motion exercises, have proven to be of limited benefit in contracture reduction. Low-load, prolonged stretch has been shown to be more effective than traditional methods of treatment in producing the desired elongation of connective tissue. A splinting device known as the Dynasplint is designed to provide this type of stretch. The purpose of this case report is to describe the application of the Dynasplint in the successful treatment of a patient with elbow flexion contracture secondary to head trauma.

Adult↗
PubMed1997

An analysis of the predictive probability of the in vitro contracture test for determining susceptibility to malignant hyperthermia.

An objective estimate of the likelihood of correct designation of malignant hyperthermia (MH) susceptibility from in vitro contracture test (IVCT) results is essential if genetic linkage studies of MH are to be more informative. The aim of this study was to generate and test statistical models that could be used to predict the probability of susceptibility of an individual to MH from the results of their IVCTs. Logistic regression of the IVCT results of an index group of 50 patients (age range 9-73 years; MH susceptible [MHS], n = 13; MH normal [MHN], n = 32; MH equivocal [MHE], n = 5) who were either at low risk of MH or were proband cases were used to generate models to predict probability of MH susceptibility. Models incorporated data from individual contracture tests or from combinations of tests (static halothane, dynamic halothane, caffeine, ryanodine) performed according to the protocols of the European Malignant Hyperthermia Group. Of the individual contracture tests, the ryanodine test was most closely correlated with MH status. Discriminatory ability of the models was assessed using receiver operating characteristic (ROC) curves. Inclusion of predictor variables from the ryanodine, caffeine, and dynamic halothane tests improved upon the discriminatory ability of the models incorporating variables from individuals tests and was considered to be the best model. The reproducibility of this model was confirmed using an ROC curve constructed using data from 47 patients (age range 10-62 years; MHS, n = 15; MHN, n = 28; MHE, n = 4) who were classified in a way similar to the index group. A further group of 153 patients (age range 9-74 years; MHS, n = 44; MHN, n = 92; MHE, n = 17) who were consecutively tested relatives of susceptible individuals was used to assess the generalizability of the best model. The model met the criteria for a useful discriminatory model with this group of patients, 125 of whom (including 9 MHE patients) could be designated as positive or negative for MH with a likelihood of more than 95%. The logistic regression models provide objective likelihoods for the MH phenotype that could be usefully incorporated into genetic linkage studies of the condition.

Adolescent↗
PubMed1998

The sensitivity and specificity of the caffeine-halothane contracture test: a report from the North American Malignant Hyperthermia Registry. The North American Malignant Hyperthermia Registry of MHAUS.

BACKGROUND: The caffeine-halothane contracture test (CHCT) is the only recognized laboratory test to diagnose malignant hyperthermia (MH). The authors report the results of their analysis of pooled data from the North American Malignant Hyperthermia Registry database to determine the sensitivity and specificity of the CHCT. METHODS: The MH Clinical Grading Scale was used to identify 32 case subjects who were "almost certain" to be MH susceptible based on clinical criteria alone. Their CHCT results were compared with those of a group of 120 control subjects considered to be at low risk for MH. Diagnostic thresholds of the CHCT were adjusted, and its component tests were combined to generate receiver operating characteristic curves. The maximal Youden index for each component test was chosen as the diagnostic threshold indicative of MH susceptibility. RESULTS: The highest sensitivity (97%; 95% CI, 84-100%) was achieved with a two-component test with thresholds of > or = 0.5 g contracture for 3% halothane, > or = 0.3 g contracture at 2 mM caffeine, or both, considered positive for MH. The test specificity was 78% (95% CI, 69-85%). The addition of other CHCT component tests did not improve CHCT sensitivity or specificity. CONCLUSION: The CHCT achieves high sensitivity and acceptable specificity as a clinical laboratory diagnostic test when it is performed according to published standards. However, it cannot be used as a screening test because of the low prevalence of MH in the general population.

Adult↗
PubMed1998

Bayesian modeling of muscle biopsy contracture testing for malignant hyperthermia susceptibility.

BACKGROUND: Phenotyping malignant hyperthermia (MH) by contracture testing has a low but quantifiable degree of inaccuracy, measured by its sensitivity and specificity. Quantifying the limitations inherent in diagnostic testing for MH can help resolve issues in clinical practice, such as the interpretation of a negative test and the apparent lack of complete genetic linkage to RYR1. METHODS: Bayesian models, mathematical descriptions of the outcome of diagnostic testing, were constructed. The inputs to the model include patient factors, summarized in a single number called pretest probability (PTP), and sensitivity and specificity that specify the accuracy of the entire test process. The outputs of the model include positive predictive value (PPV) and negative predictive value (NPV), which are numeric expressions of diagnostic certainty of positive and negative test results. A special case was constructed for equivocal results. RESULTS: The PPV, NPV, and efficiency of contracture testing for MH are functions of PTP, sensitivity, and specificity. The NPV is high for all clinical PTP, whereas PPV is clinically useful for moderate to high PTP. CONCLUSIONS: Diagnostic contracture testing for MH is clinically useful because of high NPV and can exclude MH with near certainty. For MH probands, the clinical grading scale for MH may guide PTP estimation, whereas for relatives of probands, PTP is a function of kinship to a known MH-susceptible relative. A sequential testing strategy optimizes diagnostic information by maximizing PTP within a pedigree. Incomplete testing of parents of an MH susceptible child can pose a significant risk of false-negative results for the untested parent. Even with optimal pedigree testing strategies, the PPV drift effect results in a considerable source of phenotypic uncertainty for genetic linkage studies.

Bayes Theorem↗
PubMed1980

Early scar plasticity as a cause of scar contracture.

Little is known about the cause of scar contracture. The contractile capability of myofibroblasts in the early scar provides a partial explanation; however, clinical and experimental findings indicate that the early scar possesses plasticity, and that its size and shape can be altered by mechanical forces. Even if a scar possesses no contractile capability itself, scar contracture may develop if: (1) the affected joint (skin) is kept in flexion (relaxation); (2) the scar is over a contracted wound; or (3) compression is applied to the early scar. Many instances of scar contracture may therefore be attributable not to active motility but to the passive response of scar tissue to mechanical forces.

Adolescent↗
PubMed1982

External compression for the prevention of scar capsule contracture--a preliminary report.

One of the many methods that have been suggested for the prevention of capsule contracture is the use of capsule expansion exercises. However, the effectiveness of such treatment has remained controversial and has never been studied in a controlled manner. An experiment was designed to study the effect of intermittent external compression on gel implants in dogs. In adult mongrel dogs 200 cc gel implants were placed subcutaneously on either side of the chest wall. Postoperatively, the dogs were treated with an inflation panel which was held over one implant by a canvas jacket. The other implant served as a control. The implants were evaluated by both applanation and indention tonometry. Treatment continued for three months and the dogs were followed for an additional twelve months postoperatively. Of the original 5 dogs, 2 failed to develop contracture on either side. The remaining 3 developed varying degrees of contracture which was in all cases more severe on the control side. In the twelve months of subsequent follow-up, 2 of these dogs remained soft on the treated side and firm on the control side.

Animals↗
PubMed1997

Effects of capsular contracture on ultrasonic screening for silicone gel breast implant rupture.

Unlike computed tomography and magnetic resonance imaging, ultrasound is an inexpensive test of potential use in detecting silicone gel breast implant (SBI) rupture. However, periprosthetic capsular contracture can make ultrasonic diagnosis of rupture difficult because the contracture-related radial folds inside the SBI can lead to a false-positive diagnosis of rupture. This study was conducted to determine the effects of capsular contracture on the ability of ultrasound to diagnose SBI rupture. Preoperative ultrasonic results of 122 SBIs were compared with surgical findings at the time of implant removal. The sensitivity and negative predictive values of ultrasound were lower in the presence of a contracted capsule (41.2% vs. 68.7%, p = 0.062; and 58.3% vs. 79.6%, p = 0.056 respectively). Ultrasound should be considered reliable in diagnosing SBI rupture only in the absence of a contracted capsule.

Adult↗
PubMed1999

Surgical management of hand contractures and pseudosyndactyly in dystrophic epidermolysis bullosa.

The term epidermolysis bullosa refers to a group of disorders characterized by skin blistering following minor trauma. The hands, because of constant use during normal daily activity, are especially exposed to blistering, with secondary scarring leading to pseudosyndactyly, adduction contracture of the thumb, and flexion or extension contracture of the fingers. The standard surgical approach for the correction of these deformities is based on the incisional release of pseudosyndactyly and contractures, and split skin grafting of the secondary wounds. A simplified approach without skin grafting is presented in this paper. Four children (8 hands) underwent 25 operations over two decades. The results, in terms of postoperative healing and recurrence, were comparable with those of the standard approach involving skin grafting.

Adolescent↗
PubMed2000

Correction of scar contracture deformities of the big toe with a multiplanar distraction device.

A multiplanar distraction device was used in a 65-year-old woman for correction of multiplanar deformities of her right big toe. These deformities were caused by long-standing scar contracture after a crushing injury to the right foot. Without the necessity of other complicated procedures, the dorsal contracture and lateral deviation were corrected from 43 deg to 0 deg and from 22 deg to 0 deg respectively 3 weeks postoperatively. Kirschner wires were inserted temporarily for prevention of recurrence after removal of the frame, and were removed 6 weeks later. In follow-up after 8 months, the position of the big toe was stable and without recurrence of contracture. Application of the multiplanar distraction device simplified the surgical procedure to achieve this correction.

Aged↗
PubMed2001

Severe wrist contracture in a child with linear scleroderma.

Linear scleroderma is an unusual disorder characterized by linear streaks of fibrotic skin involvement, which can lead to severe limb deformities and contractures. The authors present a case of severe wrist contracture in a child with linear scleroderma treated by release of the contracture with coverage of the exposed carpus with an abductor digiti minimi flap and skin graft. Reports of successful treatment of extremity deformities are rare. At 1 year this correction appears to have been successful.

Child↗
PubMed1975

Effects of cortisone acetate, methylprednisolone and medroxyprogesterone on wound contracture and epithelization in rabbits.

Standardized flank wounds were made on 20 rabbits divided into the following five groups: Group 1 served as controls, Group 2 were given cortisone acetate 6.25 mg/kg/day (I.M.), Group 3--methylprednisolone (Solu-Medrol) 1 mg/kg/day, Group 4--medroxyprogesterone (Depo-Provera) 35 mg/kg/day, Group 5--methylprednisolone 1 mg/kg/day and medroxyprogresterone 35 mg/kg/day. Wound contracture and epithelization was measured by planimetry of photographs taken twice weekly; weekly weights were recorded, and the maturation phase of wound healing followed in the control and methylprednisolone groups. All three steroids prolonged the latent phase of wound healing, slowed the rate and decreased the total amount of contracture. Cortisone showed the most inhibition of wound contracture and was the only steroid to inhibit epithelization suggesting it may have a slightly different or more potent mode of action. When the methylprednisolone group was followed for seven weeks on daily injections, the maturation phase of wound healing was inhibited, and this inhibition persisted during the next nine weeks after the drug was withdrawn. Only the control and the medroxyprogesterone group gained weight. Combining medroxyprogesterona and methylprednisolone resulted in the severest weight loss of 20% with a 60% mortality.

Animals↗
PubMedDate not supplied

Tissue-expanded radial forearm free flap in neck burn contracture.

Neck contracture after burn injury can result in severe functional as well as aesthetic deformities. Contracture can recur even after wide and complete release and full-thickness skin grafting. Recurrence is partly due to the inherent difficulties in both early postoperative immobilization and the required long-term splinting. When adjacent tissues are also burned, adequate local tissue for reconstruction may not be available; therefore, free-tissue transfer may be necessary. The large surface area that is required after adequate release may be provided by tissue expansion before free-tissue transfer. In the case presented the use of tissue-expanded radial forearm free flap for the reconstruction of a recurrent neck contracture is described.

Adult↗
PubMedDate not supplied

The early release of axillary contractures in pediatric patients with burns.

In spite of the common teaching that contracture releases should be avoided until scars have matured, the Cincinnati Shriners Burns Institute has been releasing contractures in immature scars to prevent prolonged loss of range of motion. To evaluate the efficacy of axillary releases and, especially, to determine whether releases performed in immature scars were detrimental, axillary releases that were performed between January 1, 1988 and December 31, 1989 were evaluated for improvements in abduction and flexion. Overall, axillary releases significantly improved abduction and flexion, and the improvement was maintained for at least 1 year. Comparison of early (less than 1 year after burn injury) with late (more than 1 year after burn injury) releases revealed that the preoperative limitation was worse in the early release group but that the ultimate outcomes were similar. Waiting for scars to mature before performance of contracture releases is not necessary.

Adolescent↗
PubMed1998

Z-lengthening and gastrocnemius muscle flap in the management of severe postburn flexion contractures of the knee.

Five patients with seven severe flexion contractures after burn were treated. The problems confronted at the time of release of these contractures were bowstringing of contracted neurovascular bundles and hamstring tendons. These problems were overcome by Z-lengthening of tendons to achieve nearly normal extension. The medial head of the gastrocnemius muscle and local adipofascial flaps were used for coverage of exposed tendons and neurovascular bundles. Complete correction with full range of active motion of the knee joint was achieved in all of the patients after physiotherapy with no significant complication. We recommend this procedure routinely for patients with severe postburn flexion contractures of the knee with shortened tendons and neurovascular bundles.

Adolescent↗
PubMed1980

Effects of laser, scalpel, and electrosurgical excision on wound contracture and graft "take".

Current literature recommends the use of a carbon dioxide laser for excision of lesions where minimal damage and wound contracture are desirable. The extent of tissue damage is evaluated as a correlate of percentage of split-thickness skin graft "take" following excision of full-thickness skin with scalpel, electrocutting current, or carbon dioxide laser. The poorest overall percentage "take" is apparent following laser excision, while the highest overall percentage "take" occurs following scalpel excision. Wound contracture, an inherent part of wound healing, is reportedly minimal or clinically inapparent with laser excision. On the contrary, this experimental evaluation suggests that wound contracture following laser excision is at least as great if not greater than that following other methods of excision when a split-thickness skin graft is applied to the wound bed.

Animals↗
PubMed1990

Capsular contracture after breast reconstruction with silicone-gel and saline-filled implants: a 6-year follow-up.

A major problem after breast reconstruction with augmentation mammaplasty is contracture of the fibrous capsule around the prosthesis. In a series of 72 breasts in 65 women, silicone-gel and saline-filled implants were randomly selected prior to breast reconstruction. The results were judged with respect to consistency, tenderness, wrinkles, and sounds by two independent plastic surgeons according to the breast augmentation classification (BAC) and by the patients themselves. Capsular contracture was found by the surgeons in 50 percent of the gel implant group and in 16 percent of the saline implant group, which is in conformity with the results of the follow-up 5 years earlier. The incidence of deflation was 16 percent in the saline group and occurred in different sizes of both overinflated and underinflated prostheses. The degree of slow leakage from saline implants will be discussed. Despite the high rate of contractures in the gel group, 85 percent of all patients were satisfied with the result of the reconstruction.

Adult↗
PubMed1999

Breast augmentation: compression--a very important factor in preventing capsular contracture.

The incidence of capsular contracture is reduced when smooth-surfaced, saline-filled implants are placed subpectorally, avoiding contamination and the presence of blood. In addition, since the authors began using compression, they have not had one single capsular contracture requiring surgery. The authors' technique, their preoperative and postoperative regimens, an explanation of how they use compression, and the scientific and mathematical explanation of why compression could be the most important factor in preventing capsular compression are described. Of more than 1700 augmentations performed in our private clinic, only 830 could be included in the study. The patients were followed clinically for 1 year, after which time they completed a questionnaire, the results of which showed the authors that capsular contracture had not developed.

Breast Diseases↗