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PubMed2004

Treatment of internal rotation contracture of the shoulder in obstetric brachial plexus lesions by subscapular tendon lengthening and open reduction: early results and complications.

In this prospective study of 19 consecutive children, the operative treatment of internal rotation contracture of the shoulder in obstetric brachial plexus lesions by subscapular tendon lengthening and open reduction of the humeral head is evaluated. The average age of the children was 3.7 years and average follow-up was 20 months. Active shoulder function, as measured by the Mallet score, improved significantly in the dimensions of external rotation, hand-mouth movement and hand-neck movement. However, eight of the 19 children developed a severe, functionally disturbing external rotation contracture of the shoulder. This contracture was found predominantly in children who had a lower preoperative Mallet score for abduction and hand-back movement.

Brachial Plexus↗
PubMed2004

Severe neck scar contracture reconstructed with a ninth dorsal intercostal perforator augmented "Super-Thin Flap".

The authors have reconstructed neck scar contractures with "super-thin flaps" (subdermal vascular network [SVN] flaps) since 1994 and have used the circumflex scapular artery and veins (CSAV) and dorsal intercostal perforators (DICPs) to augment the blood flow in the distal portion of the flaps. These free microvascular augmentations enlarge the flap survival area. In this report, the authors describe a severe neck scar contracture reconstructed with a ninth DICP augmented "super-thin flap." The patient was a 51-year-old woman with severe flame burns on 44% of her total body surface area, resulting from a cooking accident. After emergency skin grafting, the patient had a severe scar contracture and intractable ulcer of the anterior neck. CSAV and a ninth DICP augmented occipito-cervico-dorsal (OCD) "super-thin flap" transfer were used to reconstruct the anterior neck. The flap size was 28 x 15 cm, and it survived completely. The cervico-mental angle was clear and esthetically pleasing, and not only the aesthetic results but also the functional results were excellent.

Cicatrix↗
PubMed2004

Integrin-linked kinase: a possible role in scar contracture.

Integrin-linked kinase (ILK) participates with beta1 integrin to mediate extracellular matrix interactions, such as extracellular matrix reorganization. Thus, ILK is hypothesized to influence wound contraction and scar contracture and, as such, would be a target molecule to manipulate pharmacologically in expediting wound contraction or possibly preventing scar contracture. The expression of ILK messenger ribonucleic acid, along with ILK-protein expression, was found in fibroblasts. The localization of ILK in human skin and rat granulation tissue was documented by immunohistology. ILK was present in human dermal fibroblasts, but was not found in human epidermal cells in skin. Cells were transfected with wild-type ILK or kinase-deficient ILK (E359K) and were assayed for collagen lattice contraction, migration, and myosin adenosine triphosphatase (ATPase) activity. Cells overexpressing E359K were poorer at collagen lattice contraction than control cells, whereas cells overexpressing wild-type ILK were equal to control cells at lattice contraction. ILK overexpression enhanced cell migration, but E359K overexpression did not affect cell migration. Neither ILK nor E359K overexpression altered myosin ATPase activity. Hence, ILK action within fibroblasts appears unrelated to myosin ATPase control of microfilament-generated forces. ILK appears to be a target molecule for pharmacologic manipulation to expedite wound contraction or to prevent scar contracture.

Animals↗
PubMed2006

Kirschner-wire fixation for postburn flexion contracture deformity and consequences on articular surface.

Kirschner-wire (K-wire) fixation for 3-6 weeks is an approved method for stabilization of the fingers after the release of flexion contracture deformity. On the other hand, articular surface damage in small joints due to pin fixation is still a topic of debate. Reports claiming permanent joint destruction due to this procedure exist in the literature. To clarify this doubt, a prospective study was carried out in 72 patients with flexion contracture of the hand fingers. After the surgical release of the deformity, immobilization of the interphalangeal (IP) and metacarpophalangeal (MCP) joints was carried out with K-wire fixation for 3 weeks. Clinical evaluation of the patients was accomplished with total active motion (TAM), grip, and pinch force measurements, whereas magnetic resonance (MR) and radionuclide imaging were used as radiodiagnostic tools. Mean follow-up period of the patients was 32 months. Satisfactory results were obtained in terms of functional and esthetic aspects. Evaluation of the data derived from the clinical and radiologic measurements revealed no permanent articular surface damage. K-wire fixation was documented to be an invaluable therapeutic approach not only to prevent recurrence of the contracture deformity but also to stabilize the skin graft effectively. This technique was concluded to provide effective immobilization without permanent articular damage.

Adolescent↗
PubMed2006

Skin regeneration for children with burn scar contracture using autologous cultured dermal substitutes and superthin auto-skin grafts: preliminary clinical study.

We have evaluated a novel treatment of burn scar contracture in children. This method involves the application of an autologous cultured dermal substitute (CDS), followed by a graft of superthin split-thickness skin. In the first operation, the autologous CDS was applied to the skin defect that had occurred after releasing the scar contracture. In the second operation, a superthin thickness skin graft (4 approximately 6/1000 inches) was applied 5 approximately 12 days after the first operation. The autologous CDS was applied to 10 sites of 5 children. On 8 sites, the skin grafts were contracted to some extent at an early stage. However, these skin grafts were stretched gradually to a range from 60% to 100% of an original size. At 2 sites, the skin grafts had stretched from 110% to 130% of the original size. This strategy may be useful for the treatment of burn scar contracture in children.

Burns↗
PubMed2000

Follow-up study after treatment of knee flexion contractures in spina bifida patients.

Knee flexion contractures in spina bifida patients are seen in all levels of paralysis. The majority is encountered in children with thoracolumbar lesions. Positional deformation, spinal reflex activity, fractures around the knee joint and a weak quadriceps are the main causes of the flexion deformity of the knee. One hundred and forty-five knee flexion contractures in 80 children have been treated between 1980 and 1995; 15 with unilateral contracture, 65 with bilateral involvement. The age at the time of correction in 38 patients with thoracolumbar lesions was between 24 months and 11 years (average, 7.7 years). In 42 patients with sacral or lumbosacral lesions, the age at the time of correction was between 10 and 19 years (average, 16.3 years). Associated surgery was mainly carried out on hip flexors, adductors and triceps surae. Complete posterior release was practiced in thoracolumbar lesions including posterior capsulotomy and release of the posterior cruciate ligament. In lumbosacral lesions, the lengthened tendons are sutured to prevent flexor weakness in the postoperative course. Vascular and neurologic structures are spared. Postoperative serial casts are helpful to achieve full extension without vascular or skin troubles. The long-term results were very good in 59 patients with 106 knees, good in 16 patients with 29 knees, and unsatisfactory in 5 patients with 10 knees. Slow deterioration years after surgery can be anticipated. The main causes are lack of personal initiative to stand and to walk, and obesity.

Adolescent↗
PubMedDate not supplied

Extension-abduction contracture of the spastic hip.

Patients with cerebral palsy and fixed hip extension are often unable to sit and therefore lose social and educational opportunities. At Texas Scottish Rite Hospital (Dallas, TX, U.S.A.), 29 patients had hip extension-abduction contractures. Eleven patients with mild involvement were managed with physical therapy. Six patients had moderate involvement and required wheelchair modification to maintain sitting. Twelve patients demonstrated severe contractures that required major soft tissue releases and often femoral shortening osteotomies to regain flexion. Patients with athetosis or rigidity were identified as those most likely to develop extension-abduction contractures either spontaneously or following adductor releases.

Adolescent↗
PubMedDate not supplied

Periarticular fractures after manipulation for knee contractures in children.

We report two cases, each of which sustained two separate periarticular fractures from overzealous manipulation for knee contracture. The four fractures reported in this study involve one normal child sustaining asynchronous ipsilateral distal femoral and proximal tibial fractures and a child with the diagnosis of amyoplasia sustaining bilateral proximal tibial fractures. The child with knee contracture must be treated carefully and not exposed to overzealous physiotherapy or manipulation. The child who has developed a joint contracture secondary to lengthy immobilization may be at increased risk for periarticular fracture secondary to disuse osteopenia. The knee joint is at particular risk because of the long lever arm of the leg. These concerns should be conveyed to anyone involved in the patient's care, including the parents, therapists, nurses, and physicians. Passive range of motion in the child should never be painful. Normal children often can obtain maximal range of motion if left alone and not restricted.

Arthrogryposis↗
PubMed2007

Primary frozen shoulder: global capsular stiffness versus localized contracture.

Stiffness in primary (idiopathic) frozen shoulders has been attributed to a global fibroplasia of the capsule despite the fact surgical release of the capsule at the rotator interval and of the coracohumeral ligament restores motion in almost all patients. Occurrence of vimentin, a cytocontractile protein known to be present in Dupuytren's contracture and in club-feet, has been reported in resection specimens of anterior capsular structures. We hypothesized vimentin would occur only in the anterior structures but fibroplasia would occur throughout the capsule. Tissues removed from four patients were stained with antibodies against vimentin, allowing us to confirm its presence in only in anterior capsular structures, supporting our first hypothesis contracture is due to a selective involvement of the anterior capsule. Staining the sections against types I and III collagen permitted the detection of both collagens in the anterior and the posterior capsular structures and thus confirmed our second hypothesis that fibroplasia involves the entire joint capsule. Therefore it seems, in patients with primary frozen shoulder, fibroplasia and contracture are two distinct processes.

Aged↗
PubMed2007

Management of neglected joint contractures.

This review is based on the author's experience treating over 5,000 joint contractures of the lower limbs in developing countries in the tropics and subtropics over the past 40 years. It includes realistic methods of correction of neglected, untreated joint contractures mainly due to poliomyelitis and other paralytic conditions by general duty medical officers. Corrections were performed in centers where medical facilities were often limited and where millions of untreated patients still await treatment. The treatment includes percutaneous correction of flexed hips, knees and equinus ankles and rotational osteotomy of the distal femur for severe knee contractures. Surgery is followed by simple cheap braces made out of local materials. These methods will usually allow early mobility, and in severe cases survival instead of early death.

Contracture↗
PubMed2006

Poikiloderma, tendon contracture and pulmonary fibrosis: a new autosomal dominant syndrome?

Members of two generations of a South African family have a unique syndrome comprising poikiloderma, tendon contractures and progressive pulmonary fibrosis. The condition is clinically important as the skin changes, which involve the face, have considerable cosmetic impact, while lung involvement is potentially lethal in adulthood. Skin manifestations which facilitate diagnosis include facial telangiectasia, mottled hypo- and hyperpigmentation, papules and epidermal atrophy. The scalp, facial and body hair are fine and scanty. The tendon contractures lead to progressive digital flexion deformities and abnormalities of the ankles and feet, with disturbance of gait. Pulmonary involvement manifests as progressive dyspnoea. Pedigree data are compatible with an autosomal dominant mode of transmission. Poikiloderma of Weary is characterized by linear sclerotic and fibrous bands and not tendon contractures and is not associated with potentially lethal pulmonary fibrosis. Rather than name this disorder a variant of Weary syndrome, it might be prudent to use as an umbrella title one composed by Weary himself: 'hereditary sclerosing poikiloderma' (HSP), under which variants such as HSP Weary type, HSP with cardiac involvement (aortic stenosis described as inconsistently associated with Weary syndrome) and HSP with tendon/pulmonary involvement (current family) may be classified. The manifestations in this family differ from other poikilodermata and, to the best of our knowledge, have not been previously documented.

Adult↗
PubMed1989

Osteogenesis imperfecta with congenital joint contractures (Bruck syndrome).

Five children from three unrelated families were born with symmetrical contractures of the knees, ankles and feet. An initial diagnosis of arthrogryposis multiplex was made, but frequent fracturing occurred after walking commenced and it was then recognised that the children had osteogenesis imperfecta. The pathogenesis of the congenital contractures is unknown, but the symmetry and lack of evidence of prior fracturing is suggestive of articular immobility during early intra-uterine development. The consistency of the anatomical distribution of the contractures, in the setting of a uniform OI phenotype, is suggestive of syndromic identity. A similar case was documented by Alfred Bruck in 1897 and we propose that the eponymous designation "Bruck syndrome" should be applied to the disorder.

Adolescent↗
PubMed2005

Mapping of an autosomal dominant gene for Dupuytren's contracture to chromosome 16q in a Swedish family.

Mapping of an autosomal dominant gene for Dupuytren's contracture to chromosome 16q in a Swedish family.Dupuytren's contracture (DC) (OMIM 126900) is the most common connective tissue disease of mankind and has both heritable and sporadic forms. The inherited form is most frequently observed among the xanthochroi peoples of Northern Europe where its most common manifestations are thickening of the palmar fascia and contracture of the fingers. We ascertained a five-generation Swedish family in which DC is inherited in an autosomal dominant manner with high, but incomplete, penetrance by the end of the fifth decade. Blood was collected from all affected and informative unaffected family members for the performance of a genome-wide scan at a resolution of approximately 8 cM for all autosomes. Linkage was established to a single 6 cM region between markers D16S419 and D16S3032 on chromosome 16. A maximal two-point logarithm of odds (LOD) score of 3.18 was achieved at microsatellite marker D16S415 with four other markers in the region producing LODs of >1.5.

Chromosome Mapping↗
PubMed1989

Effects of droperidol, haloperidol and ketamine on halothane, succinylcholine and caffeine contractures: implications for malignant hyperthermia.

The effects of two structurally similar butyrophenones (droperidol and haloperidol) and ketamine were evaluated in an in vitro system to determine their potential for eliciting or exacerbating an episode of malignant hyperthermia. Muscle strips from patients referred for diagnostic testing for malignant hyperthermia and muscle strips from the rat diaphragm were exposed to droperidol, haloperidol, or ketamine prior to challenge with halothane, succinylcholine or caffeine. If any agent augmented the contracture response to the malignant hyperthermia triggering or diagnostic agents, then the agent was considered unsafe for use in malignant hyperthermia susceptible patients. Droperidol 10 mumol/l and ketamine 100 mumol/l did not induce contractures in human or rat skeletal muscle when added alone, nor did they augment halothane, succinylcholine or caffeine contractures. These agents appear to be safe for use in patients susceptible to malignant hyperthermia. In contrast, haloperidol 10 mumol/l augmented the response to succinylcholine about 1.5-fold and may be contraindicated in MH susceptibles.

Animals↗
PubMed1992

Height measurement of patients with neuromuscular disease and contractures.

Patients with neuromuscular diseases frequently have joint contractures, which preclude standard measurements of standing height. Standing height, arm-span, forearm and ulnar-segment measurements were taken of 116 normal children without contractures. Measurement of the forearm segment had the highest correlation with standing height, but it requires a special ruler. Arm-span measurement had good correlation with standing height, although this cannot be used if elbow or shoulder contractures are present; in such patients ulnar segment measurement can be used, but it has the lowest correlation with standing height.

Adolescent↗
PubMed2005

Autosomal-dominant familial hematuria with retinal arteriolar tortuosity and contractures: a novel syndrome.

BACKGROUND: Autosomal-dominant forms of hematuria have been mostly related to mutations in the COL4A3/COL4A4 genes. Patients with thin basement membrane (BM) disease do not have extrarenal manifestations, while those with Alport syndrome often present with hearing loss, anterior lenticonus, and dot-and-fleck retinopathy. METHODS: We performed a phenotypic study and a candidate gene approach in a four-generation family presenting with autosomal-dominant hematuria associated with extrarenal manifestations. Renal biopsy was analyzed for determination of BM thickness and expression of chains of type IV collagen. Linkage to 18 candidate genes/loci was investigated using polymorphic microsatellite markers. RESULTS: In all affected patients, hematuria without proteinuria was associated with muscular contractures and retinal arterial tortuosities responsible for retinal hemorrhages. Cardiac arrhythmia, Raynaud phenomena, and brain MRI abnormalities were also observed. Despite the presence of red cells in tubule sections, no glomerular abnormalities were found by electron microscopy. Expression of type IV collagen chains and glomerular BM thickness was normal. We searched for a molecular defect affecting either BM or angiogenesis. Linkage analyses of genes encoding BM components (COL4A3/COL4A4, COL6A1, COL6A2, COL6A3, FBLN1), and angiogenic factors or their receptors (VHL, ANPT1, ANPT2, TIE, TEK, NOTCH2, NOTCH3, NOTCH4, DLL4, JAG1, JAG2) and of the facio-sapulo-humeral dystrophy and 3q21 loci failed to show segregation of the disease with those gene loci. CONCLUSION: We have identified a new inherited hematuria syndrome associated with retinal vessel tortuosities and contractures. We recommend performing a fundus examination in patients with familial hematuria and episodes of visual impairment, as well as a urinary analysis in patients with retinal arterial tortuosity or congenital muscular contractures.

Collagen Type IV↗
PubMed2004

Different frequency treadmill running in immobilization-induced muscle atrophy and ankle joint contracture of rats.

We investigated the effects of different frequencies of treadmill running on immobilization-induced soleus and gastrocnemius muscle atrophy and ankle joint contracture in rats using morphology and histochemistry. The right ankle joint of rat was immobilized for 2 weeks. Thereafter, the rats were randomly assigned to four groups for 6 weeks of exercise under different conditions: free cage activity and free remobilization (FR), once-a-week treadmill running (low-frequency running program (LFR)), three-time-a-week running (middle-frequency running program (MFR)), and six-time-a-week running (high-frequency running program (HFR)) groups. Two weeks of immobilization significantly reduced the cross-sectional area of soleus type I (62%, P<0.05) and type II muscle fibers (66%, P<0.05), gastrocnemius type I (78%, P<0.05) and type II muscle fibers (68%, P<0.05), and the range of ankle joint movement (46%, P<0.05). Immobilization also increased the ratio of type II to total fiber numbers in the soleus (P<0.05), and gastrocnemius (P<0.05), and induced pathological changes in muscle fibers. Some of these changes could not be corrected by free remobilization; however, the LFR, MFR, and HFR groups clearly recovered toward normal levels with exercise frequency, the effect on muscle recovery being more beneficial in the MFR and HFR groups. In addition, the range of ankle joint contracture was improved in LFR, MFR, and HFR groups in comparison with that in the FR group. These findings indicate that treadmill running exercise improved the immobilization-induced muscle fiber histochemical alterations and the range of the ankle motion in rats. Running three times and six times a week was more beneficial for recovery of immobilization-induced muscle atrophy and joint contracture compared with no running or once-a-week running.

Animals↗
PubMed1994

Fluo-3 signals associated with potassium contractures in single amphibian muscle fibres.

1. The calcium-sensitive dye fluo-3 AM was used to obtain fluorescence signals and calcium transients associated with K+ contractures, twitches and tetani, in intact single muscle fibres of the tropical toad Leptodactylus insularis. 2. The changes in free calcium concentration in the myoplasm ([Ca2+]i) were calculated using the values of the 'off' (k- = 33.5 s-1) and 'on' (k+ = 13.1 microM-1 s-1) rate constants for the binding of calcium to the dye (dissociation constant, Kd = k-/k+). The mean (+/- S.E.M., n = 7) peak [Ca2+]i value during twitches or tetani was 3.9 +/- 0.3 or 4.1 +/- 0.3 microM, respectively, while during maximal K+ contractures, it was 10.3 +/- 0.8 microM. The threshold [Ca2+]i for tension development was about 1 microM. 3. For responses elicited with high [K+]o (80-190 mM), the calcium transients decayed faster than tension. At lower [K+]o (30-70 mM), the decay was slower, and relaxation was complete when [Ca2+]i was still above contractile threshold values. 4. Following a K+ contracture, recovery of the calcium transients associated with twitches occurred before recovery of tension, indicating an apparent dissociation between [Ca2+]i and tension output. This apparent dissociation between calcium and tension output could be attributed to the desensitization of the contractile proteins to calcium, or, more probably, to the non-uniform behaviour of calcium release and/or uptake sites, leading to an unhomogeneous distribution of active sarcomeres along the fibre length and localized sarcomere relaxation.

Animals↗