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PubMed2003

A new method to measure post-traumatic joint contractures in the rabbit knee.

A new device and method to measure rabbit knee joint angles are described. The method was used to measure rabbit knee joint angles in normal specimens and in knee joints with obvious contractures. The custom-designed and manufactured gripping device has two clamps. The femoral clamp sits on a pinion gear that is driven by a rack attached to a materials testing system. A 100 N load cell in series with the rack gives force feedback. The tibial clamp is attached to a rotatory potentiometer. The system allows the knee joint multiple degrees-of-freedom (DOF). There are two independent DOF (compression-distraction and internal-external rotation) and two coupled motions (medial-lateral translation coupled with varus-valgus rotation; anterior-posterior translation coupled with flexion-extension rotation). Knee joint extension-flexion motion is measured, which is a combination of the materials testing system displacement (converted to degrees of motion) and the potentiometer values (calibrated to degrees). Internal frictional forces were determined to be at maximum 2% of measured loading. Two separate experiments were performed to evaluate rabbit knees. First, normal right and left pairs of knees from four New Zealand White (NZW) rabbits were subjected to cyclic loading. An extension torque of 0.2 Nm was applied to each knee. The average change in knee joint extension from the first to the fifth cycle was 1.9 deg +/- 1.5 deg (mean +/- sd) with a total of 49 tests of these eight knees. The maximum extension of the four left knees (tested 23 times) was 14.6 deg +/- 7.1 deg, and of the four right knees (tested 26 times) was 12.0 deg +/- 10.9 deg. There was no significant difference in the maximum extension between normal left and right knees. In the second experiment, nine skeletally mature NZW rabbits had stable fractures of the femoral condyles of the right knee that were immobilized for five, six or 10 weeks. The left knee served as an unoperated control. Loss of knee joint extension (flexion contracture) was demonstrated for the experimental knees using the new methodology where the maximum extension was 35 deg +/- 9 deg, compared to the unoperated knee maximum extension of 11 deg +/- 7 deg, 10 or 12 weeks after the immobilization was discontinued. The custom gripping device coupled to a materials testing machine will serve as a measurement test for future studies characterizing a rabbit knee model of post-traumatic joint contractures.

Animals↗
PubMed1990

Contractural arachnodactyly with mitral regurgitation and iridodonesis.

An infant girl with arachnodactyly, spontaneously resolving contractures, dolichostenomelia, iridodonesis, and mitral and tricuspid incompetence died in cardiac failure. We confirm that congenital contractural arachnodactyly may exhibit serious cardiovascular and ophthalmic complications like Marfan's syndrome. The presence of iridodonesis further obscures the differentiation between classical Marfan's syndrome and congenital contractural arachnodactyly.

Contracture↗
PubMed1985

Congenital contractural deformities of the fingers and arthropathy.

Four patients are described who presented with congenital finger contractures and arthropathy. There was synovial cell hyperplasia and giant cells but no inflammatory process. Radiographs showed flattening of the metacarpal and metatarsal heads and the proximal femoral ossification centres. In the oldest patient the process had subsided leaving slight contractures but severe impairment of hip mobility. In another the arthropathy was still prominent in the early teens. In a third, finger contractures had failed to respond to conservative or surgical measures.

Contracture↗
PubMed1994

Congenital contractural arachnodactyly (Beals syndrome).

Congenital contractural arachnodactyly (CCA) is an autosomal dominant disorder akin to, but usually less severe than, Marfan syndrome. The clinical features are marfanoid habitus, arachnodactyly, crumpled ears, camptodactyly of the fingers and adducted thumbs, mild contractures of the elbows, knees, and hips, and mild muscle hypoplasia especially of the calf muscles. Many patients have kyphoscoliosis and mitral valve prolapse and, very occasionally, aortic root dilatation and ectopia lentis have been described. Linkage to a gene coding for fibrillin on chromosome 5q23-31 has been shown in several kindreds. The prognosis for a normal lifespan is good and improvement in joint contractures is usual.

Abnormalities, Multiple↗
PubMed1990

Contracturing granulomatous myositis: a separate entity.

Granulomatous muscle disease is most commonly seen in sarcoidosis, but may be seen in association with a wide variety of other disorders or in isolation. Patients with granulomatous myositis usually present with slowly progressive muscle pain and weakness affecting mainly proximal muscles. There are, however, a few reports of granulomatous muscle disease presenting with flexion contractures of the limbs. Two further patients with granulomatous muscle disease and flexion contractures of the limbs, but with no evidence of systemic granulomatous disease, is presented. It is suggested that such patients represent a separate clinical entity that is distinct from idiopathic granulomatous myositis presenting with muscle pain and weakness. The association of contracturing granulomatous myositis with a long-standing vasculitis in one patient suggests that the two conditions may be related.

Aged↗
PubMed1996

Capsular contracture after lumpectomy and radiation therapy in patients who have undergone uncomplicated bilateral augmentation mammoplasty.

PURPOSE: To assess complications and cosmesis in patients with breast cancer who underwent lumpectomy and radiation therapy and who previously underwent uncomplicated bilateral augmentation mammoplasty. MATERIALS AND METHODS: Twenty-one patients (aged 36-70 years; median age, 50 years) with breast cancer who had previously undergone bilateral breast augmentation without complications underwent ipsilateral lumpectomy and radiation therapy. Radiation therapy was delivered to the augmented breast in opposed tangential fields with a 4- or 6-MV linear accelerator. The tangential fields received an average radiation dose of 5,021 cGy (range, 4,500-5,600 cGy), with an average fraction of 187 cGy (range, 180- 200 cGy). Sixteen patients received an additional 1,000-2,000-cGy boost to the surgical bed with a 9-18-MeV electron beam. Follow-up was 4-48 months (median, 22 months). RESULTS: At the last follow-up examination, 18 (86%) of the 21 patients were free of disease. Twelve patients had capsular contracture (57%). Seven patients underwent attempted surgical repair of capsular contracture. Twelve patients (57%) reported fair to poor cosmesis. The radiation dose, the location of the implant, the type of implant, and systemic therapy were not correlated with poor cosmesis. CONCLUSION: Lumpectomy and radiation therapy in patients with breast cancer who have previously undergone augmentation mammoplasty result in a high prevalence of capsular contracture and suboptimal cosmesis.

Adult↗
PubMed1996

Protection of ischemic myocardium by inhibition of contracture in isolated rat heart.

Protection of the ischemic myocardium by pretreatment with a high dose of 2,3-butanedione monoxime (BDM) is attributed to the enhancement of glycolytic ATP production rather than to the inhibition of contracture during mild ischemia. Our objective was to investigate whether the inhibition of contracture would protect the arrested heart during prolonged ischemia. Isolated perfused rat hearts were subjected to 30 min of low-flow ischemia followed by reperfusion. Ischemic hearts were treated with BDM (5 mmol/l) after beating stopped. BDM ameliorated the increase in intraventricular pressure after ischemia without significant changes in ATP levels and with a decreased accumulation of lactate. BDM treatment accelerated the recovery of function and high-energy phosphates with reduced myocardial Ca2+ overload. The results of this study suggested that inhibition of contracture can protect the heart from ischemia-reperfusion injury.

Adenosine Triphosphate↗
PubMed2000

Abdomino-perineal repair of recurrent and complex bladder neck-prostatic urethra contractures.

OBJECTIVE: To evaluate the effectiveness of abdomino-perineal repair in treating complex and recurrent bladder neck-prostatic urethra contractures. METHODS: The study included 6 patients retrospectively. Their ages ranged from 66 to 75 years (67.83+/-8.13, mean + SD). All presented with a long history of voiding difficulty and urinary incontinence. Prior to definitive treatment all the patients had been subjected to multiple unsuccessful transurethral resections of bladder neck-prostatic urethra contractures. They were all subjected to diagnostic work-up including retrograde and voiding urethrogram, urethroscopy and urodynamics. Finally all the patients underwent abdomino-perineal excision of the stenotic area and end to end anastomosis. All of them received simultaneously an artificial urinary sphincter insertion for concurrent sphincteric deficiency and three were subjected simultaneously to clam type ileocystoplasty for intractable detrusor instability. The follow-up ranged from 8 to 56 months (24.42+/-19.64, mean + SD). RESULTS: The actual surgical time ranged from 3.5 to 5.5 h (4.1+0.4, mean + SD). Five patients void satisfactorily remaining unobstructed through the entire follow-up period, while one has to empty his augmented bladder by means of clean intermittent self catheterization. Five patients are continent and one significantly improved. Major complications due to infection-erosion of the prosthetic material were encountered in one patient. CONCLUSIONS: Abdomino-perineal repair is an effective surgical procedure for the management of recurrent and complex bladder neck-prostatic urethra contractures, although it is time consuming and requires in the majority of cases combined techniques in order to achieve optimal results.

Aged↗
PubMed1994

Myocardial ischemic contracture. Metabolites affect rigor tension development and stiffness.

Myocardial ischemia is characterized by a decrease in phosphocreatine (PCr) and Mg(2+)-ATP contents as well as an accumulation of myosin ATPase reaction products (inorganic phosphate [P(i)], protons, and Mg(2+)-ADP). The possibility that these metabolites play a role in rigor tension development was checked in rat ventricular Triton X-100-skinned fibers. Rigor tension was induced by stepwise decreasing [Mg(2+)-ATP] in the presence or in the absence of 12 mmol/L PCr. To mimic the diastolic ionic environment of the myofibrils, [free Ca2+] was set at 100 nmol/L (pCa 7); [free Mg2+], at 1 mmol/L; and ionic strength, at 160 mmol/L. In control conditions (pH 7.1, with no added P(i) or Mg(2+)-ADP), the pMg(2+)-ATP for half-maximal rigor tension (pMg(2+)-ATP50) was 5.07 +/- 0.03 in the presence of PCr. After withdrawal of PCr, the pMg2+)-ATP50 value was shifted toward higher Mg(2+)-ATP values (3.57 +/- 0.03). Addition of 20 mmol/L P(i) shifted the pMg(2+)-ATP50 to 3.71 +/- 0.04 (P < .05) in the absence of PCr and in the opposite direction to 4.98 +/- 0.02 (P < .01) in the presence of PCr. Acidic pH (6.6) strongly increased pMg(2+)-ATP50 in both the absence (3.90 +/- 0.03, P < .001) and presence (5.44 +/- 0.02, P < .001) of PCr. Conversely, Mg(2+)-ADP (250 mumol/L) decreased pMg(2+)-ATP50 to 3.26 +/- 0.06 (P < .001) in the absence of PCr; at pMg(2+)-ATP 4, no rigor tension was observed until PCr concentration was decreased to < 2 mmol/L. At acidic pH, maximal rigor tension was lower by 29% compared with control conditions, whereas in the presence of Mg(2+)-ADP, maximal rigor tension developed to 143% of the control value; P(i) had no effect. The tension-to-stiffness (measured by the quick length-change technique) ratio was lower in rigor (no PCr and pMg(2+)-ATP 6) than during Ca2+ activation in the presence of both PCr and ATP. Compared with control rigor conditions, this parameter was unchanged by Mg(2+)-ADP and decreased by acidic pH, suggesting a proton-induced decrease in the amount of force per crossbridge. In addition to their known effects on active tension, Mg(2+)-ADP and protons affect rigor tension and influence ischemic contracture development. It is concluded that ischemic contracture and increased myocardial stiffness may be mediated by a decreased PCr and local Mg(2+)-ADP accumulation. This emphasizes the importance of myofibrillar creatine kinase activity in preventing ischemic contracture.

Adenosine Diphosphate↗
PubMed2006

Effects of splinting on wrist contracture after stroke: a randomized controlled trial.

BACKGROUND AND PURPOSE: Splints are commonly applied to the wrist and hand to prevent and treat contracture after stroke. However, there have been few randomized trials of this intervention. We sought to determine whether wearing a hand splint, which positions the wrist in either a neutral or an extended position, reduces wrist contracture in adults with hemiplegia after stroke. METHODS: Sixty-three adults who had experienced a stroke within the preceding 8 weeks participated. They were randomized to either a control group (routine therapy) or 1 of 2 intervention groups (routine therapy plus splint in either a neutral or an extended wrist position). Splints were worn overnight for, on average, between 9 and 12 hours, for 4 weeks. The primary outcome, measured by a blinded assessor, was extensibility of the wrist and long finger flexor muscles (angle of wrist extension at a standardized torque). RESULTS: Neither splint appreciably increased extensibility of the wrist and long finger flexor muscles. After 4 weeks, the effect of neutral wrist splinting was to increase wrist extensibility by a mean of 1.4 degrees (95% CI, -5.4 degrees to 8.2 degrees), and splinting the wrist in extension reduced wrist extensibility by a mean of 1.3 degrees (95% CI, -4.9 degrees to 2.4 degrees) compared with the control condition. CONCLUSIONS: Splinting the wrist in either the neutral or extended wrist position for 4 weeks did not reduce wrist contracture after stroke. These findings suggest that the practice of routine wrist splinting soon after stroke should be discontinued.

Aged↗
PubMed2006

The use of standing lateral tibial-calcaneal angle as a quantitative measurement of Achilles tendon contracture in adult acquired flatfoot.

BACKGROUND: To quantitate the association of Achilles tendon contracture (ATC) with adult acquired flatfoot, the authors hypothesized that the standing lateral tibial-calcaneal angle increases because of ATC. METHODS: The standing lateral tibial-calcaneal angle, talo-first metatarsal angle, lateral talocalcaneal angle, lateral standing medial cuneiform, arch height, and anteroposterior talonavicular coverage angle were measured in 21 patients (25 feet) with clinical diagnoses of ATC and adult acquired flatfoot (AAF) and compared to the same measurements in a control group of 15 patients (30 feet) with no foot deformities or previous foot surgeries. RESULTS: The mean lateral tibial-calcaneal angle in the control group was 64.43 degrees and in the AAF group 71.24 degrees (p < 0.001). The mean lateral talo-first metatarsal angle in the control group was 11.77 degrees, and in the AAF group with ATC it was 25.80 degrees (p < 0.001). The mean arch height in the control group was 17.90 mm and in the AAF group, 8.48 mm (p < 0.001). In the ATC and AAF group an increasing standing lateral tibial-calcaneal angle was correlated with a decreasing lateral talo-calcaneal angle (p = 0.044), and a decreasing arch height was correlated to an increasing lateral talo-first metatarsal angle (p < 0.001). CONCLUSION: Adults with flatfeet and Achilles tendon contracture may have a statistically significant increase in the standing lateral tibial-calcaneal angle. This angle may be a reproducible measure of ATC. An increase in the standing lateral tibial-calcaneal angle may confirm and quantitate the clinical diagnosis of Achilles tendon contracture. Further studies with more patients are needed.

Achilles Tendon↗
PubMed1994

Use of skin Z-plasty for management of extension contracture in recurrent claw- and hammertoe deformity.

Nine patients with recurrent metatarsophalangeal joint extension contracture after clawtoe or hammertoe procedures were treated with Z-plasty skin closures as part of the revision surgical procedure. The indication for performing the Z-plasty was the presence of scar contracture in the skin that prevented satisfactory correction of the toe. Soft tissue release of the metatarsophalangeal joint was followed by a simple dorsal skin Z-plasty transposition. Patients were evaluated 1 1/2 to 6 years after revision surgery. No recurrence of the extension contracture had occurred.

Collateral Ligaments↗
PubMed2000

Obstetrical brachial plexus injuries: incidence, natural course and shoulder contracture.

The incidence of obstetric brachial plexus injury (OBPI) was investigated and the natural course of this disorder and the frequency of shoulder contracture described. Between 1988 and 1997 13,366 children with a gestational age of 30 weeks or more, were born at the Academic Medical Center, Amsterdam. Of these, 62 had an OBPI (4.6 per 1000). Complete neurological recovery occurred in 72.6% of cases. Half of them had a delayed recovery of more than three weeks (mean recovery time 6.2 +/- 3.1 months). Shoulder contracture occurred in at least one-third of the children with delayed recovery and in at least two-thirds of the children with incomplete recovery. The incidence of OBPI in our hospital was found to be higher and to have a less favourable natural course than is usually reported in the literature. Contracture of the shoulder joint is frequently found even in infants with complete neurological recovery.

Academic Medical Centers↗
PubMed1989

Torticollis due to a combination of sternomastoid contracture and congenital vertebral anomalies.

We report four children with sternomastoid contracture combined with torticolis secondary to congenital vertebral anomalies. Two had features of Klippel-Feil syndrome and a proximal release of the contracted sternomastoid produced good cosmetic correction initially. Progression of the deformity occurred subsequently without recurrence of sternomastoid contracture. One child had such mild deformity that it was merely observed. The fourth child was born with torticollis without sternomastoid tightness and a vertebral anomaly was later recognised. He slowly developed a sternomastoid contracture and his condition was considerably improved by sternomastoid release. This combination of causes of torticollis has not, as far as we know, been previously reported. The clinician should be aware of it and should also realise that radiographs of the very immature spine may not disclose the bony anomalies.

Child↗
PubMed1998

A new test for estimating iliotibial band contracture.

Contracture of the iliotibial band leading to flexion and abduction deformity at the hip is common in residual paralysis after polio. Ober's test has been used to detect this, but it is unreliable and cannot determine the degree of contracture. We describe a new test which quantifies this contracture and can be used for comparative purposes.

Contracture↗
PubMed2000

The effectiveness of turnbuckle splinting for elbow contractures.

We have treated 22 patients with an elbow contracture using a static progressive turnbuckle splint for a mean of 4.5 +/- 1.8 months. All had failed to improve with supervised physiotherapy and splinting. The mean range of flexion before splintage was from 32 +/- 10 degrees to 108 +/- 19 degrees and afterwards from 26 + 10 (p = 0.02) to 127 +/- 12 degrees (p = 0.0001). A total of 11 patients gained a 'functional arc of movement,' defined as at least 30 degrees to 130 degrees. In eight patients movement improved with turnbuckle splinting, but the functional arc was not achieved. Six of these were satisfied and did not wish to proceed with surgical treatment and two had release of the elbow contracture. In three patients movement did not improve with the use of the turnbuckle splint and one subsequently had surgical treatment. Our findings have shown that turnbuckle splinting is a safe and effective treatment which should be considered in patients whose established elbow contractures have failed to respond to conventional physiotherapy.

Adolescent↗
PubMed1996

The effect of a flexion contracture of the elbow on the ability to transfer in patients who have quadriplegia at the sixth cervical level.

We studied six patients (twelve upper extremities) who had quadriplegia at the sixth cervical level. Our purpose was to evaluate how the loss of terminal extension of the elbow adversely affected the ability of the patient to perform transfers with a sliding board and so-called depression raises (lifting of the body with use of the extended upper extremities to reduce the pressure on the ischial tuberosities). Function of the triceps muscle was considered to be absent in eight upper extremities and present in four. A flexion contracture of the elbow was simulated with use of a specially fabricated, hinged elbow brace. Terminal extension was progressively limited, in 5-degree increments, until the patient was no longer able to perform the transfer or the depression raise. The mean flexion contracture at which the patient could not perform the transfer or the depression raise was approximately 25 degrees when function of the triceps was absent and approximately 50 degrees when function of the triceps was intact. The results of this study emphasize the importance of maintaining the full range of motion of the elbow in a patient who has high-level quadriplegia. In a patient who has quadriplegia at the sixth cervical level who otherwise would be independent with regard to transfer skills and mobility in bed, a flexion contracture of the elbow of approximately 25 degrees or more can result in the loss of a functional level and render the patient as dependent as one who has quadriplegia at the fifth cervical level.

Activities of Daily Living↗
PubMed2005

Hinged elbow external fixation for severe elbow contracture.

BACKGROUND: When it was first introduced, it was hoped that hinged external fixation with a built-in gear mechanism for applying passive motion and static progressive stretch by turning a dial would improve the arc of ulnohumeral motion, by gradually stretching contracted muscles, after open release of a severe elbow contracture. METHODS: Forty-two patients were evaluated at an average of thirty-nine months after operative release of a severe posttraumatic elbow contracture (defined as < or =40 degrees of motion). Twenty-three patients had been treated, during the early part of the study, with a hinged external fixator that incorporated a worm gear to apply static progressive stretch postoperatively. These patients were compared with nineteen patients who had been treated without hinged external fixation during the later part of the study, when the hinge was used less frequently. The operative techniques did not otherwise change during the study period. Demographic and injury characteristics as well as associated problems were comparable between the two groups. RESULTS: The average gain in the range of motion after the index procedure was 89 degrees in the patients treated with a hinge and 78 degrees in those treated without a hinge, an insignificant difference with the numbers available (p = 0.175). Complications associated with use of the hinge included five pin-track infections, one case of pin-track osteomyelitis, one ulnar fracture through a pin site, two broken Schanz screws, and two cases of irritation of the ulnar nerve. CONCLUSIONS: Open release of a severe elbow contracture results in a substantial gain in motion, with or without hinged elbow fixation. The slightly greater improvement in motion provided by the hinge does not justify the associated increase in risk, expense, and complications.

Adolescent↗