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PubMed2003

Flexion contractures of the legs as the initial manifestation of adrenocortical insufficiency.

A 51-year-old woman presented with flexion contractures of the legs. Physical examination showed decreased passive movements of the bilateral hip and knee joints without muscle spasms or neurological abnormalities. Laboratory evaluation showed no response of ACTH or plasma cortisol to stimulation with CRH or insulin. Diagnosis of isolated adrenocorticotropic hormone deficiency was made. The patient was started on prednisolone 5 mg daily, and flexion contractures of the legs rapidly disappeared. Although the musculoskeletal manifestation of this patient is similar to that of stiff-person syndrome, flexion contracture of the legs associated with adrenocortical insufficiency seems to be a separate disease entity from stiff-person syndrome.

Adrenal Insufficiency↗
PubMedDate not supplied

[Treatment of knee flexion contracture in patients with chronic juvenile arthritis--a case report].

INTRODUCTION: Knee flexion contractures are common after-effects of juvenile arthritis. Treatment is usually conservative and may include physical therapy and kinesitherapy. Surgical treatment, particularly of the soft parts, indicated for contractures resistant to conservative treatment, helps to correct the deformity, maintain movements, and relieves pain. Intensive postoperative physiotherapy is of special importance. CASE REPORT: A 23-year-old female patient with chronic juvenile arthritis since the age of one was admitted for treatment of flexion contractures in both knees, muscle hypotrophy, loss of strength and gait disability. The patient underwent arthroscopic synovectomy. The operation was first performed on the right and after 3 mouths on the left knee. The preoperative range of motion in the right knee was 30 degrees - 70 degrees and in the left 40 degrees - 80 degrees. The patient underwent intensive physical therapy to reduce postoperative swelling of knees and firstly passive and then active kinesitherapy. Nine months after the first surgery and six months after the second, the range of motion in the right knee was 0 degrees - 100 degrees and in the left 0 degrees - 105 degrees. The strength of tested muscles was increased and gait was improved. CONCLUSION: Management and rehabilitation of patients with chronic juvenile arthritis include maintenance or improvement in position and function of joints that is achieved with synovectomy. The results depend on combined interdisciplinary rehabilitation, well-experienced staff and pre- and post-operative physiotherapy as well as kinesitherapy. Arthroscopic synovectomy has many advantages and we believe that it was a better solution than open capsulosynovectomy in this patient with chronic juvenile arthritis of the knee.

Adult↗
PubMed1977

A modified McCash operation for Dupuytren's contracture.

The open palm technique for Dupuytren's contracture in connection with a midlateral ulnar incision on the fifth finger was used in selected cases of severe contracture with skin shrinkage (13% of all cases during a 2 1/2 year period). Special attention was drawn to the "cornerflap" of the incision, but no vascular problems were found. All wounds closed spontaneously in 3--6 weeks. The finger release was as good as in other series of patients with similar severity of the disease. We propose this technique only in cases with severe contracture and in good physical and mental condition.

Dupuytren Contracture↗
PubMed1999

Preliminary clinical experience of a contracture correction device.

Joint contractures which do not respond to conventional physiotherapy can be difficult to treat. Serial plastering has been used effectively but is expensive, inconvenient to the patient and does not permit daily hygiene or clinical inspection. A mechanical device has been developed consisting a hinged orthosis which spans the affected joint to which is attached a gas strut to provide a corrective moment about the anatomical joint. Such an arrangement enables prescribed corrective moments to be applied accurately following clinical assessment using routine physiotherapy techniques. The inherently low spring rate of a gas strut ensures that the specified corrective torque is maintained as correction occurs. Initial treatment experience under the control of the developers had generated wider interest in the system. A geographically distant independent orthotic supply centre was trained in the techniques of application. They treated nine elbow and three knee joints in patients who had not responded to physiotherapy treatment. All of the patients experienced improvement. The average for elbow joints was a reduction in the contracture of 25.6 degrees with a corrective moment of 6.8 Nm over a period of 3.9 weeks. For the knee joints the averages were a reduction in contracture of 10.7 degrees with a corrective moment of 12.7 Nm over a period of 4 weeks. The results confirmed the practicality of transferring the system to independent clinical centres and provide evidence to support funding for a formal prospective clinical trial of the treatment approach.

Adult↗
PubMed1999

In vitro contractile responses and contracture testing of skeletal muscle from Quarter Horses with exertional rhabdomyolysis.

OBJECTIVE: To determine whether increased sensitivity to pharmacologic agents was a general property of equine exertional myopathies, including polysaccharide storage myopathy (PSSM) in Quarter Horses. ANIMALS: 5 adult Quarter Horses with exertional rhabdomyolysis and abnormal polysaccharide accumulation in skeletal muscle and 4 clinically normal adult Quarter or Quarter-type horses. PROCEDURES: Twitch time course measurements and contracture responses to various concentrations of caffeine and halothane for small bundles of intact external intercostal muscle fibers were measured in all horses. RESULTS: Caffeine contracture threshold of muscles from Quarter Horses with PSSM was not different from that of clinically normal horses (5 mM in both groups). Muscles from horses with PSSM and from clinically normal horses did not have contracture in response to up to 2% halothane. CONCLUSIONS AND CLINICAL RELEVANCE: Results were in contrast to the increased sensitivity to caffeine and halothane for muscles from Thoroughbreds with recurrent exertional rhabdomyolysis (RER). Although clinical signs of muscular stiffness after exercise are similar between Quarter Horses with PSSM and Thoroughbreds with RER, these breeds appear to have 2 distinct myopathies with different pathophysiologic bases. Unlike RER in Thoroughbreds, PSSM in Quarter Horses does not appear to be accompanied by a defect in regulation of muscle contraction.

Animals↗
PubMed1975

Presence of modified fibroblasts in ischemic contracture of the intrinsic musculature of the hand.

Biopsies of fibrotic interosseous muscles were obtained from three patients with ischemic contracture of the intrinsic muscles of the hand. Control biopsies were taken from normal contralateral interossei and from normal interossei crushed three weeks earlier. Examination of the specimens from the affected muscles under the electron microscope demonstrated large numbers of modified fibroblasts with ultrastructural features of both fibroblasts and smooth muscle cells. The atypical fibroblasts observed resembled myofibroblasts seen in contracting wounds, Dupuytren's contracture, stenosing tenosynovitis, and idiopathic carpel tunnel syndrome. Biopsies from normal muscle and crushed normal muscle contained normal fibroblasts and smooth muscle cells but no modified fibroblasts. Active contraction of modified fibroblasts could be responsible for progressive muscle shortening seen in intrinsic contracture.

Adolescent↗
PubMed2000

Surgical treatment of infected knee contracture after war injury.

From June 1991 till March 1994, sixteen patients with extension knee contracture as a war injury complication were operatively treated at the Department of Orthopedics, Zagreb University School of Medicine. Infection was present in all patients. During the same period of time, 32 patients with extension knee contracture as a war injury complication and free from the signs of infection were also treated at the Department and served as a control group. The mean age at the time of wounding was 28.3 and 31.8 years in the study and control group, respectively. Operative procedures of extensive intra- and extra-articular adhesiolysis of the knee were performed in all patients. The mean duration of immobilization following injury infliction was 5.5 and 4.9 months in the study and control group, respectively. The mean preoperative knee motion amplitude ranged from 8 degrees in extension to 37 degrees in flexion in the study group, and from 5 degrees in extension to 38 degrees in flexion in the control group. Postoperatively, the mean knee motion amplitude ranged from 2.8 degrees in extension to 97 degrees in flexion in the study group, and from 1.9 degrees in extension to 100 degrees in flexion in the control group. Treatment results did not depend on either the presence of infection in the region of injury or on the duration of preoperative knee immobilization. The treatment of infection was most important for the success of operative treatment of knee contracture. A significant role was also played by adequate intra- and extra-articular adhesiolysis with appropriate intensive postoperative rehabilitation.

Adolescent↗
PubMed2001

Different levels of COX-1 and COX-2 enzymes in synoviocytes and chondrocytes during joint contracture formation.

OBJECTIVE: To measure the levels of prostaglandin endoperoxide H synthase (PGHS) isozymes (or cyclooxygenase, COX) in vivo during the development of joint contractures secondary to immobilization in rats. METHODS: Rats had one knee joint immobilized for up to 32 weeks. Three groups were compared: 47 rats had knee joints immobilized, 38 animals had sham surgery, and 13 unoperated animals served as controls. Levels of PGHS-1 and PGHS-2 enzymes were characterized in the chondrocytes and synoviocytes of the knee joint by immunohistochemistry. Immunostaining intensity was quantified by microscopy using conventional analysis. RESULTS: PGHS-1 level was lower in synoviocytes of the anterior capsule compared with shams (1.3 vs 2.0; p < 0.05). PGHS-2 level was also lower in synoviocytes of the posterior capsule (1.8 vs 2.3; p < 0.05), but higher in chondrocytes at the anterior aspect of the tibia compared with shams (1.6 vs 0.8; p < 0.05). PGHS-2 staining was increased in chondrocytes at the posterior, opposed, and anterior aspects of the tibia compared with controls (1.1, 0.6, 0.8 vs 0.2, 0.1, 0.2, respectively; all p < 0.05). CONCLUSION: Immobility induced joint contractures are characterized by a contrasting cellular pattern of PGHS enzyme levels: decreased in the synovium and increased in the chondrocytes. These findings suggest that chondrocytic PGHS isoenzymes are important in cartilage degradation of contractured joints.

Animals↗
PubMedDate not supplied

External rotation contracture of the extended hip. A common phenomenon of infancy obscuring femoral neck anteversion and the most frequent cause of out-toeing gait in children.

External rotation contracture of the extended hip is common in young infants, decreasing progressively with growth so that it appears to be present in less than 5 per cent of the children over age 18 months. Persistence of the external rotation contracture was the main cause of toeing-out gait in this study. Femoral neck anteversion, as a cause of internal rotation posturing of the limb, does not become clinically recognizable until complete resolution of the external rotation contracture of the hip has occurred, that is, usually after 18 months of age. Femoral neck retroversion was not present clinically in any of the patients examined, and so appears to be quite rare. Approximately 80 per cent of children under 18 months of age who toe-in have internal tibiofibular torsion; most of these also have significant talar neck adductus! Approximately 70 per cent of children over age 2 years who toe-in have excess femoral neck anteversion as the cause. Approximately 75 per cent of the children with metatarsus adductus deformity have coexistent internal tibial torsion and talar neck adductus; only 25 per cent of children with internal tibial torsion have coexistent metatarsus adductus deformity. Physiologic genu varum usually occurs prior to 2 years of age and physiologic genus valgum usually occurs after 2 years of age.

Bone Diseases↗
PubMed1999

[Transposition of expanded superficial cervical artery skin flaps for the repair of cicatricial contracture of neck].

OBJECTIVE: In order to reduce the complication of the transposition of superficial cervical artery skin flap for the repair of neck defect, the method of pre-expanded skin flap was designed, and its clinical result was observed. METHODS: From March 1995 to October 1997, 12 cases with cicatricial contracture of the neck were treated by the following methods, preexpanded superficial cervical artery skin flap, and then transposed it for the reconstruction the cervical scar after burns. There were 8 males and 4 females and the age ranged from 6 to 32 years. A maximal size of flap was 35 cm x 14 cm and a minimal size was 16 cm x 7 cm. RESULTS: All the flaps were survived except one, which partial necrosis occurred in the tip. Postoperative follow-up for 6 months to 3 years showed that the physiological angle of cervico-mandibular angle was recovered and the appearance of flap was satisfactory without swelling and contracture. CONCLUSION: The preexpanded superficial cervical artery skin flap has many advantages, and it is particularly suitable for reconstruction of severe cervical contracture after extensive burns.

Adolescent↗
PubMed2002

[Pathogenesis of Dupuytren's contracture--a review].

Dupuytren's disease is a palmar fibromatosis bringing about irreversible finger contracture. Histopathologically, the disease is characterized by the presence of the two types of structures: nodules, containing of intensively proliferating cells, and fibrous cords, formed by thick bundles of collagen fibers. It seems that key role in the development of Dupuytren's contracture play alterations of palmar fibroblasts activity. These cells begin intensively proliferate and transform to myofibroblasts. The later ones sharing phenotypic features of fibroblasts and smooth muscle cells take part in remodelling of extracellular matrix and are a source of palmar contracture. The pivotal factors involved in changes of palmar fibroblasts functions seem to be growth factors (mainly TGF beta, PDGF and bFGF). However, the participation of reactive forms of oxygen in mentioned process is also considered.

Dupuytren Contracture↗
PubMed2001

Knee flexion contractures: soft tissue correction with monolateral external fixation.

We assessed the efficacy of progressive soft tissue distraction using monolateral external fixation in the management of severe knee flexion contractures. We prospectively evaluated 10 knee deformities in seven pediatric patients. After gradual distraction using the modified Orthofix Limb Reconstruction System (LRS), most recent functional status and knee range of motion were determined. This treatment was applied to 10 extremities in seven patients, ranging in age from 2 to 16 years. Diagnoses included arthrogryposis (4), sickle cell disease (1), previous sepsis (1), and congenital pterygium (1). Average preoperative flexion contracture was 80.5 degrees. Each patient achieved full extension. There was one recurrence, despite bracing, which was managed with replacement of the fixator and soft tissue procedures. Management of knee flexion contractures using a monolateral fixator appears to be a viable alternative to extensive release or femoral osteotomy. Long-term follow-up will be essential to assess the overall risk of recurrence and complications.

Adolescent↗
PubMed2000

[Repairing of inguinal scar contracture deformity in children with transpositional fasciocutaneous flap].

OBJECTIVE: To investigate the repairing method of inguinal scar contracture deformity in children with transpositional fasciocutaneous flap of anterior-medial side of thigh. METHODS: From August 1989 to August 1999, 33 cases with inguinal scar contracture deformity were adopted in this study. Among them, there were 26 males and 7 females, aged from 3 to 11 years old. The transpositional fasciocutaneous flap consisted of a huge tongue-shape flap with a pedicled triangular flap between the edge of skin defect and the above tongue-shape flap. The maximal size of the transpositional fasciocutaneous flap was 18 cm x 10 cm and the minimal size was 13 cm x 8 cm, the transpositional angle was 60 degrees to 80 degrees. During operation, the tongue-shape flap was used to repair the inguinal region and the triangular flap was used to repair the donor site in one stage. RESULTS: All the flaps survived. The function and appearance of perineum were satisfactory. CONCLUSION: The transpositional fasciocutaneous flap is suitable for repairing the inguinal scar contracture deformity in children, and skin graft is unnecessary.

Burns↗
PubMed2004

Silastic sheet integrated polymethylmetacrylate splint in addition to surgery for commissure contractures complicated with hypertrophic scar.

Numerous appliances or methods have been used to manage perioral deep burns and resultant contractures, however, until now, no particular technique is considered to be the "ideal technique". In this article, a new modified design of an extraoral appliance, composed of polymethylmetacrylate and silicon sheet is introduced. Two female and one male patient of a mean age of 33 were included in the study. They had a common history of facial thermal injury and hypertrophic scar formation. All three had a history of failed preceding operations to release commissure contractures. The appliance was placed within 14 days following the operation and stretched continuously for 6 months. During 14 months of follow-up period, no recurrence was encountered and a relatively symmetrical and satisfactory mouth opening was obtained. Owing to the effect of the silicon sheet, a more smooth, flattened scar surface and pliable commissure was achieved. No ulcerations, or tissue breakdown was observed. Extraoral appliances composed of polymethylmetacrylate silicon sheet were considered to be practical, convenient and efficient for the postsurgical treatment of the oral commissure contractures complicated with hypertrophic scar formation.

Adult↗
PubMed2005

[Tissue reaction to breast prostheses. Periprosthetic capsular contracture].

Silicone breast prostheses prompt the development of a fibrous casing or periprosthetic capsule. Capsular contracture, due to retraction of the fibrous tissue, is the most frequent and important complication of these implants. It produces varying degrees of hardening and, in advanced cases, deformity of the breast. It has been closely related to the type of surface of the implant (smooth or textured) and with the alignment of the collagen fibers, and it has been suggested that the formation of a continuous capsule, with collagen fibers aligned in parallel and circularly around the smooth prostheses, promotes the development of concentric contractile forces that pulling in unison give rise to contracture. With microporous textured prostheses a significantly lower incidence of capsular contracture has been shown in comparison with smooth prostheses. It is believed that tissue growth within the microporous structure gives rise to multidirectional contractile forces, with a tendency to neutralize one another when their effect is added over the implant. The capsule of these implants presents a base zone composed of multiple layers of collagen fibers aligned in parallel, which might contract. However, the adherence of the microporous textured prostheses might counteract the contractile forces.

Breast Implants↗
PubMed2005

[The experimental researches on the use of triamcinolone acetonide for the prevention of implant capsular contracture].

OBJECTIVE: To explore the use of triamcinolone acetonide for the prevention of implant capsular contracture. METHODS: 20 rabbits were randomly undivided into 2 groups of 10 animals each. Every 10 ml silicone implant was implanted beneath the panniculus carnosus muscle of one rabbit. At the same time, a modified expander catheter was mounted on the implant. This catheter has many lateral holes and the end was blind. Triamcinolone acetonide (10 mg/3 ml) was infused through the expander pot and catheter as the experimental groups. On the other hand, 3 ml saline was used as the control group at 1, 2, and 3 months. At 6 months, measures related to contracture and capsular histology examinations were performed on anesthetized animals. RESULTS: Baker scores, capsular incision width and capsular thickness of the saline groups were evidently higher than that of triamcinolone acetonide groups (P < 0.01). Implant compression of the saline groups was evidently lower than that of triamcinolone acetonide group. Histology revealed a thinner capsules and less fibrous tissue deposition around the triamcinolone acetonide group, as compared with saline group. CONCLUSIONS: It is effective to deliver triamcinolone acetonide to reduction of capsular contracture through the catheter and its pot.

Animals↗
PubMed1991

[A familial form of progressive muscular dystrophy with multiple contractures of the major joints].

The paper treats of a case of progressive myodystrophy coupled with multiple contractures of the large joints. In an Uzbek family placed under observation and living in the Uzbek SSR, the disease was revealed in 3 members of the family (in mother and two children). Contractures of the large joints grew on parallel with the myodystrophic process. The pattern of myodystrophy seen in the family was characterized by a number of unusual clinical features and by pronounced clinical pleomorphism. The differences of the clinical manifestations within the family lay in variability of the debut, localization and intensity of the contractures, and in the rate of the myodystrophy course.

Adolescent↗
PubMed2005

[An assessment of the influence of the severity of Dupuytren's contracture on the dexterity of the hand before and after surgery].

It seems to evident that deformation of the hand as a result of Dupuytren's contracture should cause weakness and overall functional impairment of the hand, and an increase of range of motion of the fingers as a result of the operation should effect in improvement of these parameters. The objective of this study was to investigate the effect of extension loss of fingers, number of fingers involved and age of the patients on the power and dexterity of the hand, as well as influence of the age of the patients and recovery of extension of the fingers on the power and dexterity of the hand after surgery for Dupuytren's contracture. 54 patients in an age range 32-83 years (mean 60) with the disease lasting av. 5 years underwent subtotal fasciectomy. Total extension loss of the fingers and total grip strength were measured and dexterity of the hand was assessed with DASH questionnaire prior to surgery. Patients were followed-up for 1 year and assessments were repeated at 1, 3 and finally at 12 months. Median values of measured variables at presentation were as follows: extension loss 80 degrees, total grip strength 41 kG, and DASH score 54. At 12 months median extension loss decreased to 10 degrees (stat. sign.), DASH score to 32 (stat. sign. improvement of dexterity) and grip strength decreased slightly to 40 kG. An analysis of the relationship between the variables showed that severity of the contracture (expressed as an extension loss) had no effect on dexterity of the hand but had significant influence on deterioration of the total grip strength. Number of fingers involved did affect neither dexterity nor power of the hand. Age of the patients did not influence subjective feeling of dexterity of the hand, however, older patients experienced lesser functional benefit from the operation, than younger patients. An increase of extension of the fingers following surgery had significant beneficial effect on subjective improvement of the dexterity of the hand, but had not effect on the increase of power of the hand.

Adult↗