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{{short description|Permanent shortening of a muscle or joint}}
''This article refers to permanent shortening of muscles, tendons, or ligaments. For short-term contraction of muscles, see [[Muscle contraction]].''
{{Hatnote|This article refers to permanent shortening of muscles, tendons, or ligaments. For contracture of the muscle specifically, see [[Muscle contracture]]. For short-term contraction of muscles that occurs during exercise, see [[Muscle contraction]].}}
{{Infobox medical condition (new)
{{Infobox medical condition (new)
| name = Contracture
| image = Diseases of infancy and childhood (1914) (14771754012).jpg
| name = Contracture
| image = Diseases of infancy and childhood (1914) (14771754012).jpg
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| field = [[Orthopedics]]
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[[File:Muscle contractures of young man.jpg|thumb|Muscle contractures in terminal neurological condition]]
[[File:Freeman-Sheldon syndrome.JPG|thumb|Hand contractures as seen in [[Freeman–Sheldon syndrome]]]]
A muscle '''contracture''' is a permanent shortening of a [[muscle]]<ref>{{DorlandsDict|two/000023974|contracture}}</ref> or [[joint]].<ref name="pmid18332384">{{cite journal |vauthors=Clavet H, Hébert PC, Fergusson D, Doucette S, Trudel G |title=Joint contracture following prolonged stay in the intensive care unit |journal=CMAJ |volume=178 |issue=6 |pages=691–7 |date=March 2008 |pmid=18332384 |pmc=2263098 |doi=10.1503/cmaj.071056 |url=http://www.cmaj.ca/cgi/pmidlookup?view=long&pmid=18332384}}</ref> It is usually in response to prolonged [[hypertonia|hypertonic]] [[spasticity]] in a concentrated muscle area, such as is seen in the tightest muscles of people with conditions like [[spastic diplegia|spastic cerebral palsy]].
In [[pathology]], a '''contracture''' is a shortening of [[Skeletal muscle|muscles]], tendons, skin, and nearby soft tissues that causes the [[joint]]s to shorten and become very stiff, preventing normal movement.<ref name="pmid18332384">{{cite journal |vauthors=Clavet H, Hébert PC, Fergusson D, Doucette S, Trudel G |title=Joint contracture following prolonged stay in the intensive care unit |journal=CMAJ |volume=178 |issue=6 |pages=691–7 |date=March 2008 |pmid=18332384 |pmc=2263098 |doi=10.1503/cmaj.071056 }}</ref><ref>{{Cite web |date=2011-02-02 |title=Definition of contracture |url=https://www.cancer.gov/publications/dictionaries/cancer-terms/def/contracture# |access-date=2023-05-06 |website=www.cancer.gov |language=en}}</ref> A contracture is usually permanent, but less commonly can be temporary (such as in [[Glycogen storage disease type V|McArdle disease]]),<ref>{{Cite journal |last1=Lucia |first1=Alejandro |last2=Martinuzzi |first2=Andrea |last3=Nogales-Gadea |first3=Gisela |last4=Quinlivan |first4=Ros |last5=Reason |first5=Stacey |last6=International Association for Muscle Glycogen Storage Disease study group |date=December 2021 |title=Clinical practice guidelines for glycogen storage disease V & VII (McArdle disease and Tarui disease) from an international study group |url=https://pubmed.ncbi.nlm.nih.gov/34848128/ |journal=Neuromuscular Disorders |volume=31 |issue=12 |pages=1296–1310 |doi=10.1016/j.nmd.2021.10.006 |issn=1873-2364 |pmid=34848128|s2cid=240123241 |doi-access=free }}</ref> or resolve over time but reoccur later in life (such as in [[Bethlem myopathy]] 1).<ref>{{Cite journal |last=Bönnemann |first=Carsten G. |date=2011-06-21 |title=The collagen VI-related myopathies: muscle meets its matrix |journal=Nature Reviews. Neurology |volume=7 |issue=7 |pages=379–390 |doi=10.1038/nrneurol.2011.81 |issn=1759-4758 |pmc=5210181 |pmid=21691338}}</ref>
⚫
Contractures are essentially muscles or tendons that have remained too tight for too long, thus becoming shorter. They develop when these normally elastic tissues are replaced by inelastic tissues. This results in the shortening and hardening of these tissues, ultimately causing rigidity, joint deformities, and a total loss of movement around the joint. Most of the [[physical therapy]], [[occupational therapy]], and other exercise regimens targeted towards people with [[spasticity]] focuses on trying to prevent contractures from happening in the first place. However, research on sustained traction of connective tissue in approaches such as adaptive yoga has demonstrated that contracture can be reduced,<ref name="pmid">{{cite journal |author=Nambi, Gopal S |author2=Amisha Atul Kumar Shah |last-author-amp=yes|title=Additional effect of iyengar yoga and EMG biofeedback on pain and functional disability in chronic unilateral knee osteoarthritis |journal=International Journal of Yoga |volume=6 |issue=2 |pages=123–127 |date=2013 |pmid= 23930031|pmc=3734638 |doi=10.4103/0973-6131.113413 }}</ref> at the same time that tendency toward spasticity is addressed.


It is usually in response to prolonged [[hypertonia|hypertonic]] [[spasticity]] in a concentrated muscle area, such as is seen in the tightest muscles of people with conditions like [[spastic diplegia|spastic cerebral palsy]], but can also be due to the congenital abnormal development of muscles and connective tissue in the womb.
Contractures can also be due to [[ischemia]], as in [[Volkmann's contracture]].


Contractures develop usually when normally elastic tissues such as muscles or tendons are replaced by inelastic tissues ([[fibrosis]]). This results in the shortening and hardening of these tissues, ultimately causing rigidity, joint deformities and a total loss of movement around the joint.
Excessive [[matrix metalloproteinase]] and [[myofibroblast]] accumulation in the wound margins can result in contracture.

⚫
Most of the [[physical therapy]], [[occupational therapy]] and other exercise regimens targeted towards people with [[spasticity]] focuses on trying to prevent contractures from happening in the first place. However, research on sustained traction of connective tissue in approaches such as adaptive yoga has demonstrated that contracture can be reduced,<ref name="pmid">{{cite journal |author=Nambi, Gopal S |author2=Amisha Atul Kumar Shah |name-list-style=amp|title=Additional effect of iyengar yoga and EMG biofeedback on pain and functional disability in chronic unilateral knee osteoarthritis |journal=International Journal of Yoga |volume=6 |issue=2 |pages=123–127 |date=2013 |pmid= 23930031|pmc=3734638 |doi=10.4103/0973-6131.113413 |doi-access=free }}</ref> at the same time that tendency toward spasticity is addressed.

== Causes of muscle contracture ==
{{main|Muscle contracture}}

Contractures can have a variety of causes other than spasticity. In regards to muscle, these include (but not limited to):

* [[Ischemia]] (restriction of blood flow) leading to the death of muscle tissue, as in [[Volkmann's contracture]].
* Muscle injury leading to [[Adhesion (medicine)|adhesions]] and [[fibrosis]] (internal scarring). Fibrosis occurs within a muscle or organ, whereas adhesions bind two separate tissues or organs together.
* Immobilization,
* A muscle imbalance between an [[Anatomical terms of muscle#Agonists and antagonists|agonist and antagonist muscle]],
* In response to impending muscle damage associated with ATP (energy) deficiency,
* Congenital abnormalities of muscle development.

== Skin contracture ==
[[Wound contraction]], where the edges of the skin are pulled together to close the wound, is a normal part of [[wound healing]]. However, large wounds and abnormal wound healing cause skin contractures by excessively tightening the skin and limiting movement.<ref name=":0">{{Cite web |title=Contractures |url=https://stanfordhealthcare.org/medical-treatments/s/scar-revision-surgery/procedures/contractures.html |access-date=2023-05-07 |website=stanfordhealthcare.org |language=en}}</ref><ref name=":1">{{Cite journal |last1=Kwan |first1=Peter O. |last2=Tredget |first2=Edward E. |date=2017-05-01 |title=Biological Principles of Scar and Contracture |url=https://www.sciencedirect.com/science/article/pii/S0749071216301585 |journal=Hand Clinics |series=Burns |language=en |volume=33 |issue=2 |pages=277–292 |doi=10.1016/j.hcl.2016.12.004 |pmid=28363295 |issn=0749-0712}}</ref><ref name=":2">{{Cite journal |last1=Gauglitz |first1=Gerd G |last2=Korting |first2=Hans C |last3=Pavicic |first3=Tatiana |last4=Ruzicka |first4=Thomas |last5=Jeschke |first5=Marc G |date=2011 |title=Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies |journal=Molecular Medicine |volume=17 |issue=1–2 |pages=113–125 |doi=10.2119/molmed.2009.00153 |issn=1076-1551 |pmc=3022978 |pmid=20927486}}</ref> A skin contracture due to a burn is known as a [[burn scar contracture]].

Large areas of missing skin (such as large burns, grazes, and gouges) drastically reduce the area of skin causing it to become tight when pulled together during wound healing.<ref name=":0" /><ref name=":1" /> Scars initially lack elasticity with synthesis of elastic tissue fibres ([[elastogenesis]]) being a function of duration and site of the scar.<ref>{{Cite journal |last1=Roten |first1=S. V. |last2=Bhat |first2=S. |last3=Bhawan |first3=J. |date=February 1996 |title=Elastic fibers in scar tissue |url=https://pubmed.ncbi.nlm.nih.gov/8720985/ |journal=Journal of Cutaneous Pathology |volume=23 |issue=1 |pages=37–42 |doi=10.1111/j.1600-0560.1996.tb00775.x |issn=0303-6987 |pmid=8720985|s2cid=37823718 }}</ref> Deep wounds and abnormal wound healing causes abnormal scarring such as [[hypertrophic scar]]s.<ref name=":2" /> Studies on hypertrophic scars have shown a lack of improvement to both elasticity and stiffness suggesting a prolonged healing phase without amelioration seen in a normal wound-healing curve.<ref>{{Cite journal |last1=Rapp |first1=Scott J. |last2=Rumberg |first2=Aaron |last3=Visscher |first3=Marty |last4=Billmire |first4=David A. |last5=Schwentker |first5=Ann S. |last6=Pan |first6=Brian S. |date=February 2015 |title=Establishing a Reproducible Hypertrophic Scar following Thermal Injury: A Porcine Model |url=https://journals.lww.com/prsgo/fulltext/2015/02000/establishing_a_reproducible_hypertrophic_scar.3.aspx |journal=Plastic and Reconstructive Surgery – Global Open |language=en-US |volume=3 |issue=2 |pages=e309 |doi=10.1097/GOX.0000000000000277|pmid=25750848 |pmc=4350315 }}</ref><ref>{{Cite journal |last1=Linares |first1=Hugo A. |last2=Larson |first2=Duane L. |date=1976-10-01 |title=Elastic tissue and hypertrophic scars |url=https://dx.doi.org/10.1016/0305-4179%2876%2990003-6 |journal=Burns |language=en |volume=3 |issue=1 |pages=4–7 |doi=10.1016/0305-4179(76)90003-6 |s2cid=72414472 |issn=0305-4179}}</ref>

Surgery can help alleviate skin contractures in the form of skin grafts and removal of hypertrophic scars.<ref name=":2" /><ref name=":0" /> For hypertrophic scars, timing is important when considering surgery, as over time scars will mature and may show decreased contractures along with flattening, softening, and repigmentation without surgical intervention.<ref name=":2" />


==See also==
==See also==
* [[Arthrogryposis]]
* [[Burn scar contracture]]
* [[Burn scar contracture]]
* [[Capsular contracture]]
* [[Capsular contracture]]
* [[Clubfoot]]
* [[Dupuytren's contracture]]
* [[Dupuytren's contracture]]
* [[Marden-Walker syndrome]]
* [[Freeman–Sheldon syndrome]]
* [[Marden–Walker syndrome]]
* [[Muscle contracture]]
* [[Muscle contracture]]
* [[Volkmann's contracture]]


==References==
==References==
{{reflist}}
{{reflist}}










== External links ==
== External links ==
{{Medical resources
{{Medical resources
| DiseasesDB =
| DiseasesDB =
| ICD10 = {{ICD10|M|24|5|m|20}}, {{ICD10|M|62|4|m|60}}, M67.1, M72.0, {{ICD10|T|79|6|t|79}}
| ICD10 = {{ICD10|M|24|5|m|20}}, {{ICD10|M|62|4|m|60}}, M67.1, M72.0, {{ICD10|T|79|6|t|79}}
| ICD9 = {{ICD9|718.4}}, {{ICD9|727.81}}, {{ICD9|728.6}}, {{ICD9|958.6}}
| ICD9 = {{ICD9|718.4}}, {{ICD9|727.81}}, {{ICD9|728.6}}, {{ICD9|958.6}}
| ICDO =
| ICDO =
| OMIM =
| OMIM =
| MedlinePlus = 003185
| MedlinePlus = 003185
| eMedicineSubj =
| eMedicineSubj =
| eMedicineTopic =
| eMedicineTopic =
| MeshID = D003286
| MeshID = D003286
| SNOMED CT = 57048009
}}
}}
{{commons category}}
{{commonscat}}
{{Arthropathies and related conditions}}
{{Arthropathies and related conditions}}
{{Acquired musculoskeletal deformities}}
{{Acquired musculoskeletal deformities}}
{{Myopathy}}
{{Myopathy}}
{{Soft tissue disorders}}
{{Soft tissue disorders}}
{{Certain early complications of trauma}}
{{Trauma |state=autocollapse}}
{{Trauma |state=autocollapse}}
{{Authority control}}
{{Authority control}}

Latest revision as of 10:23, 17 August 2024

This article refers to permanent shortening of muscles, tendons, or ligaments. For contracture of the muscle specifically, see Muscle contracture. For short-term contraction of muscles that occurs during exercise, see Muscle contraction.
Contracture
SpecialtyOrthopedics
Hand contractures as seen in Freeman–Sheldon syndrome

In pathology, a contracture is a shortening of muscles, tendons, skin, and nearby soft tissues that causes the joints to shorten and become very stiff, preventing normal movement.[1][2] A contracture is usually permanent, but less commonly can be temporary (such as in McArdle disease),[3] or resolve over time but reoccur later in life (such as in Bethlem myopathy 1).[4]

It is usually in response to prolonged hypertonic spasticity in a concentrated muscle area, such as is seen in the tightest muscles of people with conditions like spastic cerebral palsy, but can also be due to the congenital abnormal development of muscles and connective tissue in the womb.

Contractures develop usually when normally elastic tissues such as muscles or tendons are replaced by inelastic tissues (fibrosis). This results in the shortening and hardening of these tissues, ultimately causing rigidity, joint deformities and a total loss of movement around the joint.

Most of the physical therapy, occupational therapy and other exercise regimens targeted towards people with spasticity focuses on trying to prevent contractures from happening in the first place. However, research on sustained traction of connective tissue in approaches such as adaptive yoga has demonstrated that contracture can be reduced,[5] at the same time that tendency toward spasticity is addressed.

Causes of muscle contracture

[edit]
Main article: Muscle contracture

Contractures can have a variety of causes other than spasticity. In regards to muscle, these include (but not limited to):

  • Ischemia (restriction of blood flow) leading to the death of muscle tissue, as in Volkmann's contracture.
  • Muscle injury leading to adhesions and fibrosis (internal scarring). Fibrosis occurs within a muscle or organ, whereas adhesions bind two separate tissues or organs together.
  • Immobilization,
  • A muscle imbalance between an agonist and antagonist muscle,
  • In response to impending muscle damage associated with ATP (energy) deficiency,
  • Congenital abnormalities of muscle development.

Skin contracture

[edit]

Wound contraction, where the edges of the skin are pulled together to close the wound, is a normal part of wound healing. However, large wounds and abnormal wound healing cause skin contractures by excessively tightening the skin and limiting movement.[6][7][8] A skin contracture due to a burn is known as a burn scar contracture.

Large areas of missing skin (such as large burns, grazes, and gouges) drastically reduce the area of skin causing it to become tight when pulled together during wound healing.[6][7] Scars initially lack elasticity with synthesis of elastic tissue fibres (elastogenesis) being a function of duration and site of the scar.[9] Deep wounds and abnormal wound healing causes abnormal scarring such as hypertrophic scars.[8] Studies on hypertrophic scars have shown a lack of improvement to both elasticity and stiffness suggesting a prolonged healing phase without amelioration seen in a normal wound-healing curve.[10][11]

Surgery can help alleviate skin contractures in the form of skin grafts and removal of hypertrophic scars.[8][6] For hypertrophic scars, timing is important when considering surgery, as over time scars will mature and may show decreased contractures along with flattening, softening, and repigmentation without surgical intervention.[8]

See also

[edit]

References

[edit]
  1. ^ Clavet H, Hébert PC, Fergusson D, Doucette S, Trudel G (March 2008). "Joint contracture following prolonged stay in the intensive care unit". CMAJ. 178 (6): 691–7. doi:10.1503/cmaj.071056. PMC 2263098. PMID 18332384.
  2. ^ "Definition of contracture". www.cancer.gov. 2011-02-02. Retrieved 2023-05-06.
  3. ^ Lucia, Alejandro; Martinuzzi, Andrea; Nogales-Gadea, Gisela; Quinlivan, Ros; Reason, Stacey; International Association for Muscle Glycogen Storage Disease study group (December 2021). "Clinical practice guidelines for glycogen storage disease V & VII (McArdle disease and Tarui disease) from an international study group". Neuromuscular Disorders. 31 (12): 1296–1310. doi:10.1016/j.nmd.2021.10.006. ISSN 1873-2364. PMID 34848128. S2CID 240123241.
  4. ^ Bönnemann, Carsten G. (2011-06-21). "The collagen VI-related myopathies: muscle meets its matrix". Nature Reviews. Neurology. 7 (7): 379–390. doi:10.1038/nrneurol.2011.81. ISSN 1759-4758. PMC 5210181. PMID 21691338.
  5. ^ Nambi, Gopal S & Amisha Atul Kumar Shah (2013). "Additional effect of iyengar yoga and EMG biofeedback on pain and functional disability in chronic unilateral knee osteoarthritis". International Journal of Yoga. 6 (2): 123–127. doi:10.4103/0973-6131.113413. PMC 3734638. PMID 23930031.
  6. ^ a b c "Contractures". stanfordhealthcare.org. Retrieved 2023-05-07.
  7. ^ a b Kwan, Peter O.; Tredget, Edward E. (2017-05-01). "Biological Principles of Scar and Contracture". Hand Clinics. Burns. 33 (2): 277–292. doi:10.1016/j.hcl.2016.12.004. ISSN 0749-0712. PMID 28363295.
  8. ^ a b c d Gauglitz, Gerd G; Korting, Hans C; Pavicic, Tatiana; Ruzicka, Thomas; Jeschke, Marc G (2011). "Hypertrophic Scarring and Keloids: Pathomechanisms and Current and Emerging Treatment Strategies". Molecular Medicine. 17 (1–2): 113–125. doi:10.2119/molmed.2009.00153. ISSN 1076-1551. PMC 3022978. PMID 20927486.
  9. ^ Roten, S. V.; Bhat, S.; Bhawan, J. (February 1996). "Elastic fibers in scar tissue". Journal of Cutaneous Pathology. 23 (1): 37–42. doi:10.1111/j.1600-0560.1996.tb00775.x. ISSN 0303-6987. PMID 8720985. S2CID 37823718.
  10. ^ Rapp, Scott J.; Rumberg, Aaron; Visscher, Marty; Billmire, David A.; Schwentker, Ann S.; Pan, Brian S. (February 2015). "Establishing a Reproducible Hypertrophic Scar following Thermal Injury: A Porcine Model". Plastic and Reconstructive Surgery – Global Open. 3 (2): e309. doi:10.1097/GOX.0000000000000277. PMC 4350315. PMID 25750848.
  11. ^ Linares, Hugo A.; Larson, Duane L. (1976-10-01). "Elastic tissue and hypertrophic scars". Burns. 3 (1): 4–7. doi:10.1016/0305-4179(76)90003-6. ISSN 0305-4179. S2CID 72414472.
[edit]
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