Contracture

What is a contracture?

Contractures are structural changes to your soft and connective tissues that cause them to stiffen, tighten and contract. Tissues affected by contracture lose their former elasticity and range of motion.

Contracture is a type of scarring in these tissues. It’s easiest to see when it affects your skin. For example, people with significant burn injuries develop areas of skin that are shrunken and constricted.

In other tissues, like your muscles or ligaments, scarring is called fibrosis. It’s the process of gradually replacing parts of these tissues with a denser, tougher, more fibrous and more rigid type of tissue.

Rigid tissue loses its capacity to stretch and move, leading to disability. It can also shrink or shorten. This can lead to deformities as the contracture pulls other tissues around to it into abnormal formations.

Types of contractures

Different types of contractures can affect different tissues or parts of your body. Healthcare providers use a variety of different names to describe them. Some of the broader contracture types include:

• Scar contractures. These affect your skin after you’ve been wounded and the scarring process has completed. Scar contractures can lead to other types if they prevent other tissues or joints from moving normally.
• Muscle contractures. These affect one muscle or a related group of muscles. Muscle contractures can also lead to other contractures, such as joint contractures, by preventing them from moving normally.
• Joint contractures (capsular contracture). These affect the connective tissues that enclose the bones in a joint — the joint capsule. When the capsule stiffens, the bones in the joint can’t move.
• Arthrogenic contracture. These are capsular contractures that originate from the joint. A capsular contracture can easily affect the muscles connected to the joint, just as a muscle contracture can affect the joint.

Specific contractures

Some specific types of contractures have their own names. Some of these include:

• Amyoplasia. This is a birth defect (congenital disorder) involving multiple contractures in your child’s limbs
• Arthrogryposis. This general term means your child has been born with multiple contractures. It’s a feature of many genetic disorders, including muscular dystrophy and Edwards syndrome.
• Clubfoot. This congenital contracture affects the tendons in your child’s foot or feet, causing them to turn inward toward their body. It can also involve their calf muscle.
• Dupuytren’s contracture. This genetic disorder causes contracture of the soft tissues in your hands, making your finger or fingers turn gradually inward toward your palm.
• Elbow contracture (stiff elbow). This is a contracture of your elbow joint capsule.
• Equinus contracture. This is a contracture of your ankle joint, or the muscles attached to it, that makes it impossible to bring your foot to a neutral position (at a right angle to your leg).
• Flexion contracture. This is a type of joint contracture in which the joint is contracted in a bent or flexed position and can no longer be straightened. It most often affects the limbs.
• Frozen shoulder (adhesive capsulitis). This is a contracture of your shoulder joint capsule.
• Volkmann contracture. This is another type of hand contracture. It causes an inward flexion of your fingers and wrist that makes your hand look like a claw.

What are the symptoms of a contracture?

Symptoms of contractures can include:

• Visibly thickened, tightened scar tissue
• Stiffness in your muscles, joints or other soft tissues
• Musculoskeletal pain in your soft tissues
• Reduced range of motion and overall mobility
• Muscle atrophy (loss of muscle mass)
• Gait disorders (abnormalities in the way you walk)
• Flexion deformities (a permanent bend), especially in your limbs

What causes contracture?

Contracture is a type of scarring or fibrosis in your tissues. It usually happens when the tissues try to repair themselves after injury or after wasting away from disuse. Sometimes, it’s present at birth.

Causes include:

• Wounding. Injuries that cause you to lose a significant amount of tissue, like burns, infected wounds or surgery, can cause a contraction scar on your skin or in your soft tissues.
• Ischemia. Not enough blood flow to your tissues causes chronic inflammation, followed by scarring. Ischemia can happen suddenly or gradually. Lack of movement is one cause.
• Immobilization. Lack of movement is the leading cause of soft tissue contractures. Parts of your body might be immobilized because of an injury, physical disability or neurological condition.
• Neuromuscular disorders. Conditions like stroke and cerebral palsy affect the communication between your brain and muscles. This can immobilize them or over-contract them (hypertonia).
• Inherited connective tissue diseases. Conditions that affect how your connective tissues develop, like congenital myopathy, can cause overly contracted or overly lax muscles (hypotonia).
• Birth defects. Some babies are born with contractures that don’t seem to relate to any disease or obvious cause. They might be due to genetic mutations or a lack of movement in the uterus.

What complications can contractures cause?

A permanent contracture can severely inhibit your quality of life. It can affect your mobility and independence. You may find it harder to carry out the functions of your daily life without assistance.

Contractures can also contribute to chronic pain, and they can snowball, affecting other muscles and joints connected to them. The less you’re able to move, the more your tissues may start to contract.

How are contractures diagnosed?

If you have a preexisting injury or condition that can lead to contracture, your healthcare provider will be on the lookout for it. They can diagnose it with a physical exam that checks your range of motion.

Your provider might want to take images of your connective and soft tissues to learn more about what might be contributing to your contracture. They might take X-rays, an ultrasound or an MRI.

What is the best treatment for contracture?

The best treatment for contracture is prevention, and in many cases, it’s preventable. If you’re currently immobilized or have a condition that leads to contracture, physical therapy can often help prevent it.

If you do develop a contracture, it’s best to treat it earlier on. Recent contractures tend to be milder and easier to reverse, while more advanced contractures may not respond to nonsurgical treatments.

Treatments to fix a contracture include conservative, orthopedic therapies and surgeries. It’s also important to treat any underlying conditions that may be causing or contributing to your contracture.

Nonsurgical treatment for a contracture

Conservative treatments include:

• Static and dynamic stretching. Healthcare providers use different types of braces, casts and splints to fix contracted tissues in a position that provides gradual and continuous stretching.
• Heat therapy. Applying therapeutic heat to your soft tissues can help them relax and stretch, especially if you have chronic hypertonia or spasticity. Heat also helps to promote circulation.
• Physical therapy. Passive and active exercises can help improve flexibility and range of motion in contracted muscles and joints. They can also help prevent atrophy due to lack of movement.
• Myofascial release therapy. This hands-on massage therapy technique focuses on your fascia, the connective tissue that underlies your muscles. It can help prevent and treat contractures.
• Injections. Intra-articular (in the joint) and soft tissue injections can help release contractures in some cases. Botox® can help tissues relax, while collagenase injections can help break up fibrosis.
• Anti-inflammatory treatments. Anti-inflammatory drugs and treatments like low-level laser therapy (infrared light), can help reduce inflammation and prevent fibrosis after immobilization.

Contracture surgeries

Surgical treatments for contracture include:

• Tenotomy. Also called tendon lengthening, this surgery makes small cuts or holes in your tendon to release tension. As the tendon repairs itself, it can grow back longer.
• Tendon transfer. This method removes the contracted tendon and transfers another tendon from a donor or from elsewhere in your body to the site of the contracture.
• Arthroplasty. For joint capsule contractures, you might need surgery to release or replace parts of your joint capsule, or in some cases, the whole joint.
• Fasciotomy. Contractures that affect your fascia, like Dupuytren’s contracture, may benefit from fasciotomy. Surgeons cut holes in the fascia to release it or remove pieces of scar tissue.
• Z-plasty. One technique for breaking up skin and fascia contractures is making zig-zag cuts in the tissue to release tension. The Z pattern encourages the tissue to repair itself without shrinking.
• Plastic surgery. For scar contractures, a surgeon might need to remove and replace scarred tissue with a skin graft or skin flap taken from a donor or from elsewhere on your body.

What can I do to prevent contracture?

The most common cause of contracture is immobilization. If you’re hospitalized for a severe injury, surgery or disease, or you have to wear a cast for several weeks, you’re at risk of contracture.

Healthcare providers go to great lengths to prevent contractures while you’re in their care. But they need your help. It’s very important to follow through with your physical therapy during your recovery.

Exercising in a state of disease, disability or injury can be uncomfortable and difficult. In some cases, you might need help to complete your exercises, or you might need someone to remind and motivate you.

If you or someone you care for has a chronic condition that can cause contractures, you or they might need ongoing physical therapy to prevent them. Quality lifetime care is important in these cases.

What is the prognosis for contractures?

Contractures respond best to treatment when they aren’t yet too advanced and fixed. Healthcare providers caring for people at risk of contractures can take steps to prevent or minimize them.

Recent contractures often respond to conservative treatments. More advanced contractures may benefit from surgery. Some contractures may not be treatable or may not fully resolve with surgery.