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.
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 hypertonicspasticity 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.
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.
In response to impending muscle damage associated with ATP (energy) deficiency,
Congenital abnormalities of muscle development.
Skin contractureedit
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]
^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. PMC2263098. PMID 18332384.
^"Definition of contracture". www.cancer.gov. 2011-02-02. Retrieved 2023-05-06.
^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.
^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. PMC5210181. PMID 21691338.
^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. PMC3734638. PMID 23930031.
^ abKwan, 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.
^ abcdGauglitz, 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. PMC3022978. PMID 20927486.
^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.
^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. PMC4350315. PMID 25750848.
^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.
External linksedit
Wikimedia Commons has media related to Contractures.
April 14, 2024
contracture, this, article, refers, permanent, shortening, muscles, tendons, ligaments, contracture, muscle, specifically, muscle, contracture, short, term, contraction, muscles, that, occurs, during, exercise, muscle, contraction, pathology, contracture, shor. 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 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 ContractureSpecialtyOrthopedicsHand contractures as seen in Freeman Sheldon syndromeIt 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 Contents 1 Causes of muscle contracture 2 Skin contracture 3 See also 4 References 5 External linksCauses of muscle contracture editMain 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 editWound 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 editArthrogryposis Burn scar contracture Capsular contracture Clubfoot Dupuytren s contracture Freeman Sheldon syndrome Marden Walker syndrome Muscle contracture Volkmann s contractureReferences edit Clavet H Hebert 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 Definition of contracture www cancer gov 2011 02 02 Retrieved 2023 05 06 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 amp 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 Bonnemann 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 Nambi Gopal S amp 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 a b c Contractures stanfordhealthcare org Retrieved 2023 05 07 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 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 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 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 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 External links edit nbsp Wikimedia Commons has media related to Contractures Retrieved from https en wikipedia org w index php title Contracture amp oldid 1183974962, wikipedia, wiki, book, books, library,
