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Contractures are shortenings of muscle or connective tissue around joints which prevent the normal range of movement of joints. Contractures are produced by nerve or muscle disease including stroke, head injury, and neuromuscular diseases. Contractures produce physical impairment and disability by preventing the normal movement of arm and leg joints and by placing muscles which are already weakened in a position of mechanical disadvantage. They produce major impairments to walking and to the daily activities of living.
The neuromuscular disease with the greatest number and degree of impairments from contractures is Duchenne Muscular Dystrophy (DMD). Eighty-one percent of individuals with DMD have a contracture with loss of range of motion of at least 5 degrees in at least one joint. All of the joints of both the upper and lower extremities are involved in individuals with DMD. Sixty-five percent of individuals with chronic Spinal Muscular Atrophy (C-SMA) have contractures with both the upper and lower extremities involved. Individuals with Becker muscular dystrophy, myotonic muscular dystrophy, and limb-girdle syndrome also have significant problems with contractures in both the upper and lower extremities. Individuals with hereditary motor sensory neuropathy (Charcot Marie Tooth disease is one type) have fewer problems with contractures and the contractures are primarily at the knee and ankle.
Prevention of contractures is very important in maintaining ability to walk and to do daily living activities. Contractures are prevented by actively exercising the muscles and joints through their range daily. If the individual cannot do so due to muscle weakness, the family or friends can do gentle passive range of motion under the guidance of programs developed by the physician, the physical therapist, or the occupational therapist. Splints are also important in preventing contractures, especially at night when sleeping postures frequently encourage the development of contractures.
Once contractures develop they are often very difficult to correct. Physical and occupational therapists frequently help in stretching out the contractures. However, the therapists cannot do this stretching alone. The family and the individual with the neuromuscular disease must be actively involved. If the contracture cannot be corrected with exercise, surgery is sometimes necessary. However, the most important way to deal with contractures is to prevent them. (Johnson, E.R.: Archives Physical Medicine & Rehabilitation 73:807, 1992).
RRTC Neuromuscular Diseases Staff.
From RRTC Newsletter, February 1994.
