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Concept
Contracture
Summary
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. A contracture is usually permanent, but less commonly can be temporary (such as in McArdle disease), or resolve over time but reoccur later in life (such as in Bethlem myopathy 1).
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, at the same time that tendency toward spasticity is addressed.
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.
Wound contraction, where the edges of the skin are pulled together to close the wound, is a normal part of wound healing.
Official source
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Related publications (3)
Investigating the neuromechanical control of healthy gait modulation and pathological gaits observed in cerebral palsy using neuromuscular simulations
Locomotion is based on a sophisticated interaction among the environment, the musculoskeletal system, the spinal cord, and the brain locomotor areas. Quality of life is strongly related to the proper capability of this movement. However, many pathologies, ...
EPFL2023Novel Design and Implementation of a Neuromuscular Controller on a Hip Exoskeleton for Partial Gait Assistance
Auke Ijspeert, Mohamed Bouri, Ali Reza Manzoori, Andrea Di Russo, Sara Messara
Exoskeletons intended for partial assistance of walking should be able to follow the gait pattern of their users, via online adaptive control strategies rather than imposing predefined kinetic or kinematic profiles. NeuroMuscular Controllers (NMCs) are ada ...
2023A simple tool to measure spasticity in spinal cord injury subjects
Maurizio Molinari, Arash Arami, Etienne Burdet
This work presents a wearable device and the algorithms for quantitative modelling of joint spasticity and its application in a pilot group of subjects with different levels of spinal cord injury. The device comprises light-weight instrumented handles to m ...
IEEE2017Related concepts (4)
Orthotics
Orthotics (Ορθός) is a medical specialty that focuses on the design and application of orthoses, or braces. An is "an externally applied device used to influence the structural and functional characteristics of the neuromuscular and skeletal systems." Orthotists are professionals who specialize in designing these braces. Orthotic devices are classified into four areas of the body according to the international classification system (ICS): orthotics of the lower extremities, orthotics of the upper extremities, orthotics for the trunk, and orthotics for the head.
Spasticity
Spasticity () is a feature of altered skeletal muscle performance with a combination of paralysis, increased tendon reflex activity, and hypertonia. It is also colloquially referred to as an unusual "tightness", stiffness, or "pull" of muscles. Clinically, spasticity results from the loss of inhibition of motor neurons, causing excessive velocity-dependent muscle contraction. This ultimately leads to hyperreflexia, an exaggerated deep tendon reflex. Spasticity is often treated with the drug baclofen, which acts as an agonist at GABA receptors, which are inhibitory.
Cerebral palsy
Cerebral palsy (CP) is a group of movement disorders that appear in early childhood. Signs and symptoms vary among people and over time, but include poor coordination, stiff muscles, weak muscles, and tremors. There may be problems with sensation, vision, hearing, and speaking. Often, babies with cerebral palsy do not roll over, sit, crawl or walk as early as other children of their age. Other symptoms include seizures and problems with thinking or reasoning, each of which occur in about one-third of people with CP.