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Contracture: Causes, Symptoms & Treatment

A contracture is the permanent shortening of muscles, tendons, or connective tissue, leading to restricted or lost movement in a joint.

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Things worth knowing about "Contracture"

A contracture is the permanent shortening of muscles, tendons, or connective tissue, leading to restricted or lost movement in a joint.

What is a Contracture?

A contracture is a permanent, structural shortening or stiffening of muscles, tendons, ligaments, or joint tissues that significantly limits or completely prevents normal joint movement. Unlike temporary muscle cramps or spasms, contractures involve lasting changes in tissue structure and are difficult to reverse without targeted treatment. They often develop as a complication of prolonged immobility, neurological conditions, or injuries.

Causes

Contractures can arise from a variety of underlying causes:

Immobility: Prolonged bed rest or immobilization of joints leads to connective tissue remodeling and muscle shortening.
Neurological conditions: Spasticity caused by stroke, multiple sclerosis, cerebral palsy, or spinal cord injuries can result in contractures.
Burns: Scar tissue formed after severe burns contracts over time, restricting movement (known as a scar contracture).
Inflammatory conditions: Chronic joint inflammation such as rheumatoid arthritis can cause structural joint changes and contracture formation.
Muscle disorders: Certain muscle diseases (myopathies) predispose patients to contracture development.
Congenital causes: Some contractures are present at birth, such as in clubfoot (talipes equinovarus).

Symptoms

Common signs and symptoms of a contracture include:

Restricted or completely absent range of motion in the affected joint
Pain when attempting to move or stretch the joint
Visible deformity or abnormal positioning of the joint or limb
Muscle wasting (atrophy) in the affected area
Loss of function, such as difficulty gripping, walking, or performing daily activities
Pressure sores caused by abnormal positioning, particularly in bedridden patients

Diagnosis

Contractures are typically diagnosed through a clinical examination. The healthcare provider assesses the range of motion of the affected joint and compares it to normal values. Additional diagnostic tools may include:

Range of motion measurement: Standardized assessment of joint mobility measured in degrees.
Imaging studies: X-ray, ultrasound, or MRI to evaluate joint changes, bone structures, and soft tissues.
Neurological examination: If spasticity is suspected, muscle tone is assessed to identify the underlying cause.

Treatment

Treatment depends on the underlying cause, severity, and affected joint. The main goals are to restore or maintain joint mobility and to relieve pain.

Conservative Treatment

Physiotherapy: Regular passive and active stretching and mobilization exercises are the cornerstone of both prevention and treatment.
Splints and orthoses: Specialized splints or positioning aids keep joints in a functional position and prevent further shortening.
Occupational therapy: Supports daily functioning and independence.
Heat therapy: Applying heat can improve the extensibility of muscle and connective tissue and enhance the effect of stretching.
Medications: In spastic contractures, muscle relaxants (e.g., baclofen, tizanidine) or botulinum toxin injections may be used to reduce muscle tone.

Surgical Treatment

Tenotomy: Surgical cutting of shortened tendons to restore mobility.
Muscle and tendon lengthening: Surgical procedures to extend affected structures.
Scar correction: In burn-related contractures, plastic surgery may be necessary to release scar tissue.

Prevention

Contractures can often be prevented with early and consistent measures:

Regular movement and mobilization, especially for bedridden patients
Early physiotherapy following injuries or surgical procedures
Correct positioning and use of splints or orthoses
Consistent management of underlying conditions such as spasticity or joint inflammation

References

Pschyrembel Clinical Dictionary. 268th Edition. De Gruyter, Berlin 2020.
World Health Organization (WHO): Rehabilitation 2030 - A Call for Action. Geneva 2017. Available at: https://www.who.int/rehabilitation
Farmer SE, James M. Contractures in orthopaedic and neurological conditions: a review of causes and treatment. Disability and Rehabilitation, 2001; 23(13): 549-558.

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