What is a Contracture
A contracture is a permanent or semi-permanent restriction in the range of motion (ROM) of a joint caused by shortening and stiffening of muscles, tendons, ligaments, or other soft tissues. 1, 2
Definition and Clinical Characteristics
- A contracture represents a fixed limitation in joint mobility that develops when soft tissues around a joint become shortened and lose their normal extensibility 2
- The condition is functionally defined as the presence of restricted ROM at a joint, though this definition varies across clinical studies 2
- Contractures cause pain and significantly impair self-care activities including dressing and hygiene 1
Pathophysiology and Development
- Contractures develop primarily from prolonged immobility, where muscles remain in a shortened position for extended periods 2
- After stroke with hemiparesis, 60% of patients develop joint contracture on the affected side within the first year, with wrist contractures being most common in patients without functional hand recovery 1
- The number of hours per day that a muscle stays in a shortened position directly determines the risk for contracture development 1
- Contracture severity increases with disease progression, including increasing age, muscle involvement, and decreasing functional ability 3
Common Locations
- Upper extremity: Wrist contractures occur most frequently in stroke patients lacking functional hand use; elbow contractures associate with spasticity present within the first 4 months post-stroke 1
- Lower extremity: Ankle plantarflexion contractures affect gait quality and safety 1
- Other joints: Hip, knee, finger joints, and spinal deformities can all develop contractures 1
Associated Conditions
- Contractures are particularly common in neuromuscular disorders and may serve as diagnostic clues in muscle diseases, some with important cardiac manifestations 4
- They occur frequently in elderly populations, with prevalence estimated at 55% in nursing home residents 2
- In Duchenne muscular dystrophy, contracture prevalence and severity increase with age and correlate with worse ambulatory function 3