Kontraktur

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Kontraktur

  1. 1. dr Yuda Handaya, SpB,FInaCs,FMAS
  2. 2. <ul><li>Contractures are the chronic loss of joint motion </li></ul><ul><li>structural changes in non-bony tissue </li></ul><ul><li>These non-bony tissues include muscles, ligaments, and tendons. </li></ul>
  3. 4. <ul><li>C an occur at any joint of the body </li></ul><ul><li>This joint dysfunction may be a result of : </li></ul><ul><li>immobilization from injury or disease </li></ul><ul><li>nerve injury ( spinal cord damage & stroke ) </li></ul><ul><li>or muscle, tendon, or ligament disease. </li></ul>
  4. 5. <ul><li>Contractures may be caused by abnormalities of the structures surrounding a joint. These include: </li></ul><ul><ul><li>Deformity </li></ul></ul><ul><ul><li>Immobility </li></ul></ul><ul><ul><li>Injury </li></ul></ul><ul><ul><li>Chronic inflammation </li></ul></ul><ul><ul><li>Certain disorders that affect nerves and muscles almost always lead to contractures. For example: </li></ul></ul><ul><ul><ul><li>Muscular dystrophy </li></ul></ul></ul><ul><ul><ul><li>Cerebral palsy </li></ul></ul></ul><ul><ul><li>Contractures are often also associated with spasticity resulting from injuries to the central nervous system. </li></ul></ul>
  5. 6. <ul><li>Manual testing of joint mobility </li></ul><ul><li>Measuring the motion of the joint with a device termed a &quot;goniometer“ </li></ul><ul><li>X rays </li></ul><ul><li>physical examination involving physical and manual testing of the joint motion </li></ul>
  6. 7. <ul><li>A risk factor is something that increases your chances of getting a disease or condition. </li></ul><ul><li>Each of these conditions increases the risk for contractures: </li></ul><ul><ul><li>Rheumatoid arthritis </li></ul></ul><ul><ul><li>Tenosynovitis (inflammation of a tendon and its sheath) </li></ul></ul><ul><ul><li>Polio and other diseases of nerves and muscles </li></ul></ul><ul><ul><li>Trauma </li></ul></ul><ul><ul><li>Burns </li></ul></ul><ul><ul><li>Scarring </li></ul></ul><ul><ul><li>Prolonged inactivity </li></ul></ul>
  7. 9. <ul><li>The primary symptom </li></ul><ul><li>is loss of motion in a joint. </li></ul><ul><li>Pain can also be a major symptom </li></ul>
  8. 10. <ul><li>Manual techniques </li></ul><ul><li>Joint mobilization and stretching of soft tissues </li></ul><ul><li>Mechanical techniques </li></ul><ul><ul><li>continuous passive motion machines </li></ul></ul><ul><ul><li>following surgery of joints. </li></ul></ul><ul><ul><li>administered within the first 24-72 hours after the injury or surgery. </li></ul></ul><ul><ul><li>The joint is mechanically moved through the patient's tolerable motion. </li></ul></ul><ul><ul><li>CPM machines have been proved to accelerate the return motion process, allowing patients more function in less time. </li></ul></ul>
  9. 11. <ul><li>Casting or splinting </li></ul><ul><ul><li>used to provide a constant stretch to the soft tissues surrounding a joint. </li></ul></ul><ul><ul><li>initial holding cast is applied for seven to 10 days, a series of positional casts are applied at weekly intervals. </li></ul></ul><ul><li>Surgery </li></ul><ul><ul><li>manipulation of the joint under a general anesthesia </li></ul></ul><ul><li>Alternative treatment </li></ul><ul><ul><li>Massage therapy can be beneficial by promoting additional circulation to joint structures, causing better elasticity. </li></ul></ul><ul><ul><li>Yoga can help prevent as well as rehabilitate a contracture and can facilitate the return of joint mobility. </li></ul></ul>
  10. 12. <ul><li>Prevention of contractures depends on the cause. After acute injuries or orthopedic surgery, contractures may be prevented by: </li></ul><ul><ul><li>Early movement </li></ul></ul><ul><ul><li>Physical therapy </li></ul></ul><ul><ul><li>Continuous passive motion (CPM) machines, which mechanically keep joints in motion </li></ul></ul><ul><ul><li>Aggressive medical treatment of inflammatory conditions such as rheumatoid arthritis may also delay or prevent contractures. </li></ul></ul>
  11. 13. <ul><li>Prognosis </li></ul><ul><ul><li>D epend upon the cause of the contracture. </li></ul></ul><ul><ul><li>In general, the earlier the treatment for the contracture begins, the better the prognosis. </li></ul></ul><ul><li>Prevention </li></ul><ul><ul><li>program of positioning, splinting if appropriate, and range-of-motion exercises either manually or mechanically aided. </li></ul></ul><ul><ul><li>These activities should be started as early as possible for optimal results. </li></ul></ul>

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