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Orthopaedics & Traumatology, Surgery &... Feb 2015Post-traumatic knee stiffness and loss of range of motion is a common complication of injuries to the knee area. The causes of post-traumatic knee stiffness can be... (Review)
Review
Post-traumatic knee stiffness and loss of range of motion is a common complication of injuries to the knee area. The causes of post-traumatic knee stiffness can be divided into flexion contractures, extension contractures, and combined contractures. Post-traumatic stiffness can be due to the presence of dense intra-articular adhesions and/or fibrotic transformation of peri-articular structures. Various open and arthroscopic surgical treatments are possible. A precise diagnosis and understanding of the pathology is mandatory prior to any surgical treatment. Failure is imminent if all pathologies are not addressed correctly. From a general point of view, a flexion contracture is due to posterior adhesions and/or anterior impingement. On the other hand, extension contractures are due to anterior adhesions and/or posterior impingement. This overview will describe the different modern surgical techniques for treating post-traumatic knee stiffness. Any bony impingements must be treated before soft tissue release is performed. Intra-articular stiff knees with a loss of flexion can be treated by an anterior arthroscopic arthrolysis. Extra-articular pathology causing a flexion contracture can be treated by open or endoscopic quadriceps release. Extension contractures can be treated by arthroscopic or open posterior arthrolysis. Postoperative care (analgesia, rehabilitation) is essential to maintaining the range of motion obtained intra-operatively.
Topics: Arthroscopy; Contracture; Humans; Knee Injuries; Knee Joint; Orthopedic Procedures; Pain Management; Physical Therapy Modalities; Postoperative Care; Radiography; Range of Motion, Articular; Tissue Adhesions; Treatment Outcome; Wounds and Injuries
PubMed: 25583236
DOI: 10.1016/j.otsr.2014.06.026 -
Connective Tissue Research Jan 2019Large joint arthrofibrosis and scarring, involving the shoulder, elbow, hip, and knee, can result in the loss of function and immobility. The pathway of joint... (Review)
Review
Large joint arthrofibrosis and scarring, involving the shoulder, elbow, hip, and knee, can result in the loss of function and immobility. The pathway of joint contracture formation is still being elucidated and is due to aberrations in collagen synthesis and misorientation of collagen fibrils. Novel antibodies are being developed to prevent arthrofibrosis, and current treatment methods for arthrofibrosis include medical, physical, and surgical treatments. This article describes the biology of joint contracture formation, along with current and future pharmacologic, biologic, and medical interventions.
Topics: Adrenal Cortex Hormones; Animals; Cicatrix; Contracture; Fibrosis; Humans; Joints
PubMed: 30173570
DOI: 10.1080/03008207.2018.1517759 -
The Pan African Medical Journal 2022
Topics: Humans; Contracture; Hand; Finger Joint; Fingers
PubMed: 36845230
DOI: 10.11604/pamj.2022.42.239.36313 -
Foot and Ankle Clinics Mar 2018Metatarsalgia is a common cause of plantar forefoot pain. Causes of metatarsalgia include foot anatomy, gait mechanics, and foot and ankle deformity. One specific cause,... (Review)
Review
Metatarsalgia is a common cause of plantar forefoot pain. Causes of metatarsalgia include foot anatomy, gait mechanics, and foot and ankle deformity. One specific cause, mechanical metatarsalgia, occurs because of gastrocnemius muscle contracture, which overloads the forefoot. Muscular imbalance of the gastrocnemius complex alters gait mechanics, which increases recruitment of the toe extensor musculature, thereby altering forefoot pressure. Patients with concomitant metatarsalgia and gastrocnemius contracture demonstrate ankle equinus and a positive Silfverskiold test. Nonoperative therapeutic modalities are mainstays of treatment. In patients in whom these treatments fail to provide metatarsalgia symptomatic relief, gastrocnemius muscle lengthening is a therapeutic option.
Topics: Ankle Joint; Contracture; Endoscopy; Humans; Metatarsalgia; Muscle, Skeletal; Postoperative Complications; Tenotomy
PubMed: 29362034
DOI: 10.1016/j.fcl.2017.09.006 -
Clinical Rehabilitation Mar 2021Does early treatment of spasticity with botulinum-toxin (BoNTA), in (hyper)acute stroke patients without arm-function, reduce contractures and improve function. (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
Does early treatment of spasticity with botulinum-toxin (BoNTA), in (hyper)acute stroke patients without arm-function, reduce contractures and improve function.
DESIGN
Randomised placebo-controlled-trial.
SETTING
Specialised stroke-unit.
PARTICIPANTS & INTERVENTION
Patients with an Action Research Arm Test (ARAT) grasp-score⩽2 who developed spasticity within six-weeks of a first stroke were randomised to receive injections of: 0.9%sodium-chloride solution (placebo) or onabotulinumtoxin-A (treatment).
OUTCOME-MEASURES
Spasticity, contractures, splint use and arm function (ARAT) were taken at baseline, 12-weeks post-injection and six-months after stroke. Additionally, spasticity and contractures were measured at weeks-two, four and six post-injection.
RESULTS
Ninety three patients were randomised. Mean time to intervention was 18-days (standard deviation = 9.3). Spasticity was lower in the treatment group with difference being significant between week-2 to 12 (elbow) and week-2 to 6 (wrist). Mean-difference (MD) varied between -8.5(95% CI -17 to 0) to -9.4(95% CI -14 to -5) µV.Contracture formation was slower in the treatment group. Passive range of motion was higher in the treatment group and was significant at week-12 (elbow MD6.6 (95% CI -0.7 to -12.6)) and week-6 (wrist MD11.8 (95% CI 3.8 to 19.8)). The use of splints was lower in the treatment group odds ratio was 7.2 (95% CI 1.5 to 34.1) and 4.2 (95% CI 1.3 to 14.0) at week-12 and month-6 respectively.Arm-function was not significantly different between the groups MD2.4 (95% CI -5.3 to 10.1) and 2.9 (95% CI -5.8 to 11.6) at week-12 and month-6 respectively.
CONCLUSION
BoNTA reduced spasticity and contractures after stroke and effects lasted for approximately 12-weeks. BoNTA reduced the need for concomitant contracture treatment and did not interfere with recovery of arm function.
TRIAL REGISTRATION
EudraCT (2010-021257-39) and ClinicalTrials.gov-Identifier: NCT01882556.
Topics: Aged; Aged, 80 and over; Botulinum Toxins, Type A; Contracture; Female; Hand Strength; Humans; Male; Middle Aged; Muscle Spasticity; Neuromuscular Agents; Splints; Stroke; Wrist Joint
PubMed: 33040610
DOI: 10.1177/0269215520963855 -
Hand Clinics May 2018Proximal interphalangeal joint (PIPJ) flexion contracture is a challenging and often frustrating problem. Treatment of PIPJ contracture begins with conservative... (Review)
Review
Proximal interphalangeal joint (PIPJ) flexion contracture is a challenging and often frustrating problem. Treatment of PIPJ contracture begins with conservative measures. With good compliance and prolonged use, favorable results can be achieved using these modalities. For contractures that fail to respond to conservative treatment, surgical intervention can be considered. The affected structures that can be released during surgery include the accessory collateral ligaments, volar plate, checkrein ligaments, retinacular ligaments, and the flexor and extensor tendons. A stepwise approach to release is typically favored in which active motion is tested after each release to determine the need for subsequent releases.
Topics: Casts, Surgical; Contracture; Finger Joint; Humans; Orthopedic Procedures; Splints
PubMed: 29625642
DOI: 10.1016/j.hcl.2017.12.012 -
Plastic and Reconstructive Surgery Nov 2021Treatment of boutonniere Dupuytren disease is rare and is resistant to treatment because of altered tendon dynamics. The authors used a small dose of collagenase...
SUMMARY
Treatment of boutonniere Dupuytren disease is rare and is resistant to treatment because of altered tendon dynamics. The authors used a small dose of collagenase clostridium histolyticum for an enzymatic tenotomy of the distal interphalangeal joint and showed that hyperextension at the distal interphalangeal joint improved significantly. Fifteen patients with boutonniere Dupuytren disease with severe proximal interphalangeal joint contractures averaging -69 degrees of extension were included in the study. Ten patients had at least one previous intervention, including surgical fasciectomy, Digit Widget treatment, and needle aponeurotomy. Collagenase clostridium histolyticum enzymatic tenotomy was performed in-office as a wide-awake procedure. All patients received varying doses of collagenase clostridium histolyticum for volar Dupuytren disease enzymatic fasciotomy and 0.1 mg of collagenase clostridium histolyticum into the distal extensor tendon for tenotomy to treat boutonniere deformity at the same time. Collagenase clostridium histolyticum enzymatic tenotomy significantly improved total active motion of the finger by 41.0 degrees (p = 0.001). Loss of extension at both the metacarpophalangeal joint and the proximal interphalangeal joint also improved with gains of 11.7 (p = 0.04) and 20.7 degrees (p = 0.0005) of extension, respectively. The average distal interphalangeal joint hyperextension was improved from 29.7 degrees to 14.0 degrees (p = 0.002). The authors show that collagenase injection led to significant average improvement in joint contracture at all finger joints and significantly increased the arc of motion at the proximal interphalangeal joint and metacarpophalangeal joint. Although collagenase has been previously used for flexion contractures in Dupuytren disease, we believe it has a role in treating the distal interphalangeal joint hyperextension deformity associated with boutonniere deformity in Dupuytren disease as well.
CLINICAL QUESTION/LEVEL OF EVIDENCE
Therapeutic, IV.
Topics: Aged; Aged, 80 and over; Dupuytren Contracture; Female; Finger Joint; Follow-Up Studies; Humans; Injections, Intralesional; Male; Microbial Collagenase; Middle Aged; Range of Motion, Articular; Retrospective Studies; Tendons; Tenotomy; Treatment Outcome
PubMed: 34705780
DOI: 10.1097/PRS.0000000000008480 -
Hand Clinics May 2018The management of congenital proximal interphalangeal joint deformity, also known as camptodactyly, is challenging. There are numerous theories on the cause of this... (Review)
Review
The management of congenital proximal interphalangeal joint deformity, also known as camptodactyly, is challenging. There are numerous theories on the cause of this abnormal finger posture, leading to variations in classification, definition, and treatment approaches. This article assesses the previous literature and provides clarity and guidance for the practical treatment of camptodactyly.
Topics: Contracture; Diagnosis, Differential; Finger Joint; Hand Deformities, Congenital; Humans; Muscle Stretching Exercises; Orthopedic Procedures; Physical Examination; Postoperative Care; Splints
PubMed: 29625643
DOI: 10.1016/j.hcl.2017.12.013 -
American Journal of Orthopedics (Belle... 2017
Topics: Arthroscopy; Contracture; Elbow Joint; Humans; Range of Motion, Articular; Recovery of Function
PubMed: 29099884
DOI: No ID Found -
The Orthopedic Clinics of North America Jul 2014Throwers, or athletes who engage in repetitive overhead motions, are a unique subset of athletes that experience distinct shoulder injuries. Athletes engaged in baseball... (Review)
Review
Throwers, or athletes who engage in repetitive overhead motions, are a unique subset of athletes that experience distinct shoulder injuries. Athletes engaged in baseball comprise the majority of patients seeking orthopedic care for throwing related injuries. Injuries specific to throwers most commonly involve the labrum and the undersurface of the rotator cuff. In addition, tissue changes in both the anterior and posterior glenohumeral capsule are common with repetitive overhead motions. These capsular changes alter. This article will examine the pathomechanics of injuries to throwers, elaborate means of diagnoses of cuff and labral injury and discuss recent advances in both non-operative and operative interventions, including preventative principles.
Topics: Arm; Athletic Injuries; Biomechanical Phenomena; Bone Retroversion; Contracture; Hip; Humans; Joint Capsule; Rotation; Rotator Cuff Injuries; Shoulder Injuries; Shoulder Joint
PubMed: 24975765
DOI: 10.1016/j.ocl.2014.04.003