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Journal of ISAKOS : Joint Disorders &... Apr 2024Stiffness is a clinical disorder that affects the patient's function of the entire upper limb. Many classifications systems have been developed for elbow stiffness based...
Stiffness is a clinical disorder that affects the patient's function of the entire upper limb. Many classifications systems have been developed for elbow stiffness based on the plane of motion, severity, aetiology, prognosis or anatomical location. A new classification, the Stiffness types and Influencing Factors Classification System, is proposed as a treatment algorithm to guide the surgical treatment and the preferred operative approach (open or arthroscopic).
Topics: Humans; Contracture; Elbow; Elbow Joint; Joint Diseases; Prognosis
PubMed: 37923144
DOI: 10.1016/j.jisako.2023.10.011 -
Gait & Posture Sep 2023Toe-walking is one of the most common gait deviations (due to soleus and/or gastrocnemius muscle contractures), compromising the first (heel rocker) and second (ankle...
BACKGROUND
Toe-walking is one of the most common gait deviations (due to soleus and/or gastrocnemius muscle contractures), compromising the first (heel rocker) and second (ankle rocker) of the foot during walking. The aim of this study is to evaluate the effect of emulated artificially gastrocnemius and soleus contractures on the first and second rocker during walking.
METHOD
An exoskeleton was built to emulate contractures of the bilateral gastrocnemius and soleus muscles. Ten healthy participants were recruited to walk under the following conditions: without emulated contractures or with bilateral emulated contractures at 0°,10°, 20° and 30° of plantarflexion of the soleus or gastrocnemius in order to create an artificial restriction of dorsiflexion ankle movement. A linear regression from the ankle plantar-dorsiflexion angle pattern was performed on 0-5 % of the gait cycle (first rocker) and on 12-31 % of the gait cycle (second rocker) to compute the slope of the curve. The proportion of participants with the presence of the first and second rocker was then computed. A Statistical Parametric Mapping (SPM) analysis assessed the kinematic variations among different degrees of emulated contractures.
FINDINGS
The first and second rockers are completely absent from 10° of plantarflexion emulated contracture. The data indicate there was a non-linear shift of the gait pattern of the ankle kinematics and an important shift toward plantarflexion values with the loss of the rockers.
INTERPRETATION
This study suggests that toe-walking in the experimental simulation situation is not necessarily due to a high emulated contracture level and can occur with a small emulated contracture by an adaptation choice. This study may improve interpretation of clinical gait analysis and shows that the link between the level of gastrocnemius/soleus emulated contracture and progression of toe-walking (increased plantarflexion during gait) is not linear.
Topics: Humans; Gait; Muscle, Skeletal; Walking; Contracture; Ankle Joint; Movement Disorders; Toes; Biomechanical Phenomena
PubMed: 37523808
DOI: 10.1016/j.gaitpost.2023.07.285 -
Mathematical Biosciences and... Dec 2023Dynamic orthoses have a significant effect on the treatment of elbow capsular contracture. Because of the lack of quantitative research on traction forces, determining...
Dynamic orthoses have a significant effect on the treatment of elbow capsular contracture. Because of the lack of quantitative research on traction forces, determining the appropriate traction force to help stretch soft tissues and maintain the joint's range of motion is a challenge in the rehabilitation process. We developed a human elbow finite element (FE) model incorporating the activity behavior of the muscles and considering different capsular contracture locations, including total, anterior and posterior capsular contractures, to analyze the internal biomechanical responses of different capsular contracture models during flexion (30 to 80 degrees). Traction loads of 10, 20, 30 and 40 N were applied to the ulna and radius at the maximum flexion angle (80 degrees) to explore the appropriate traction loads at week 4 after a joint capsule injury. We observed a significant increase in posterior capsule stress with anterior capsular contracture (ACC), and the maximum peak stress was 1.3 times higher than that in the healthy model. During the fourth week after elbow capsule injury, the appropriate traction forces for total capsule contracture (TCC), ACC and posterior capsule contracture (PCC) were 20, 10 and 20 N, respectively; these forces maintained a stable biomechanical environment for the elbow joint and achieved a soft tissue pulling effect, thus increasing elbow mobility. The results can be used as a quantitative guide for the rehabilitation physicians to determine the traction load for a specific patient.
Topics: Humans; Elbow; Traction; Elbow Joint; Contracture; Joint Capsule; Biomechanical Phenomena
PubMed: 38124605
DOI: 10.3934/mbe.2023949 -
Acta Orthopaedica Apr 2021Background and purpose - Joint contracture is a common problem among children with cerebral palsy (CP). To prevent severe contracture and its effects on adjacent joints,...
Background and purpose - Joint contracture is a common problem among children with cerebral palsy (CP). To prevent severe contracture and its effects on adjacent joints, it is crucial to identify children with a reduced range of motion (ROM) early. We examined whether significant hip, knee, or foot contracture occurs earliest in children with CP.Patients and methods - This was a longitudinal study involving 27,230 measurements obtained for 2,693 children (59% boys, 41% girls) with CP born 1990 to 2018 and registered before 5 years of age in the Swedish surveillance program for CP. The analysis was based on 4,751 legs followed up for an average of 5.0 years. Separate Kaplan-Meier (KM) curves were drawn for each ROM to illustrate the proportions of contracture-free legs at a given time during the follow-up. Using a clustered bootstrap method and considering the child as the unit of clustering, 95% pointwise confidence intervals were generated for equally spaced time points every 2.5 years for each KM curve.Results - Contracture developed in 34% of all legs, and the median time to the first contracture was 10 years from the first examination. Contracture was most common in children with a higher Gross Motor Function Classification System (GMFCS) level. The first contracture was a flexion contracture preventing dorsiflexion in children with GMFCS level I or II and preventing knee extension in children with GMFCS level III to V.Interpretation - Early interventions to prevent knee and foot contractures in children with CP should be considered.
Topics: Adolescent; Cerebral Palsy; Child; Child, Preschool; Contracture; Female; Foot Joints; Hip Joint; Humans; Knee Joint; Longitudinal Studies; Male; Sweden; Time Factors
PubMed: 33228441
DOI: 10.1080/17453674.2020.1848154 -
Burns : Journal of the International... Feb 2022The aim of this study was to assess the development of burn scar contractures and their impact on joint function, disability and quality of life in a low-income country.
The development of burn scar contractures and impact on joint function, disability and quality of life in low- and middle-income countries: A prospective cohort study with one-year follow-up.
OBJECTIVE
The aim of this study was to assess the development of burn scar contractures and their impact on joint function, disability and quality of life in a low-income country.
METHODS
Patients with severe burns were eligible. Passive range of motion (ROM) was assessed using lateral goniometry. To assess the development of contractures, the measured ROM was compared to the normal ROM. To determine joint function, the normal ROM was compared to the functional ROM. In addition, disability and quality of life (QoL) were assessed. Assessments were from admission up to 12 months after injury.
RESULTS
Thirty-six patients were enrolled, with a total of 124 affected joints. The follow-up rate was 83%. Limited ROM compared to normal ROM values was observed in 26/104 joints (25%) at 12 months. Limited functional ROM was observed in 55/115 joints (48%) at discharge and decreased to 22/98 joints (22%) at 12 months. Patients who had a contracture at 12 months reported more disability and lower QoL, compared to patients without a contracture (median disability 0.28 versus 0.17 (p = 0.01); QoL median 0.60 versus 0.76 (p = 0.001)). Significant predictors of developing joint contractures were patient delay and the percentage of TBSA deep burns.
CONCLUSION
The prevalence of burn scar contractures was high in a low-income country. The joints with burn scar contracture were frequently limited in function. Patients who developed a contracture reported significantly more disability and lower QoL. To limit the development of burn scar contractures, timely access to safe burn care should be improved in low-income countries.
Topics: Burns; Cicatrix; Contracture; Developing Countries; Follow-Up Studies; Humans; Prospective Studies; Quality of Life; Range of Motion, Articular
PubMed: 34716045
DOI: 10.1016/j.burns.2021.04.024 -
The Knee Jun 2020To investigate the effects of ultrashort wave treatment on joint dysfunction and muscle atrophy in a rabbit model of extending knee joint contracture.
Effect of ultrashort wave treatment on joint dysfunction and muscle atrophy in a rabbit model of extending knee joint contracture: Enhanced expression of myogenic differentiation.
OBJECTIVE
To investigate the effects of ultrashort wave treatment on joint dysfunction and muscle atrophy in a rabbit model of extending knee joint contracture.
METHODS
Forty rabbits were randomly divided into eight groups. In group C, the left knee joint was not fixed. In group I-8, the left knee joint was only fixed for eight weeks. In groups R-1, R-2, and R-4, the left knee joint was fixed for eight weeks before the rabbits underwent one, two, and four weeks of self-recovery, respectively. In groups T-1, T-2, and T-4, the left knee joint was fixed for eight weeks before the rabbits underwent one, two, and four weeks of ultrashort wave treatment, respectively. The degree of total contracture and myogenic contracture were measured, the cross-sectional area (CSA) and protein levels for myogenic differentiation (MyoD) of the rectus femoris were evaluated.
RESULTS
There was a tendency toward a reduced degree of total and myogenic contracture, and also a tendency toward an increased CSA of the rectus femoris and increased protein levels for MyoD after both self-recovery and ultrashort wave treatment. The ultrashort wave was more effective than self-recovery in reducing the total and myogenic contracture, and increasing the CSA and MyoD protein levels of the rectus femoris.
CONCLUSIONS
Ultrashort wave treatment may ameliorate joint dysfunction and muscle atrophy by upregulating the expression of MyoD protein in a rabbit model of extending knee joint contracture.
Topics: Animals; Contracture; Disease Models, Animal; Joint Diseases; Knee Joint; Male; Muscular Atrophy; MyoD Protein; Quadriceps Muscle; Rabbits; Short-Wave Therapy
PubMed: 32201041
DOI: 10.1016/j.knee.2020.02.013 -
Journal of Shoulder and Elbow Surgery Mar 2018Post-traumatic elbow contracture is a debilitating complication after elbow trauma. The purpose of this study was to characterize the affected patient population,...
BACKGROUND
Post-traumatic elbow contracture is a debilitating complication after elbow trauma. The purpose of this study was to characterize the affected patient population, operative management, and outcomes after operative elbow contracture release for treatment of post-traumatic elbow contracture.
METHODS
A retrospective record review was conducted to identify all patients who underwent post-traumatic elbow contracture release performed by 1 of 3 surgeons at one academic medical center. Patient demographics, injuries, operative details, outcomes, and complications were recorded.
RESULTS
The study included 103 patients who met inclusion criteria. At the time of contracture release, patients were a mean age of 45.2 ± 15.6 years. Contracture release resulted in a significant mean increase to elbow extension/flexion arc of motion of 52° ± 18° (P < .0005). Not including recurrence of contracture, a subsequent complication occurred in 10 patients (10%). Radiographic recurrence of heterotopic ossification (HO) occurred in 14 patients (14%) after release. Ten patients (11%) elected to undergo a secondary operation to gain more motion.
CONCLUSION
Soft tissue and bony elbow contracture release is effective. Patients with post-traumatic elbow contracture can make significant gains to their arc of motion after contracture release surgery and can expect to recover a functional elbow arc of motion. Patients with severe preoperative contracture may benefit from concomitant ulnar nerve decompression. HO prophylaxis did not affect the rate of HO recurrence or ultimate elbow range of motion. However, patients must be counseled that contracture may reoccur, and some patients may require or elect to have more than one procedure to achieve functional motion.
Topics: Adult; Aged; Aged, 80 and over; Contracture; Elbow Joint; Female; Humans; Male; Middle Aged; Orthopedic Procedures; Ossification, Heterotopic; Range of Motion, Articular; Recurrence; Retrospective Studies; Young Adult
PubMed: 29290605
DOI: 10.1016/j.jse.2017.10.023 -
The Journal of Physiology Feb 2017Muscle contractures are common in patients with central motor lesions, but the mechanisms responsible for the development of contractures are still unclear. Increased or... (Review)
Review
Muscle contractures are common in patients with central motor lesions, but the mechanisms responsible for the development of contractures are still unclear. Increased or decreased neural activation, protracted placement of a joint with the muscle in a short position and muscle atrophy have been suggested to be involved, but none of these mechanisms are sufficient to explain the development of muscle contractures alone. Here we propose that changes in tissue homeostasis in the neuromuscular-tendon-connective tissue complex is at the heart of the development of contractures, and that an integrated physiological understanding of the interaction between neural, mechanical and metabolic factors, as well as genetic and epigenetic factors, is necessary in order to unravel the mechanisms that result in muscle contractures. We hope thereby to contribute to a reconsideration of how and why muscle contractures develop in a way which will open a window towards new insight in this area in the future.
Topics: Animals; Calcium Signaling; Central Nervous System Diseases; Contracture; Humans; Mechanotransduction, Cellular; Muscle, Skeletal
PubMed: 27779750
DOI: 10.1113/JP272767 -
Physiological Research Jul 2022Therapeutic approaches to treat joint contracture after anterior cruciate ligament (ACL) reconstruction have not been established. Arthrofibrosis accompanied by joint...
Therapeutic approaches to treat joint contracture after anterior cruciate ligament (ACL) reconstruction have not been established. Arthrofibrosis accompanied by joint inflammation following ACL reconstruction is a major cause of arthrogenic contracture. In this study, we examined whether anti-inflammatory treatment using low-level laser therapy (LLLT) can prevent ACL reconstruction-induced arthrogenic contracture. Rats underwent ACL transection and reconstruction surgery in their right knees. Unoperated left knees were used as controls. After surgery, rats were reared with or without daily LLLT (wavelength: 830 nm; power output: 150 mW; power density: 5 W/cm2; for 120 s/day). We assessed the passive extension range of motion (ROM) after myotomy at one and two weeks post-surgery; the reduction in ROM represents the severity of arthrogenic contracture. ROM was markedly decreased by ACL reconstruction at both time points; however, LLLT partially attenuated the decrease in ROM. One week after ACL reconstruction, the gene expression of the proinflammatory cytokine interleukin-1beta in the joint capsule was significantly upregulated, and this upregulation was significantly attenuated by LLLT. Fibrotic changes in the joint capsule, including upregulation of collagen type I and III genes, shortening of the synovium, and thickening were caused by ACL reconstruction and seen at both time points. LLLT attenuated these fibrotic changes as well. Our results indicate that LLLT after ACL reconstruction could attenuate the formation of arthrogenic contracture through inhibition of inflammation and fibrosis in the joint capsule. Thus, LLLT may become a novel therapeutic approach for ACL reconstruction-induced joint contracture.
Topics: Animals; Anterior Cruciate Ligament Injuries; Anterior Cruciate Ligament Reconstruction; Contracture; Fibrosis; Inflammation; Knee Joint; Low-Level Light Therapy; Range of Motion, Articular; Rats
PubMed: 35616040
DOI: 10.33549/physiolres.934796 -
Connective Tissue Research Nov 2023Joint contractures after anterior cruciate ligament (ACL) reconstruction are a serious problem. Given the uncertain effects of weight bearing after ACL reconstruction on...
PURPOSE
Joint contractures after anterior cruciate ligament (ACL) reconstruction are a serious problem. Given the uncertain effects of weight bearing after ACL reconstruction on contractures, this study was conducted to examine such effects.
MATERIALS AND METHODS
To control the amount of weight bearing, ACL-reconstructed rats were reared with either untreated (small weight bearing; weight bearing during locomotion was 54% of pre-surgery at minimum), hindlimb unloading (non-weight bearing), or sustained morphine administration (large weight bearing; weight bearing during locomotion was maintained at 80% or more of pre-surgery) conditions. Untreated rats were used as controls. Knee extension range of motions (ROMs) before (includes myogenic and arthrogenic factors) and after myotomy (includes arthrogenic factor only) and fibrotic reactions in the joint capsule were assessed 7 and 14 days post-surgery.
RESULTS
ACL reconstruction significantly reduced ROMs both before and after myotomy and induced fibrosis in the joint capsule accompanying upregulation of fibrosis-related genes (i.e., and and ) at both time points. Morphine administration increased the ROM before myotomy, but not after myotomy 7 days post-surgery. Unloading after ACL reconstruction improved ROMs both before and after myotomy at both time points. In addition, unloading after ACL reconstruction attenuated fibrotic reactions in the joint capsule.
CONCLUSIONS
Our results suggest that morphine administration improves myogenic contractures in parallel with an increase in the amount of weight bearing. Unloading after ACL reconstruction is effective in reducing both myogenic and arthrogenic contractures.
Topics: Rats; Animals; Knee Joint; Contracture; Fibrosis; Weight-Bearing; Morphine Derivatives; Anterior Cruciate Ligament Injuries
PubMed: 37403736
DOI: 10.1080/03008207.2023.2232881