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Physical Medicine and Rehabilitation... Feb 2012Mutations in the dystrophin gene cause Duchenne and Becker muscular dystrophy in humans and syndromes in mice, dogs, and cats. Affected humans and dogs have progressive... (Review)
Review
Mutations in the dystrophin gene cause Duchenne and Becker muscular dystrophy in humans and syndromes in mice, dogs, and cats. Affected humans and dogs have progressive disease that leads primarily to muscle atrophy. Mdx mice progress through an initial phase of muscle hypertrophy followed by atrophy. Cats have persistent muscle hypertrophy. Hypertrophy in humans has been attributed to deposition of fat and connective tissue (pseudohypertrophy). Increased muscle mass (true hypertrophy) has been documented in animal models. Muscle hypertrophy can exaggerate postural instability and joint contractures. Deleterious consequences of muscle hypertrophy should be considered when developing treatments for muscular dystrophy.
Topics: Animals; Contracture; Disease Models, Animal; Dystrophin; Humans; Hypertrophy; Kyphosis; Muscle Strength; Muscle, Skeletal; Muscular Dystrophies; Myostatin
PubMed: 22239881
DOI: 10.1016/j.pmr.2011.11.014 -
Advances in Therapy Aug 2013Joint contractures are relatively common disorders that can result in significant, long-term morbidity. Initial treatment is non-operative and often entails the use of... (Review)
Review
INTRODUCTION
Joint contractures are relatively common disorders that can result in significant, long-term morbidity. Initial treatment is non-operative and often entails the use of mechanical modalities such as dynamic and static splints. Although widely utilized, there is a paucity of data that support the use of such measures. The purpose of this systematic review was to evaluate the safety and efficacy of dynamic splinting as it is used to treat joint contracture in lower extremities, and to determine if duration on total hours of stretching had an effect on outcomes.
METHODS
Reviews of PubMed, Science Direct, Medline, AMED, and EMBASE websites were conducted to identify the term 'contracture reduction' in manuscripts published from January 2002 to January 2012. Publications selected for inclusion were controlled trials, cohort studies, or case series studies employing prolonged, passive stretching for lower extremity contracture reduction. A total of 354 abstracts were screened and eight studies (487 subjects) met the inclusion criteria. The primary outcome measure was change in active range of motion (AROM).
RESULTS
The mean aggregate change in AROM was 23.5º in the eight studies examined. Dynamic splinting with prolonged, passive stretching as home therapy treatment showed a significant direct, linear correlation between the total number of hours in stretching and restored AROM. No adverse events were reported.
DISCUSSION
Dynamic splinting is a safe and efficacious treatment for lower extremity joint contractures. Joint specific stretching protocols accomplished greater durations of end-range stretching which may be considered to be responsible for connective tissue elongation.
Topics: Contracture; Foot Joints; Humans; Knee Joint; Lower Extremity; Muscle Stretching Exercises; Range of Motion, Articular; Splints; Treatment Outcome
PubMed: 24018464
DOI: 10.1007/s12325-013-0052-1 -
International Orthopaedics 2001Winchester syndrome was first described in 1969 and since then nine patients have been reported in the literature. The syndrome is characterized by short stature, coarse...
Winchester syndrome was first described in 1969 and since then nine patients have been reported in the literature. The syndrome is characterized by short stature, coarse face, corneal opacities, generalized osteolysis and progressive painful arthropathy with joint stiffness and contractures of distal phalanges in combination with skin changes. The etiology is unknown. Parental consanguinity supports autosomal inheritance. The diagnosis is based on clinical and radiological manifestations. We describe a case in a 7-year-old Pakistani boy.
Topics: Abnormalities, Multiple; Arthritis; Child; Contracture; Corneal Diseases; Follow-Up Studies; Growth Disorders; Hand Deformities, Acquired; Humans; Infant; Male; Methotrexate; Orthopedic Procedures; Osteolysis, Essential; Radiography; Severity of Illness Index; Syndrome; Treatment Outcome
PubMed: 11794271
DOI: 10.1007/s002640100276 -
Journal of ISAKOS : Joint Disorders &... Feb 2024Stiff elbow is a complex condition whose diagnosis and management are sometimes quite a challenge. Compared to the other joints, the elbow is disproportionately affected...
Stiff elbow is a complex condition whose diagnosis and management are sometimes quite a challenge. Compared to the other joints, the elbow is disproportionately affected by loss of motion following trauma or surgery. It is unclear why the elbow tends to develop stiffness; its anatomical complexity, namely the presence of three highly congruent joints in the same capsule and synovial space, the tautness of the lateral and medial collateral ligaments through the whole range of motion, and the very close relationship among tendons, muscles, and skin 2 may account for this characteristic. In a stiff elbow, it is critical to assess the possible involvement of articular and periarticular tissues, particularly the degree of preservation of the articular surfaces and joint congruency. Morrey et al have classified post-traumatic stiff elbow into three types: 1) extrinsic contracture, which involves the soft tissue around the joint (capsule, ligaments, muscles) and heterotopic ossification across the joint, 2) intrinsic contracture, secondary to intra-articular fractures that have altered the anatomy of the articular surface, and 3) mixed contracture, combining intrinsic and extrinsic contracture. In the preoperative clinical assessment, we assume capsule contracture to be present in all patients with a stiff elbow. Two main associated lesions can affect prognosis and surgical management: heterotopic ossification and an altered bone joint anatomy. According to Morrey et al, most activities of daily living can be accomplished within an arc of motion from 30° to 130° in extension and flexion and of 50° in pronation and supination. The elbow arc of motion is not compensated for by the wrist and shoulder, thus loss of extension impairs the use of the hand in the space around the body and loss of flexion limits its use for grooming and self-care. The elbow should carefully be tested for deformity of the axial bone alignment (varus and valgus deformity) and rotational stability. Several treatment options are available for stiff elbow, from conservative management with a dedicated rehabilitation program to surgical treatment and from arthroscopic capsulectomy to joint replacement.
Topics: Animals; Humans; Elbow; Activities of Daily Living; Retrospective Studies; Contracture; Ossification, Heterotopic
PubMed: 37696358
DOI: 10.1016/j.jisako.2023.09.002 -
Chinese Journal of Traumatology =... Apr 2019The clinical treatment of joint contracture due to immobilization remains difficult. The pathological changes of muscle tissue caused by immobilization-induced joint...
The clinical treatment of joint contracture due to immobilization remains difficult. The pathological changes of muscle tissue caused by immobilization-induced joint contracture include disuse skeletal muscle atrophy and skeletal muscle tissue fibrosis. The proteolytic pathways involved in disuse muscle atrophy include the ubiquitin-proteasome-dependent pathway, caspase system pathway, matrix metalloproteinase pathway, Ca-dependent pathway and autophagy-lysosomal pathway. The important biological processes involved in skeletal muscle fibrosis include intermuscular connective tissue thickening caused by transforming growth factor-β1 and an anaerobic environment within the skeletal muscle leading to the induction of hypoxia-inducible factor-1α. This article reviews the progress made in understanding the pathological processes involved in immobilization-induced muscle contracture and the currently available treatments. Understanding the mechanisms involved in immobilization-induced contracture of muscle tissue should facilitate the development of more effective treatment measures for the different mechanisms in the future.
Topics: Atrophy; Autophagy; Calcium; Caspases; Connective Tissue; Contracture; Fibrosis; Humans; Immobilization; Joints; Lysosomes; Matrix Metalloproteinases; Muscle, Skeletal; Proteasome Endopeptidase Complex; Proteolysis; Signal Transduction; Transforming Growth Factor beta1; Ubiquitin
PubMed: 30928194
DOI: 10.1016/j.cjtee.2019.02.001 -
Hand (New York, N.Y.) Sep 2022This systematic review investigates complications and recurrence of Dupuytren's contracture in metacarpophalangeal joints (MCPJs) and/or proximal interphalangeal joints...
This systematic review investigates complications and recurrence of Dupuytren's contracture in metacarpophalangeal joints (MCPJs) and/or proximal interphalangeal joints (PIPJs) of fingers treated with collagenase clostridium histolyticum (CCH). A review of the literature on Dupuytren's disease was performed using PRISMA guidelines. Included publications described complications and/or recurrences for contractures ≥20° in MCPJs and/or PIPJs treated with CCH. Successful treatments reduced contractures to ≤5° immediately. Treatment-related adverse events (AEs) were classified as minor, major surgical, and major nonsurgical. Contracture recurrence involved return of fixed-flexion contracture ≥20° in a successfully treated finger in patients with ≥12 months of follow-up. Of 2675 patients (3753 joints), 94% experienced ≥1 treatment-related AE, most commonly peripheral edema (64%), pain in extremity (53%), and contusion (51%). Major surgical complications occurred in 9 patients (1.0%). Major nonsurgical complications occurred in 2 patients, specifically nonrupture tendon injury and anaphylaxis. Of 1488 patients (2069 joints), recurrences were reported in 23% of successfully treated joints (n = 466; 20% MCPJs, 28% PIPJs), on average 12 to 24 months after treatment. MCPJs achieved greater success than PIPJs in initial contracture reduction (77% versus 36%). CCH is a safe, effective treatment to improve hand function in Dupuytren's contracture. Most AEs are minor and self-resolving, although the risk of major AEs still exists. Following treatment, 23% of successfully treated joints experience recurrence, typically within 12 to 24 months but sometimes as early as 6 months. Surgeons are encouraged to discuss these risks with patients for shared decision-making regarding optimal treatment modalities.
Topics: Collagenases; Dupuytren Contracture; Humans; Injections, Intralesional; Microbial Collagenase; Recurrence
PubMed: 33478271
DOI: 10.1177/1558944720974119 -
Journal of Orthopaedic Research :... Aug 2021Coronal hip contracture induces pelvic obliquity in the presence of hip osteoarthritis (HOA), followed by the functional leg-length discrepancy. To promote accurate...
Coronal hip contracture induces pelvic obliquity in the presence of hip osteoarthritis (HOA), followed by the functional leg-length discrepancy. To promote accurate diagnosis of contracture and proper management of soft tissue release in total hip arthroplasty (THA), this study aimed to clarify the morphological features on plain radiographs that are related to contracture in patients with HOA. Two hundred forty-three hips of 231 patients with HOA who underwent primary THA were included in this study. Preoperative pelvic radiographs of the bilateral hips in maximum adduction and abduction were used to quantify contracture. Patients were grouped according to their contracture as having abduction contracture, adduction contracture, or minimal contracture. We investigated HOA, subluxation, anatomical factors, spinal factors, and the morphology of osteophytes at the inferomedial femoral head and compared parameters among groups to clarify the predictors of contracture. Eighteen hips (7.6%) were classified as having adduction contracture and 23 (9.4%) as having abduction contracture. Crowe classification, leg-length discrepancy, and osteophyte morphology showed significant correlations with adduction contracture. Factors significantly correlated with abduction contracture were offset difference, pelvic obliquity, functional femoral anteversion, and osteophyte morphology. Multivariate logistic regression analysis showed that the factor most strongly related to adduction contracture was Crowe III classification, whereas the strongest predictor of abduction contracture was osteophyte morphology. In conclusion, hip subluxation was related to the adduction contracture of the hip, whereas osteophyte morphology was related to abduction contracture.
Topics: Arthroplasty, Replacement, Hip; Contracture; Hip; Hip Dislocation, Congenital; Humans; Joint Dislocations; Leg Length Inequality; Osteoarthritis, Hip; Osteophyte; Retrospective Studies
PubMed: 33095496
DOI: 10.1002/jor.24891 -
Proceedings of the Royal Society of... Feb 1957
Topics: Arthritis; Contracture; Humans; Ultrasonic Therapy; Ultrasonics
PubMed: 13408213
DOI: No ID Found -
Journal of Plastic, Reconstructive &... May 2022Multiple studies have reported the effectiveness of treatment on contracture reduction in Dupuytren's disease. However, very few studies have attempted to quantify to...
Multiple studies have reported the effectiveness of treatment on contracture reduction in Dupuytren's disease. However, very few studies have attempted to quantify to which extent patient and disease characteristics influence the chance of achieving a straight finger after surgery. Therefore, the aim of this study is to explore to which extent pre-operative patient and disease characteristics can reliably predict a straight finger after surgery for Dupuytren's disease. In total, 812 and 281 patients, who underwent a limited fasciectomy or needle fasciotomy, respectively, were included in the final analyses. Analysis was performed using a logistic modeling framework. For both treatments, the combination of the extension deficit at baseline; which finger is most affected, which joint is most affected, and the number of affected fingers provided reliable predictions. Classical patient characteristics, such as age and sex, had no additional predictive value. The models presented in this study provide reliable predictions and could be helpful in informing patients and managing their expectations.
Topics: Dupuytren Contracture; Fasciotomy; Finger Joint; Fingers; Humans; Needles; Treatment Outcome
PubMed: 35370118
DOI: 10.1016/j.bjps.2021.11.087 -
Zhongguo Xiu Fu Chong Jian Wai Ke Za... Feb 2022To explore the effectiveness of thin free lateral femoral circumflex artery perforator flaps that dissected under the superficial fascia in repair of scar contracture...
OBJECTIVE
To explore the effectiveness of thin free lateral femoral circumflex artery perforator flaps that dissected under the superficial fascia in repair of scar contracture deformity in hand and foot.
METHODS
Between January 2017 and October 2020, 15 patients with scar contracture deformity in hand or foot were admitted. There were 9 males and 6 females; aged 6-42 years, with a median age of 23 years. Scar contracture lasted from 1 to 21 years, with a median of 13 years. There were 11 cases of scar contracture deformities in the hands and 4 cases in the feet, all of which showed different degrees of hand and foot joint dysfunction. After the scar contracture was released, the size of wounds ranged from 6 cm×4 cm to 9 cm×8 cm, including 12 cases with exposure of blood vessels, nerves, or tendons, and 4 cases with tendon defects. A thin free lateral circumflex femoral artery perforator flap that dissected under the superficial fascia was used to repair the wound. The size of flap ranged from 6.0 cm×5.0 cm to 10.0 cm×8.5 cm. Fascia strips were used to reconstruct tendons and the donor sites were sutured directly.
RESULTS
The venous vascular crisis occurred in 1 flap, and the flap survived successfully after treatment. The rest flaps survived well, and the wounds healed by first intention. All incisions at donor sites healed by first intention. All patients were followed up 6-12 months after operation, with an average of 9 months. The flaps were in good shape and texture. The functions of the affected hand had been restored to a large extent. According to the upper limb function evaluation standard of the Society of Hand Surgery of the Chinese Medical Association, 7 cases were excellent and 4 cases were good. The deformity of the toe joint of the affected foot significantly improved. No muscular hernia, sensory numbness, or other complications occurred at the donor sites.
CONCLUSION
The thin free lateral femoral circumflex artery perforator flap that dissected under the superficial fascia is an effective method to repair scar contracture deformity of hand and foot with well appearance, good function recovery, and less complication of the donor sites.
Topics: Adolescent; Adult; Child; Cicatrix; Contracture; Female; Femoral Artery; Hand; Humans; Male; Perforator Flap; Plastic Surgery Procedures; Skin Transplantation; Soft Tissue Injuries; Treatment Outcome; Upper Extremity; Young Adult
PubMed: 35172409
DOI: 10.7507/1002-1892.202109065