Injections of obese stem cells have been proposed as an accelerator for wound healing with a better range of motion in patients with radiation-induced cervical burn contractures and as an alternative to surgical procedures.30 Because cerebral palsy prevents the leg muscles from being adequately stimulated, contractures often develop in the hips, knees and ankles. Clinical research suggests that patients with cerebral palsy may have up to a 75% decrease in satellite cells, which help repair muscle tissue and prevent muscle fibrosis or stiffening. Specific genes associated with collagen production are also altered, resulting in irregular changes in the extracellular matrix of muscles. In institutionalized elders, it was reported that 71% of those who were immobile had joint contracture, while all mobile patients remained free of contractures.10 In addition, three-quarters of institutionalized older adults with chronic health conditions were shown to have knee flexion contractures, and more than half of residents of medically fragile nursing homes report significant functional deficits with joint contractures.6 Similarly, one-third of intensive care patients develop joint contractures with a hospital stay of more than 2 weeks, and those with joint contractures developed in the intensive care unit had an associated mortality of about 3 years after discharge. To confirm a diagnosis of contracture, your doctor may also order imaging tests, such as: The rehabilitation team, consisting of a physiotherapist, physiotherapist, occupational therapist and recreational therapist, as well as people in social work and in the case management function, is the unit responsible for managing a patient`s contracture. These include assessment, therapeutic exercises, adaptive device setting, and treatment of functional limitations related to participation restrictions and improved quality of life. An injectable collagenase enzyme derived from the bacterium Clostridium histolyticum (Collagenase clostridium histolyticum) is approved by the FDA for the treatment of Dupuytren`s contracture and as an alternative to surgery. 22 The clinical result with collagenase injections is similar to surgery, but has fewer complications, faster recovery and is more bearable for patients. The limitations of collagenase injections are that they are usually in the same place, require monthly injections and are associated with a risk of autoimmune reaction with the injections. There is research that suggests that multiple injections may provide clinically significant results. 22 The concept of rheological change after UMN injury is supported by numerous studies.

Herman25 described changes in the rheological properties of spastic muscles in a study involving 220 hemiplegic patients. Patients with contracture often had decreased reflex activity, but resistance to passive stretching was high due to increased stiffness and tissue contracture.50 His study showed that an understanding of muscle tone should take into account the complex interaction between the rheological and spastic properties of muscle, as stretching reflexes themselves can be influenced by changes in the physical properties of muscle. muscle. Similarly, Dietz and Mitarbeiter29 in stroke and cerebral palsy, as well as Thilmann and Mitarbeiter31, argued that hypertension may not be related to exaggerated reflexes, but rather to decreased soft tissue compliance. O`Dwyer and colleagues suggested that what appears clinically as spasticity after stroke is actually an increase in muscle stiffness and contracture. They suggested, like others before, that mechanical and biological changes in soft tissues played an important role in resistance to passive and active movements. Hufschmidt and Mauritz28 suggested that abnormal transverse bridge connections between actin and myosin filaments could contribute to increased resistance to passive stretching, and that these changes would most likely occur in muscles exposed to prolonged firm positioning. Animal studies conducted by Akeson et al.52 have shown that immobility leads to rigidity associated with water loss and collagen deposits. Gossman et al.,53 Herbert,30 and Carey and Burghardt54 suggested in several ways that immobility imposed on a patient by the negative signs of UMN can lead to soft tissue contracture. Other animal studies have shown that some sarcomeres are lost and others become shorter and stiffer when muscles are immobilized in a shortened position55-57 (but see Chapter 13).

Soft tissues other than muscles become less conforming, even in chronically shortened positions. For this reason, surgical correction of severe contracture is limited to about half of the lost area, for fear of breaking the contracted nerves and closing the blood vessels. After surgery, these soft tissues require progressive stretching to achieve a reversal of the residual contracture. Severe muscle contractures may also be accompanied by skin contracture, which requires corrective plastic procedures. A clinical picture dominated by contracture does not respond to central muscle relaxants such as tizanidine and baclofen, peripheral relaxants such as dantrolene sodium, phenolic neurolysis or chemiodenervation with BoNT. Although physiotherapy and surgical methods have been the mainstay of contracture management, studies by Friden and Lieber58,59 in children with cerebral palsy indicate a process of structural remodeling of the contracted muscle that may require new management techniques (see Chapter 13). The main goal of contracture surgery is to restore a full range of movements in the affected area. Associated diseases include, but are not limited to, spasticity, heterotopic ossification, degenerative joint diseases, fractures, dislocations and cartilage fissures.

Some contractures result in abnormal positioning (p.B. in a wheelchair, in bed) and predispose to pressure sores. In general, deconditioning and loss of function often occur. This immobility exacerbates or creates new contractures, leading to a vicious circle that increases disability. Most contractures begin with an insult to the body. For example, the body`s response to a painful joint is to immobilize it, which puts it at risk of developing contracture. Neurological injuries that increase muscle tone or weakness cause a muscle imbalance that leads to tonic contraction. In this way, many joint contractures are preceded by spasticity. If left untreated, the spastic joint is immobilized and contracture develops.

With burns, direct thermal injuries lead to deformities of the hands and limbs. Subsequent scar contraction of the skin passing through a joint can also lead to immobility and contracture. Prevention of muscle wasting associated with prolonged immobilization If other treatments do not work, your doctor may suggest contracture surgery at: 40. Is there a difference between the use of high-intensity electrical stimulators and low-frequency or battery-powered stimulators in terms of quadriceps femorus muscular power production in the early stages of anterior cruciate ligament (ACL) rehabilitation? The soft tissue changes that contribute to contractures begin very soon after immobility begins. .