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Physical Examination of the Hand
Published in J. Terrence Jose Jerome, Clinical Examination of the Hand, 2022
The spastic deformities should be differentiated from muscle contractures. In a relaxed patient with spastic deformity, the passive range of movements are full and normal at the affected joint. Muscle or joint contracture has restricted passive movements in the affected joints. Spasticity is classically classified by the number of limbs involved: Monoplegia (one extremity), hemiplegia (one arm, one leg), diplegia (two legs), triplegia (two legs, one arm) and quadriplegia (all four extremities). Motor function is also classified as spastic, flaccid and athetoid. Many patients have a combination of movement patterns (Table 3.3).Hand fractures
Diagnosis and Treatment Model of the COVID-19 Rehabilitation Unit
Published in Wenguang Xia, Xiaolin Huang, Rehabilitation from COVID-19, 2021
Joint contracture refers to the limitation of the active and passive range of joint motion due to the inactive state of patient’s joints, muscles, and soft tissues. Joint contractures can be caused by pain, poor posture for a long time, fear of increased oxygen consumption by activities, and psychological factors. The pathological basis of contracture caused by any reason is the abnormality of collagen tissue. Long-term immobilization can cause inflammatory changes in the joints, resulting in intra-articular adhesions, proliferation, and bursa’s fibrosis. Simultaneously, joint fixation can lead to changes in the synovium and proliferation and shortening of collagen in the joints, which can cause joint contractures. The essence of contracture is connective tissue abnormality, including abnormality of collagen and matrix, and the two influence each other. Active and passive exercises are the simplest means to deal with contractures, which have preventive and therapeutic effects.
Principles of lower limb prosthetics and rehabilitation
Published in Maneesh Bhatia, Essentials of Foot and Ankle Surgery, 2021
Rajiv S Hanspal, John Sullivan
The amputee's general medical condition, physical fitness and cognitive status will influence the outcome in terms of prosthetic rehabilitation and mobility. Many amputees who are systemically unwell will not have the required level of fitness to follow a prosthetic rehabilitation pathway. It has been shown that there is a positive linear relationship between cognitive ability and level of mobility achievable with a prosthesis (8). Sensory impairment, especially visual impairment and neglect, may be additional problems to overcome. Cardiorespiratory fitness is important because of the additional energy required for walking with a prosthesis (9). Musculoskeletal impairment including motor weakness and joint contractures especially in the lower limbs will impair mobility. Upper limb problems like weak grasp or lack of dexterity make independent donning and doffing difficult. Coexisting medical problems such as heart failure or renal impairment can affect the socket fit due to associated peripheral oedema and fluctuating stump volume. All these factors need to be considered when assessing the amputee and setting expectations and realistic goals. The aim however should be a return to maximum independence and participation in society.
Factors associated with upper extremity contractures after cervical spinal cord injury: A pilot study
Published in The Journal of Spinal Cord Medicine, 2018
Dustin Hardwick, Anne Bryden, Gina Kubec, Kevin Kilgore
Spinal cord injury (SCI) is the second leading cause of paralysis, with approximately 1.3 million people living with paralysis due to SCI. Joint contractures, reported to affect as much as 85% of persons with SCI, is a common complication in SCI.1–3 Joint contractures are an insidious co-morbidity of spinal cord injury that can lead to pain, deformity, loss of function, chronic pain, skin breakdown, sleep disturbance, increased caregiver needs, difficulty with bladder and bowel management, and ultimately contribute to decreased levels of independence and an overall lower quality of life.4,5 Furthermore, joint contractures may exclude individuals for eligibility or limit potential functional gains from upper extremity reconstruction surgery such as tendon transfers.6 Wrist and hand contractures may exclude individuals from tendon transfer surgeries aimed at restoring pinch and grasp. Elbow and shoulder joint contractures limit reach and workspace for the hand limiting function even if grasp is restored through tendon transfer and may exclude individuals from eligibility for tendon transfers to restore elbow extension.7–9
Knee and foot contracture occur earliest in children with cerebral palsy: a longitudinal analysis of 2,693 children
Published in Acta Orthopaedica, 2021
Erika Cloodt, Philippe Wagner, Henrik Lauge-Pedersen, Elisabet Rodby-Bousquet
Joint contracture prevents mechanical alignment of the joints, which affects standing and lying positions, and the quality and energy cost of gait (Raja et al. 2007). Contracture of the foot, knee, or hip joint may also affect adjacent joints and lead to severe postural asymmetries, windswept hips, and scoliosis (Agustsson et al. 2017, 2018, Pettersson et al. 2020). Contracture is often associated with pain, which occurs most frequently in the lower limbs of children with CP (Alriksson-Schmidt and Hägglund 2016, Blackman et al. 2018). To prevent severe joint contracture and reduce its effects on adjacent joints, it is crucial to identify children with reduced range of motion (ROM) to begin targeted treatment early (Chan and Miller 2014).
Parent Carer Quality of Life and Night-Time Attendance in Non-Ambulant Youth with Neuromuscular Disorders
Published in Developmental Neurorehabilitation, 2021
Vivienne Travlos, Shane Patman, Jenny Downs, Dana Hince, Andrew C. Wilson
In the absence of standardized descriptors of severity of joint contracture, novel descriptors relating to functional limitation were developed for this study. The number of severe joint contractures was totaled from responses to “very tight” descriptors of range of motion for shoulder elevation, elbow flexion and extension, hip extension, knee flexion and extension, and ankle dorsiflexion (for example, contracture at the right ankle joint was described as 0 = “flexible in all directions”, 1 = “a bit tight: I can get normal shoes on and rest my right foot on my wheelchair footplates”, 2 = “very tight: I can’t get normal shoes on and my right foot hangs off my footplate/I can’t use footplates”.)