Myotatic contracture occurs in muscles that are not allowed to function in their full range of motion. The muscle tends to lose its stretching reflex abilities and there is a gradual shortening of the muscle. Pain or immobilization of a room over a long period of time leads to myotatic contracture.64 As a rule, contracture mainly affects one joint of the limb, so flexor contracture is described according to the main joint involved: carpal contracture (knee), ankle contracture or contracture of the coffin joint. The paster compound may also be involved in the contracture of the ankle or joint of the coffin. The following postures are typical: their characteristic is the fact that the contracture is of voluntary origin. With the exception of the joint contracture of the coffin, the hoof is rarely strongly affected by the contracture of the flexor. Hoof manipulation can be a component of treating ankle contractures and paster joint, so the following discussion focuses on flexor contracture of the ankle, paster and coffin joints. The management of other types of flexor contractures is discussed elsewhere.11 Campbell TM, Dudek N, Trudel G. Joint contractures. In: Frontera, WR, Silver JK, Rizzo TD Jr, ed. Grundlagen der physikalische Medizin und Rehabilitation. 4th edition Philadelphia, PA: Elsevier; 2019: Ch.
127 Contractures can also be due to ischemia (restriction of blood flow), which leads to the death of muscle tissue, as in Volkmann`s contracture. They can also be caused by excessive accumulation of myofibroblasts and matrix metalloproteinase in the edges of the wound after an injury. Before considering surgical treatment for contractures, the clinician, patient and family should set goals for the procedure and identify possible complications. The goal of surgery may be to facilitate transfers, positioning, and hygiene for caregivers, rather than restoring the ability to walk. For example, Forst and Forst (1995) identified an extension of assisted standing with the lower limbs, which are free of contractures and deformations, as a reasonable objective compared to an extension of walking ability. Joint stretching is the main treatment for established contractures. An aggressive stretching program can be useful for restoring the ROM after the development of contractures. Most recommend that the stretching program be slow, long, regular and frequent. Series casting may be advantageous for longer and continuous stretching of joints (Kottke et al., 1966; Tardieu et al., 1988; Hurvitz, 1989). However, serial watering is not without possible complications – special care should be taken to monitor skin loss, irritation and pain. The exposure of this tonic by a voluntary effort underlines its distinction with the contracture. Rupture of the common digital extender tendon (CDET) can occur with significant carpal contracture and has been reported in conjunction with hypothyroidism, forelimb contracture and mandibular prognathia.
In the chewing muscles, this problem occurs secondarily to the inability of patients to fully open their mouth. Patients often report that they avoid opening widely for fear of hearing clicks or crepi tus, while others may not open far due to pain. Over time, this practice leads to the development of an addiction-free protective pattern that causes myotatic contracture. Similarly, limited movement of the cervical region leads to myotatic contracture. This condition is relieved by treatment. Contracture in the forelimb has most often been reported in the infraspinatus muscle. Infraspinatus contracture causes a slight lameness, especially in hunting or working dogs. The cause is believed to be acute muscle trauma, which leads to incomplete rupture of the infraspinatus muscle.
The injury leads to inflammation and subsequent compartment syndrome.28-30 Replacing muscle fibers with fibrous tissue occurs over days or weeks. Supraspinatus and deltoid muscles can also be affected and have atrophy or contracture.31 The humerus is kept in adduction while the antecedrum is turned outwards, the foot being drained. The joint of the shoulder blade can not expand completely. There is a bearing lameness, in which the limb turns when pushed forward during the step, and the paw tilts into the extension before the foot is placed. Fetus contracture – the horse stands with a reduced angle at the level of the fetus (i.e. straight or straight through the fetus) and “loop” or “ankles” often forward at the level of the fetus; In severe cases, the horse is permanently bent forward with the fetus (that is, in a partially bent position); Physical rehabilitation can be beneficial if the condition is diagnosed early. Continuous therapeutic ultrasound with stretching exercises can help lengthen the contracted tissues, but the degree of contracture at the time of diagnosis is usually so strong that it is difficult to improve the condition.3 When the dog is presented with contracture, the treatment of choice is a surgical cut of the infraspinatus tendon and associated fibrous tissue.31 This immediately restores the movement of the shoulder joint and the prognosis is good. Myofibrotic contracture often occurs as a result of an inflammatory process that leads to fibrous changes in the muscle or its vagina. Muscle trauma and the resulting inflammation and muscle splint can lead to irreversible fibrosis. Radiation therapy, incision through a muscle with fibrotic healing and standing still for long periods of time (>6 weeks) can also lead to myofibrian contracture. In patients with chewing muscle involvement, myotatic or myofibrotic contracture occurs with a limited interincision opening.
If the muscles of the elevator are involved, there is a deviation when opening, but not in the protrusion, and lateral movement is normal. Follow your doctor`s instructions to treat contractures at home. Treatments may include: Treatment may include physical therapy, medications, and braces. Surgery may be helpful for certain types of contractures. Contracture occurs when the normally stretchy (elastic) fabric is replaced by a non-stretchy (inelastic) fiber-like fabric. This fabric makes it difficult to stretch the area and prevents normal movements. Pain is absent unless there are sudden and vigorous stretches or bites. As a rule, there is a history of injury or long-term immobility of the lower jaw. Acute or chronic malocclusion does not occur as a result of contracture. Palpation usually does not cause pain, especially with myofibbrotic type contracture.
Additional treatments for contracted tendons include physical therapy, systemic painkillers, Robert Jones packs, and controlled (limited) exercise to prevent worsening of the contracture and rupture of the extensor tendon. Joint contracture of the coffin – initially, the heels are lifted from the ground, and the horse carries the weight mainly on the toe; If they are not treated immediately and aggressively, a “clubfoot” often develops in these cases (see p. 218) The simplicity of Morrey`s classification system favors its use by the clinician and the researcher. However, the attending physician must understand the underlying cause of the contracture, which may be elusive. The Kay system, although anatomically based, cannot take into account elbow contractures due to multiple sources. Conversely, the Morrey system allows the diagnostician to easily determine whether or not the stiffness is related to the surface of the joint. Knee flexion contractures often develop after the patient has been confined to the wheelchair and can develop simultaneously with hip flexion and abduction contractures. Knee and hip contractures inhibit the ability to walk, transfer and even lie down in bed and can be painful. The upper limbs are also prone to contractures, which can occur on the shoulders, elbows, wrists and fingers. Upper limb contractures can limit the patient`s ability to perform fine motor skills, ADLs, but can also hinder the use of aids such as walking aids or wheelchairs. According to him, ocular mobility interfered with any idea of contracture due to central lesions.
Contractures are defined as the absence of a full passive range of motion (ROM) of a joint resulting from structural changes in non-bone tissues such as muscles, tendons, ligaments, joint capsules, and/or skin. Contractures occur when normal elastic connective tissue is replaced by inelastic fibrous tissue. There are many causes of contractures, including chronic inflammation (rheumatoid arthritis), deformity (osteoarthritis, scoliosis), immobility (after fractures or surgery), injuries (burns, stroke), disease (Parkinson`s disease), or a combination of these factors. The flexibility of the joints is conversely associated with aging. In general, there is a systemic decrease in the active and passive movement of all joints with age, with the decline becoming more pronounced during the ninth decade. However, not all older people experience a decrease in joint flexibility with age. Significant increases in ROM can be achieved with movement, activity and good stretching programs (Hoffman et al 2005). Depending on the cause and type of contracture, you may need tests such as an X-ray. Secondary changes in the joints, which are the site of paralytic contracture, are taken into account in the functioning of the extremities. Tendon extension operations for equine deformities should be carefully considered. In patients with early signs of distal contractures and weakness, lengthening of the Achilles tendon can lead to excessive stretching and exacerbate weakness, which may accelerate wheelchair dependence (Jeu, 2002). Main et al.
(2007) found that serial irrigation of the tendo-Achilles tendon is an effective alternative to tendon lengthening in patients with DMD and moderate tendo-Achilles contractures without significant narrowing of the iliotibial ligament. Although they found that serial watering may not be as effective as surgery, it could be considered in patients with contraindications to surgery. Treatment of myotatic contracture is a progressive stretching of the affected muscle by ultrasound, which is used as adjunctive therapy. .