Contracture Management in Spinal Cord Injury: Difference between revisions
No edit summary |
No edit summary |
||
| Line 12: | Line 12: | ||
According to a prospective cohort studying the incidence of contracture at one year after spinal cord injury showed that 66% of the patients developed at least one contracture in any joint at one year after acute spinal cord injury. The proportion of participants with paraplegia developing at least one contracture in any joint was 47%, while the proportion of participants with tetraplegia who got at least one contracture in any joint was 83%.<ref>Diong J, Harvey LA, Kwah LK, Eyles J, Ling MJ, Ben M, Herbert RD. [https://www.nature.com/articles/sc201225 Incidence and predictors of contracture after spinal cord injury—a prospective cohort study.] Spinal cord. 2012 Aug;50(8):579-84.</ref> | According to a prospective cohort studying the incidence of contracture at one year after spinal cord injury showed that 66% of the patients developed at least one contracture in any joint at one year after acute spinal cord injury. The proportion of participants with paraplegia developing at least one contracture in any joint was 47%, while the proportion of participants with tetraplegia who got at least one contracture in any joint was 83%.<ref>Diong J, Harvey LA, Kwah LK, Eyles J, Ling MJ, Ben M, Herbert RD. [https://www.nature.com/articles/sc201225 Incidence and predictors of contracture after spinal cord injury—a prospective cohort study.] Spinal cord. 2012 Aug;50(8):579-84.</ref> | ||
== Causes of contracture == | |||
Contractures occur in patients with SCI as a result of paralysis combined with prolonged sitting and lying | |||
* prolonged immobilization and | |||
* habitual use of soft tissues in their shortened range. | |||
=== Factors === | === Factors === | ||
| Line 31: | Line 36: | ||
Patients with motor complete C5 tetraplegia are prone to developing elbow flexion contractures due to paralysis of the triceps. However, the biceps are spared and as they commonly sit with their elbows positioned in flexion on the armrests of wheelchairs and lie with their elbows flexed, these factors increase susceptibility to elbow flexion. contractures <ref name=":0" /> | Patients with motor complete C5 tetraplegia are prone to developing elbow flexion contractures due to paralysis of the triceps. However, the biceps are spared and as they commonly sit with their elbows positioned in flexion on the armrests of wheelchairs and lie with their elbows flexed, these factors increase susceptibility to elbow flexion. contractures <ref name=":0" /> | ||
* | |||
* | |||
== Treatment == | == Treatment == | ||
Revision as of 14:02, 12 December 2020
This article or area is currently under construction and may only be partially complete. Please come back soon to see the finished work! (12/12/2020)
Original Editor - Add a link to your Physiopedia profile here.
Top Contributors - Vidya Acharya, Naomi O'Reilly, Kim Jackson and Anas Mohamed
Introduction[edit | edit source]
The most common complication of spinal cord injury is contractures. It is a debilitating problem for patients suffering from a spinal cord injury. Contractures result from a loss in the extensibility of the soft tissue structures-skin, ligaments, muscles, and joint capsules crossing joints, leading to restriction in joint mobility, causing joint stiffness, and later on the deformity.[1] Contractures reduce joint mobility and restrict activities of daily living. They are also associated with pain, spasticity, sleep disturbances and skin breakdown.
According to a prospective cohort studying the incidence of contracture at one year after spinal cord injury showed that 66% of the patients developed at least one contracture in any joint at one year after acute spinal cord injury. The proportion of participants with paraplegia developing at least one contracture in any joint was 47%, while the proportion of participants with tetraplegia who got at least one contracture in any joint was 83%.[2]
Causes of contracture[edit | edit source]
Contractures occur in patients with SCI as a result of paralysis combined with prolonged sitting and lying
- prolonged immobilization and
- habitual use of soft tissues in their shortened range.
Factors[edit | edit source]
Contractures are characterized by decreased range of motion and increased stiffness. An increased resistance to stretch caused by changes in the mechanical properties of tissues is due to both neurally and non-neurally mediated factors[3]
Non-neural factors
- changes in mechanical properties of tissue resulting from stress deprivation,
- secondary to orthopedic injury, heterotopic ossification,
- pain,
- paralysis,
- severe spasticity or
- any disorder that restricts movement Contractures also produce structural changes within muscles; myofibril shortening and loss of sarcomeres are often observed, as well as relative increase in connective tissue causing loss of elasticity.
Neural factors
Are due to central origin and cause muscle overactivity. They cause spasticity, increase interdigitation between actin and myosin, thus reducing muscular concentric contraction range and producing rigidity, because of the absence of monosynaptic reflex inhibition.
Common contractures[edit | edit source]
Research findings suggest that patients with tetraplegia have a higher rate of contractures than those with paraplegia.[4] Patients with motor complete C5 tetraplegia are prone to developing elbow flexion contractures as they commonly sit with their elbows positioned in flexion on the armrests of wheelchairs and lie with their elbows flexed in bed and triceps paralysis, and they retain voluntary control of the biceps muscles.
Patients with motor complete C5 tetraplegia are prone to developing elbow flexion contractures due to paralysis of the triceps. However, the biceps are spared and as they commonly sit with their elbows positioned in flexion on the armrests of wheelchairs and lie with their elbows flexed, these factors increase susceptibility to elbow flexion. contractures [1]
Treatment[edit | edit source]
Stretch
Passive Movements
Positioning
Splints
References[edit | edit source]
References will automatically be added here, see adding references tutorial.
- ↑ 1.0 1.1 Harvey LA, Glinsky JA, Katalinic OM, Ben M. Contracture management for people with spinal cord injuries. NeuroRehabilitation. 2011 Jan 1;28(1):17-20.
- ↑ Diong J, Harvey LA, Kwah LK, Eyles J, Ling MJ, Ben M, Herbert RD. Incidence and predictors of contracture after spinal cord injury—a prospective cohort study. Spinal cord. 2012 Aug;50(8):579-84.
- ↑ Salierno F, Rivas ME, Etchandy P, Jarmoluk V, Cozzo D, Mattei M, Buffetti E, Corrotea L, Tamashiro M. Physiotherapeutic procedures for the treatment of contractures in subjects with traumatic brain injury (TBI). Traumatic Brain Injury. InTechOpen. 2014 Feb 19:307-28.
- ↑ Dalyan M, Sherman A, Cardenas DD. Factors associated with contractures in acute spinal cord injury. Spinal Cord. 1998 Jun;36(6):405-8.
