Contracture Management in Spinal Cord Injury
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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 are 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]
Common contractures[edit | edit source]
Research findings suggest that patients with tetraplegia have a higher rate of contractures than those with paraplegia.[3] 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]
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.
Treatment[edit | edit source]
Stretch
Passive Movements
Positioning
| Type of contracture | Loss | ||
|---|---|---|---|
References[edit | edit source]
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- ↑ 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.
- ↑ Dalyan M, Sherman A, Cardenas DD. Factors associated with contractures in acute spinal cord injury. Spinal Cord. 1998 Jun;36(6):405-8.
