CONTRACTURES AND ROM IN ENGLISH

                                                

                                  CONTRACTURES AND ROM IN ENGLISH

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CONTRACTURE-

Ø Contractures are defined as a physical deformity and lack of full passive range of motion (ROM) of a joint resulting from structural changes of non-bony tissues, such as muscles, tendons, ligaments, joint capsules and/or skin. Mostly flexion contracture develop because flexor muscles are stronger than extensors.

CAUSES-

Ø Contractures can be caused by many disorders including-

Ø Brain and nervous system disorders, such as cerebral palsy or stroke

Ø Inherited disorders (such as muscular dystrophy)

Ø Nerve damage and neuropathies

Ø Reduced use (for example, from lack of mobility or inability to move due to injuries, unconsciousness, paralysis etc.)

Ø Severe muscle and bone injuries.

Ø Scarring after traumatic injury 

Ø  Scarring after burns

CLINICAL MANIFESTATIONS-

Ø Clinical manifestations of contractures includes

Ø Physical deformity

Ø Loss of normal function of the body part

Ø Loss of range of motion

Ø pain

TREATMENT-

Ø Treatment of contractures may include longtime aggressive physiotherapy.

Ø Splinting, plastering may also help to reduce contractures and regaining ROM.

Ø Surgical management includes contracture release with or without  grafting

Ø Main stress is given on prevention of contractures.

PREVENTION OF CONTRACTURES-

Ø Proper positioning is very important for prevention of contractures.

Ø In fowler’s position flexion contracture of the neck is prevented by placing head against the mattress in supine position and providing support by a small pillow.

Ø Flexion contracture of the wrist can be prevented by using hand pillow to support the hand.

Ø During positioning is very important to provide a natural flexion position at all joints by providing support for prevention of contractures.

Ø Special attention should be given while providing care to unconscious and paralysis patients as they are at more risk for developing flexion contractures.

Ø Placing the patient in the prone position for 30 minutes two or three times daily helps prevent knee and hip flexion contractures.

Ø Active and passive ROM exercises help maintain joint mobility, increase circulation and prevent development of contracture in the paralyzed extremity.

Ø Maintaining correct body alignment when the patient is in bed is essential regardless of the position selected.

Ø The nurse explains the benefits of body alignment and positioning and helps the patient assume these positions and uses pillows to support the body in correct alignment.

Ø A trochanter roll  can be placed at both side of hip joints extending from the crest of the ilium to the mid thigh to prevent external rotation of hip.

Ø Patients should be encouraged to wear shoes for support and protection to prevent footdrop because shoes keep ankle at 90 degree angle.

Ø Exercising the quadriceps muscles prevents flexion contractures of the knee.

Ø If the patient has had an amputation,  uses of compression dressings can promote residual limb shaping, and minimizes contracture formation

Ø frequent lubrication of the skin with water or a silica based lotion, exercise and splinting to prevent skin contracture in burn patients.

Ø Splints or functional devices may be applied to the extremities for contracture control in burn patients.

Ø Daily exercises for muscle stretching are prescribed to minimize joint contractures. Special attention is given to the hamstrings, gastrocnemius muscles, hip adductors, biceps, and wrist and finger flexors.

 

ROM EXERCISESES MOVEMENTS-

           Abduction: movement away from the midline of the body

           Adduction: movement toward the midline of the body

           Flexion: bending of a joint so that the angle of the joint diminishes

           Extension: the return movement from flexion; the joint angle is increased

           Rotation: turning or movement of a part around its axis

           Internal: turning inward, toward the center

           External: turning outward, away from the center

           Dorsiflexion: movement that flexes or bends the hand back toward the body or the foot toward the leg

           Palmar flexion: movement that flexes or bends the hand in the direction of the palm

           Plantar flexion: movement that flexes or bends the foot in the direction of the sole

           Pronation: rotation of the forearm so that the palm of the hand is down

           Supination: rotation of the forearm so that the palm of the hand is up

           Opposition: touching the thumb to each fingertip of same hand

           Inversion: movement that turns the sole of the foot inward

           Eversion: movement that turns the sole of the foot outward