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{{short description|Permanent shortening of a muscle}}
{{
[[File:Dupuytren's contracture.jpg|thumb|A finger contracture caused by [[Dupuytren's contracture]].]]
'''Muscle contractures''' can occur for many reasons, such as [[paralysis]], [[muscle atrophy|muscular atrophy]], and forms of [[muscular dystrophy]]. Fundamentally, the muscle and its tendons shorten, resulting in reduced flexibility.
Various interventions can slow, stop, or even reverse muscle contractures, ranging from physical therapy to surgery.
For example, in the case of partial paralysis (i.e. [[polio]]myelitis) the loss of strength and muscle control tend to be greater in some muscles than in others, leading to an imbalance between the various muscle groups around specific joints. Case in point: when the muscles which dorsiflex (flex the foot upward) are less functional than the muscles which plantarflex (flex the foot downward) a contracture occurs, giving the foot a progressively downward angle and loss of flexibility. Various interventions can slow, stop, or even reverse muscle contractures, ranging from physical therapy to surgery. A common cause for having the ankle lose its flexibility in this manner is from having sheets tucked in at the foot of the bed when sleeping. The weight of the sheets keep the feet plantarflexed all night. Correcting this by not tucking the sheets in at the foot of the bed, or by sleeping with the feet hanging off the bed when in the prone position, is part of correcting this imbalance.▼
It occurs also due to muscle tightening for example if after fracture when immobilization is done by putting plaster of paris the muscle length shortens because the muscle is not used for a large span of time.▼
==Cause==
===Immobilization===
[[File:Toe Walking in Autism 1.jpg|thumb|184x184px|Toe walking in an autistic individual]]
Joints are usually immobilized in a shortened position resulting in changes within the joint [[connective tissue]], and the length of the muscle and associated tendon. Prolonged immobilization facilitates tissue proliferation which impinges on the joint space.<ref name = "farmer">{{cite journal | title= Contractures in orthopaedic and neurological conditions: a review of causes and treatment | journal= Disability and Rehabilitation | year= 2001 | first= S.E | last= Farmer |author2=M. James | volume= 23 | issue= 13 | pages= 549–558 |
▲
A common cause for having the ankle lose its flexibility in this manner is from having sheets tucked in at the foot of the bed when sleeping. The weight of the sheets keep the feet plantarflexed all night. By not tucking the sheets in at the foot of the bed, or by sleeping with the feet hanging off the bed when in the prone position, is part of correcting this imbalance.
Due to sensory issues, some [[autism spectrum|autis]]tic people prefer to [[Toe walking|toe walk]] instead of their feet making full contact with the ground. Chronic toe walking leads to muscle contracture due to the lack of calf muscles being adequately stretched. Once the muscle contracture has developed, the voluntary toe walking then becomes involuntary.<ref>{{Cite journal |last1=Valagussa |first1=Giulio |last2=Balatti |first2=Valeria |last3=Trentin |first3=Luca |last4=Piscitelli |first4=Daniele |last5=Yamagata |first5=Momoko |last6=Grossi |first6=Enzo |date=2020-08-20 |title=Relationship between tip-toe behavior and soleus - gastrocnemius muscle lengths in individuals with autism spectrum disorders |journal=Journal of Orthopaedics |volume=21 |pages=444–448 |doi=10.1016/j.jor.2020.08.013 |issn=0972-978X |pmc=7493131 |pmid=32982098}}</ref> If someone has a disability that causes spasticity (such as [[cerebral palsy]]), they may walk on their toes involuntarily.
===Spasticity===
If [[spasticity]] is left untreated, contractures can occur. A loss of
===Muscle
A muscle imbalance between an
▲For example, in the case of partial paralysis (i.e. [[polio]]myelitis) the loss of strength and muscle control tend to be greater in some muscles than in others, leading to an imbalance between the various muscle groups around specific joints. Case in point: when the muscles which dorsiflex (flex the foot upward) are less functional than the muscles which plantarflex (flex the foot downward) a contracture occurs, giving the foot a progressively downward angle and loss of flexibility
=== Low ATP reservoir in the muscle ===
In the [[Metabolic myopathy|metabolic myopathies]] of [[Glycogen storage disease type VI|GSD-V]] (McArdle disease) and [[Phosphofructokinase deficiency|GSD-VII]] (Tarui disease), temporary muscle contractures develop in response to impending muscle damage associated with the [[Adenosine triphosphate|ATP]] (energy) deficiency.<ref name=":0">{{Cite journal |last1=Lucia |first1=Alejandro |last2=Martinuzzi |first2=Andrea |last3=Nogales-Gadea |first3=Gisela |last4=Quinlivan |first4=Ros |last5=Reason |first5=Stacey |last6=International Association for Muscle Glycogen Storage Disease study group |date=December 2021 |title=Clinical practice guidelines for glycogen storage disease V & VII (McArdle disease and Tarui disease) from an international study group |journal=Neuromuscular Disorders |volume=31 |issue=12 |pages=1296–1310 |doi=10.1016/j.nmd.2021.10.006 |issn=1873-2364 |pmid=34848128|s2cid=240123241 |doi-access=free }}</ref> The muscle contracts and fails to relax again, becoming hard or stiff, the muscle may swell up, and although temporary, it is longer lasting and generally more painful than muscle cramps.<ref name=":0" /><ref name=":1">{{Cite web |title=IAMGSD {{!}} Medical emergencies |url=https://www.iamgsd.org/medical-emergencies |access-date=2023-05-07 |website=iamgsd |language=en}}</ref> These contractures are different from cramps, because they are not elicited by the nerve, but by intrinsic mechanisms in the muscle itself and are silent on electromyography.<ref name=":0" /> This type of transient contracture has also been called pseudomyotonia.<ref>{{Cite web |last=Bhai |first=Salman |date=September 2021 |title=Neuromuscular Notes: Diagnosing Metabolic Myopathies |url=https://practicalneurology.com/articles/2021-sept/neuromuscular-notes-diagnosing-metabolic-myopathies |access-date=2023-10-13 |website=Practical Neurology |language=en}}</ref><ref>{{Cite web |last1=Chen |first1=Y. |last2=Hagen |first2=M. |last3=Lawandy |first3=M. |last4=Do |first4=J.Y. |date=2017-03-09 |title=Congenital and Acquired Myotonia |url=https://now.aapmr.org/congenital-and-acquired-myotonia/ |access-date=2023-10-13 |website=PM&R KnowledgeNow |language=en-US}}</ref>
In GSD-V and GSD-VII, a cramp or contracture is managed by cessation of the causal activity until pain resolves; however, repeated episodes can accumulate muscle damage ''(see below under fibrosis)''.<ref name=":0" /> Unlike stretching of muscle cramps, stretching of a muscle in contracture should be avoided as it may cause further muscle damage by tearing muscle fibres (i.e. resist uncurling the fingers of a "clawed" hand).<ref name=":0" /><ref name=":1" />
=== Congenital muscular dystrophies ===
Some [[congenital muscular dystrophies]], such as [[Bethlem myopathy]], [[Ullrich congenital muscular dystrophy]], Merosin-deficient congenital muscular dystrophy (MDC1A) or LAMA2-related CMD, [[rigid spine syndrome]] and LMNA-related congenital muscular dystrophy cause muscle contractures to develop.<ref name=":2">{{Cite journal |last=Bönnemann |first=Carsten G. |date=2011-06-21 |title=The collagen VI-related muscular dystrophies: muscle meets its matrix |journal=Nature Reviews. Neurology |volume=7 |issue=7 |pages=379–390 |doi=10.1038/nrneurol.2011.81 |issn=1759-4758 |pmc=5210181 |pmid=21691338}}</ref><ref>{{cite journal |last1=El-Sobky |first1=Tamer A. |last2=Abdulhady |first2=Hala |last3=Mahmoud |first3=Shady |last4=Amen |first4=John |title=Orthopedic manifestations of congenital muscular dystrophy subtypes in children: Emerging signatures need consolidation: a scoping review |journal=Journal of Musculoskeletal Surgery and Research |date=31 January 2024 |volume=8 |pages=11–23 |doi=10.25259/JMSR_229_2023}}</ref> In [[Bethlem myopathy]] and [[Ullrich congenital muscular dystrophy]], mutations in [[collagen]] VI and XII genes result in deficient or dysfunctional microfibrillar collagen in the extracellular matrix of muscle and other connective tissues.<ref name=":2" /><ref>{{Cite journal |last1=Hicks |first1=Debbie |last2=Farsani |first2=Golara Torabi |last3=Laval |first3=Steven |last4=Collins |first4=James |last5=Sarkozy |first5=Anna |last6=Martoni |first6=Elena |last7=Shah |first7=Ashoke |last8=Zou |first8=Yaqun |last9=Koch |first9=Manuel |last10=Bönnemann |first10=Carsten G. |last11=Roberts |first11=Mark |last12=Lochmüller |first12=Hanns |last13=Bushby |first13=Kate |last14=Straub |first14=Volker |date=2014-05-01 |title=Mutations in the collagen XII gene define a new form of extracellular matrix-related myopathy |journal=Human Molecular Genetics |volume=23 |issue=9 |pages=2353–2363 |doi=10.1093/hmg/ddt637 |issn=1460-2083 |pmid=24334769|doi-access=free }}</ref> The potential effects on muscle include progressive dystrophic changes, fibrosis and evidence for increased apoptosis. In Bethlem myopathy 1, contractures presenting in infancy may resolve by age 2 years, but reoccur as the disease progresses, typically by late of the first decade or early teens.<ref name=":2" />
=== Congenital myopathies ===
[[Congenital myopathy]] such as, core myopathies, nemaline myopathies and centronuclear myopathies and so forth can result in muscle contractures of the extremities and spine.<ref>{{cite journal |last1=Claeys |first1=KG |title=Congenital myopathies: an update. |journal=Developmental Medicine and Child Neurology |date=March 2020 |volume=62 |issue=3 |pages=297–302 |doi=10.1111/dmcn.14365 |pmid=31578728}}</ref>
=== Ischemia ===
Following trauma (such as fractures, crush injuries, burns and arterial injuries), [[ischemia]] (restriction of blood flow) leads to the death of muscle tissue ([[necrosis]]) and can cause contracture, such as [[Volkmann's contracture]].<ref>{{Citation |last1=Mirza |first1=Taaha M. |title=Volkmann Contracture |date=2023 |url=http://www.ncbi.nlm.nih.gov/books/NBK557754/ |work=StatPearls |access-date=2023-05-07 |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=32491686 |last2=Taqi |first2=Muhammad}}</ref>
=== Adhesions and fibrosis ===
[[Adhesion (medicine)|Adhesions]] bind two separate tissues or organs together with fibrotic scar tissue, joining muscle fibres to facia, ligaments, or joints. [[Fibrosis]] occurs within the same organ, the fibrotic scar tissue within skeletal muscle known as myofibrosis, limits muscle contractibility and stiffens muscles.<ref>{{Cite web |last=Massage |first=Walnut Creek |date=2014-10-02 |title=Adhesions vs. Fibrosis • Loosen Up Bodywork |url=https://loosenupbodywork.com/2014/10/injuries/adhesions-vs-fibrosis/ |access-date=2023-05-07 |website=Loosen Up Bodywork |language=en-US}}</ref><ref>{{Citation |last1=Nelson |first1=Fred R. T. |title=2 - Musculoskeletal Diseases and Related Terms |date=2015-01-01 |url=https://www.sciencedirect.com/science/article/pii/B9780323221580000020 |work=A Manual of Orthopaedic Terminology (Eighth Edition) |pages=43–104 |editor-last=Nelson |editor-first=Fred R. T. |access-date=2023-05-07 |place=Philadelphia |publisher=W.B. Saunders |language=en |isbn=978-0-323-22158-0 |last2=Blauvelt |first2=Carolyn Taliaferro |editor2-last=Blauvelt |editor2-first=Carolyn Taliaferro}}</ref><ref name=":3">{{Cite journal |last1=Lieber |first1=Richard L. |last2=Ward |first2=Samuel R. |date=2013-08-01 |title=Cellular Mechanisms of Tissue Fibrosis. 4. Structural and functional consequences of skeletal muscle fibrosis |journal=American Journal of Physiology. Cell Physiology |volume=305 |issue=3 |pages=C241–C252 |doi=10.1152/ajpcell.00173.2013 |issn=0363-6143 |pmc=3742845 |pmid=23761627}}</ref>
Muscle injury (such as a large burn or surgery) can cause muscle contractures as internal scar tissue (adhesions and fibrosis) develops. Repetitive muscle injuries (e.g. [[Sports injury|sports injuries]], major [[Strain (injury)|muscle strains]]) and micro-injuries (e.g. [[Repetitive strain injury|overuse injuries]], minor muscle strains) can also cause this. Adhesions and fibrosis are made of dense fibrous tissue, which are strong and supportive, helping to prevent the injury or micro-injury from reoccurring. However, the fibrotic scar tissue causes the muscle tissue to become stuck together which restricts movement, causing pain, weakness, and limited joint mobility.<ref name=":3" /><ref>{{Cite journal |last=Nemoto |first=F. |date=January 1980 |title=[Pathogenesis of quadriceps contracture in children and adolescence (author's transl)] |url=https://pubmed.ncbi.nlm.nih.gov/7381269/ |journal=Nihon Seikeigeka Gakkai Zasshi |volume=54 |issue=1 |pages=15–31 |issn=0021-5325 |pmid=7381269}}</ref><ref>{{Cite web |last=Bugden |first=Krista |date=2018-11-30 |title=Muscle Adhesions: What Are They & How Do I Treat Them? {{!}} Sidekick Blog |url=https://blog.sidekicktool.com/muscle-adhesions-are-they-getting-in-the-way-of-your-athletic-performance/,%20https://blog.sidekicktool.com/muscle-adhesions-are-they-getting-in-the-way-of-your-athletic-performance/ |access-date=2023-05-07 |website=blog.sidekicktool.com |language=en-US}}</ref><ref>{{Cite journal |last1=Taylor |first1=J. |last2=Tangner |first2=C. H. |date=2007 |title=Acquired muscle contractures in the dog and cat. A review of the literature and case report |url=https://pubmed.ncbi.nlm.nih.gov/17546206/ |journal=Veterinary and Comparative Orthopaedics and Traumatology: V.C.O.T |volume=20 |issue=2 |pages=79–85 |doi=10.1160/vcot-06-01-0007 |issn=0932-0814 |pmid=17546206|s2cid=4026694 }}</ref>
==Treatment==
===Passive stretching===
Typically performed by physical therapists, passive stretching is a more beneficial preventative measure and tool to maintain available [[range of motion]] (ROM) rather than used as a treatment.<ref>Worland, R., Arredondo, J., Angles, F., Lopez-Jimenez, F., & Jessup, D. (1998). Home continuous passive motion machine versus professional physical therapy following total knee replacement. Journal of Arthroplasty, 784-787, {{
A 2017 Cochrane review found that stretching does not provide any short-term pain relief.<ref>{{Cite journal|last1=Harvey|first1=Lisa A|last2=Katalinic|first2=Owen M|last3=Herbert|first3=Robert D|last4=Moseley|first4=Anne M|last5=Lannin|first5=Natasha A|last6=Schurr|first6=Karl|date=2017-01-09|title=Stretch for the treatment and prevention of contractures|journal=Cochrane Database of Systematic Reviews|volume=1|issue=2 |pages=CD007455|doi=10.1002/14651858.cd007455.pub3|pmid=28146605|pmc=6464268|issn=1465-1858}}</ref>
===Splinting===
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===Surgery===
Surgery is a solution to muscle shortening but other complications may arise. Following muscle lengthening surgery, [[force]] production and [[Range of motion|ROM]] is usually reduced due to the shift in sarcomere locations between a muscle's maximal and minimal length.<ref name = "farmer"/> In adjunct with surgery, refractory muscle contracture can also be treated with [[Botulinum toxin]]s A and B; however, the effectiveness of the toxin is slowly lost over time, and most patients need a single treatment to correct muscle contracture over the first few weeks after surgery.<ref>{{Citation |last=Sanchez-Sotelo |first=Joaquin |title=56 - Elbow Stiffness: Rehabilitation After Surgical Contracture Release |date=2018-01-01 |url=https://www.sciencedirect.com/science/article/pii/B9780323341691000565 |work=Morrey's the Elbow and its Disorders (Fifth Edition) |pages=552–556 |editor-last=Morrey |editor-first=Bernard F. |access-date=2023-05-06 |place=Philadelphia |publisher=Elsevier |language=en |isbn=978-0-323-34169-1 |editor2-last=Sanchez-Sotelo |editor2-first=Joaquin |editor3-last=Morrey |editor3-first=Mark E.}}</ref> Shortening of the surgically lengthened muscle can re-occur.
==References==
{{reflist}}
{{Arthropathies and related conditions}}
{{Acquired musculoskeletal deformities}}
{{Myopathy}}
{{Soft tissue disorders}}
{{Trauma}}
[[Category:Muscular system]]
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