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Muscle contractures are caused by a permanent shortening of muscle fibres, which results in a loss of elasticity and an increase in resistance to passive stretch. This can be caused by a decrease in the number of sarcomeres—the fundamental units of muscles that cause contraction. The condition can also be caused by a lack of movement, which is often the result of an injury, physical disability, or neurological condition. In addition, certain diseases such as cerebral palsy, muscular dystrophy, and multiple sclerosis are associated with an increased risk of developing muscle contractures.
| Characteristics | Values |
|---|---|
| Definition | Permanent shortening and tightening of muscle fibres that reduces flexibility and makes movement difficult |
| Causes | Lack of movement, injury, neurological conditions, neuromuscular disorders, genetic mutations, immobilisation, scarring, fibrosis, burns, wounds, stroke, cerebral palsy, muscular dystrophy, multiple sclerosis, rheumatoid arthritis, osteoarthritis, inactivity, atrophy, fatty infiltration of the muscle tissue, traumatic disruption of the muscle tissue, neurologic disorders/lesions, idiopathic causes |
| Symptoms | Pain, loss of movement in the joint, deformity, limited range of motion |
| Treatment | Medicine, casts, physical therapy, electrical stimulation, surgery, nerve blocks, botulinum toxin (Botox), splints, continuous passive motion (CPM) machine, occupational therapy |
| Prevention | Regular exercise, active lifestyle |
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What You'll Learn
Lack of movement
Inactivity and immobilization can lead to structural changes in the muscles and joints, causing them to tighten and stiffen. This is because the lack of movement can cause a decrease in satellite cells, which are specialized stem cells necessary for muscle regeneration and repair. Without these cells, the muscle fibers can shorten and stiffen, leading to contractures.
Additionally, immobilization can cause an increase in the amount of collagen within the extracellular matrix of the muscles. This increase in collagen contributes to the stiffening of muscle fibers, further restricting movement. Lack of movement can also lead to muscle atrophy, or wasting away of the muscle, which can also contribute to the development of contractures.
The effects of immobilization on muscle contractures have been studied in both human and animal models. Research has shown that immobilization of a joint or muscle in a shortened position can cause a decrease in the range of motion and an increase in muscle stiffness. This can occur very quickly, even within one week of immobilization, and may require specialized therapy to treat. Therefore, it is important to maintain muscle length and joint mobility to prevent the onset of contractures. Regular exercise and an active lifestyle can help prevent muscle and joint stiffness and reduce the risk of developing contractures.
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Scarring from injury
Scar tissue causes the skin to shrink and tighten as it heals, pulling nearby tissues inwards. This tightening effect can restrict movement at the joint, causing a permanent reduction in the range of motion. This is known as a contracture, and it occurs when the muscles, tendons, joints, or other tissues shorten and tighten, resulting in deformity and loss of mobility.
Injuries that result in significant tissue loss, such as burns, infected wounds, or surgery, are particularly prone to causing contraction scars. The risk of developing a contracture is also increased during periods of immobilization, such as when an individual is hospitalized for a severe injury or illness and experiences reduced movement.
The formation of scar tissue and subsequent contractures can be influenced by several factors. For example, the application of silicone ointment or corticosteroid cream to the wound may help prevent excessive scarring and the development of contractures. Additionally, early intervention is crucial, as scar tissue is more malleable in the initial stages of healing and can be shaped to prevent contractures from forming.
In some cases, surgical intervention may be necessary to treat established contractures. This may involve removing and replacing scarred tissue with skin grafts or flaps to restore mobility and flexibility to the affected area. However, it is important to note that contractures may not always be fully treatable, even with surgery. Therefore, preventing or minimizing the formation of contractures through early intervention and conservative treatments is essential.
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Genetic factors
Muscle contractures are caused by a permanent shortening of muscle fibres and a change in normal muscle structure. This results in a significant limitation in the range of motion. While the exact mechanisms responsible for the development of contractures are still unclear, it is believed that changes in tissue homeostasis in the neuromuscular-tendon-connective tissue complex play a crucial role. Genetic factors are indeed implicated in the development of muscle contractures, and they interact with other factors in a complex network.
Furthermore, specific genes linked to collagen production can be altered, causing irregular changes to the extracellular matrix of muscles. This can lead to muscle stiffness and a limited range of motion. Clinical research has also found that patients with cerebral palsy have decreased levels of satellite cells, which are necessary for muscle regeneration and repair, increasing the risk of developing muscle contractures.
In addition to these specific genetic associations, genetic and epigenetic factors influence the composition of tissues, thereby affecting their ability to react and adapt to changes in tissue homeostasis. When there is an alteration in one factor within the complex network of tissues, adaptive changes occur to maintain homeostasis. However, if the alteration is significant, the network may settle into a new, unhealthy state, leading to the development of pathological contractures.
While genetic factors play a role, it is important to note that multiple factors contribute to the development of muscle contractures. These include neurological factors, such as reduced neurological input to the muscles from the brain and spinal cord, as well as physical factors like injuries, immobilisation, and neurological or neuromuscular conditions.
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Neurological conditions
Muscle contractures are caused by a permanent shortening of muscle fibres and a change in normal muscle structure. This results in a decrease in muscle elasticity, causing the joints to lose mobility and become painful.
Other neurological conditions that can cause muscle contractures include:
- Muscular dystrophy: This inherited neuromuscular disorder is characterised by muscle weakness and wasting. The lack of nerve supply to the muscles causes them to become stiff and tight, inhibiting the range of motion needed to move joints and activate muscles.
- Multiple sclerosis (MS): This central nervous system disease can increase the risk of developing muscle contractures.
- Stroke: Strokes can affect the communication between the brain and muscles, leading to immobilisation or over-contraction of muscles.
- Spinal cord injuries: Damage to the spinal cord can disrupt the signals between the brain and muscles, resulting in muscle stiffness and contractures.
It is important to note that the exact pathology underlying contractures is still not fully understood, and different patients may have unique causes or contributing factors.
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Connective tissue diseases
There are over 200 known connective tissue disorders, which can be inherited or autoimmune. Examples of inherited connective tissue diseases include congenital myopathy, which causes overly contracted or overly lax muscles. Autoimmune connective tissue disorders include rheumatoid arthritis, relapsing polychondritis, and myositis. Autoimmune disorders cause the immune system to generate chronic inflammation in some parts of the body, leading to pain, swelling, and permanent tissue damage.
One example of an autoimmune connective tissue disorder is mixed connective tissue disease. This disease can occur in people of any age but is most common in women under 50. Mixed connective tissue disease causes a variety of symptoms, including fatigue, fever, Raynaud's phenomenon, swollen fingers or hands, muscle and joint pain, and rashes. It can also lead to serious complications, including pulmonary hypertension, interstitial lung disease, heart disease, kidney damage, and digestive tract damage. There is no cure for mixed connective tissue disease, and treatment depends on the severity of the disease and the organs involved.
Sarcoma is a type of cancer that can start in connective tissues. It can develop in bones, cartilage, fat, muscles, ligaments, tendons, or the deep layers of the skin.
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