Joint Contracture

Overview

A joint contracture is a condition in which a joint loses some of its normal range of motion because the surrounding tissues, such as muscles, tendons, ligaments, skin, or the joint capsule, have become shortened and tight. Over time the joint may become fixed in a bent (flexed) or straightened (extended) position and resist efforts to move it. Contractures most often affect the fingers, wrists, elbows, knees, hips, and ankles.

Contractures usually develop when a joint is not moved through its full range for a long period, when scar tissue forms after a burn or injury, or when a disease affects the muscles or nerves that control movement. Because they can be difficult to reverse once established, prevention through regular movement, positioning, and stretching is a central part of care. When a contracture does develop, treatment aims to restore as much motion and function as possible.

Symptoms

The main feature of a contracture is reduced movement at a joint, which may worsen gradually.

• Difficulty straightening or bending a joint fully
• A joint that feels stiff, tight, or stuck
• A limb or finger held in a fixed bent or straight position
• Pain or discomfort when trying to move past the limit
• Trouble with everyday tasks such as walking, dressing, or gripping
• Skin breakdown or hygiene problems in deep skin creases of a severely contracted joint

The degree of disability depends on which joint is affected and how severe the loss of motion is.

Causes

Many different conditions can lead to a contracture, but they share the common thread of tissues around a joint becoming shortened:

• Immobility: Prolonged bed rest, paralysis, casting, or keeping a joint still after injury allows tissues to tighten.
• Scarring: Burns, deep wounds, and surgery can create scar tissue that pulls a joint into a fixed position.
• Nerve and muscle disorders: Conditions such as cerebral palsy, stroke, muscular dystrophy, and spinal cord injury can cause muscles to stay tight.
• Joint and connective tissue disease: Arthritis and certain inherited disorders can stiffen joints.
• Specific tissue disease: Some contractures, such as those of the palm, result from thickening of tissue beneath the skin.

Risk Factors

• Long periods of immobility, bed rest, or paralysis
• Stroke, cerebral palsy, spinal cord injury, or muscular dystrophy
• Burns or major wounds near a joint
• Severe arthritis
• Older age and limited activity
• Spasticity (persistently tight muscles)

Diagnosis

A clinician diagnoses a contracture by examining the joint and measuring how far it moves.

• Range-of-motion measurement: Using a tool called a goniometer to record how much the joint can bend and straighten.
• Physical examination: Assessing muscle tone, strength, skin, and which tissues are limiting movement.
• Medical history: Identifying underlying causes such as a recent injury, immobilization, burn, or neurological condition.
• Imaging: X-rays or other studies may be used to look at the joint itself and rule out bone problems.

Treatment

Treatment depends on the cause and severity and works best when started early, before the contracture becomes fixed.

• Physical and occupational therapy: Stretching, range-of-motion exercises, and strengthening to lengthen tight tissues and maintain function.
• Splinting and casting: Devices that hold the joint in a better position or gradually stretch it over time (serial casting).
• Medications: Muscle relaxants or injections may reduce spasticity in contractures caused by nerve conditions.
• Surgery: For severe, fixed contractures, procedures to release or lengthen tendons, divide scar tissue, or correct the joint may be considered.

Treating the underlying condition and keeping joints moving are essential to prevent the contracture from returning or worsening.

Prevention

• Move every joint through its full range regularly, especially during bed rest or recovery
• Follow positioning advice and use splints as recommended after injury or paralysis
• Begin physical therapy early after stroke, surgery, or major injury
• Stretch tight muscles and keep active within your limits
• Manage spasticity and underlying conditions with your care team
• Inspect and care for skin around stiff joints

When to See a Doctor

See a doctor if you notice a joint becoming progressively stiffer or harder to move, if you cannot fully straighten or bend a joint, or if stiffness is affecting daily activities. Early evaluation is important because contractures are easier to treat before they become fixed. Seek prompt care if a joint becomes stiff after an injury, burn, or period of immobility, or if you develop skin breakdown, sores, or signs of infection in the crease of a tightly bent joint.

Related Topics

Frequently Asked Questions

References

1. MedlinePlus, U.S. National Library of Medicine. Contracture deformity.
2. American Academy of Orthopaedic Surgeons (AAOS). Joint stiffness and contractures.
3. National Institute of Neurological Disorders and Stroke (NINDS).
4. OrthoInfo, American Academy of Orthopaedic Surgeons.