Joint Contractures

Overview

A joint contracture is a lasting loss of motion in a joint caused by tightening and shortening of the surrounding soft tissues, such as muscles, tendons, ligaments, skin, or the joint capsule. The joint becomes stuck in one position and cannot fully straighten or bend, which can interfere with movement, daily tasks, and comfort.

Contractures can affect any joint, including the fingers, wrists, elbows, hips, knees, and ankles. They develop for many reasons, but a common theme is reduced movement, which allows tissues to shorten over time. Some contractures are present at birth, while others develop later due to injury, illness, or prolonged immobility. Many can be prevented or improved with stretching, therapy, and good positioning.

Symptoms

The main feature is a joint that cannot move through its normal range. Signs include:

• Inability to fully straighten or bend a joint
• A joint held in a fixed, bent, or twisted position
• Stiffness and reduced flexibility
• Tight, shortened muscles or tendons that resist stretching
• Difficulty with tasks such as walking, gripping, dressing, or hygiene
• Sometimes discomfort, skin breakdown, or pain in the affected area

Symptoms may develop gradually, especially when caused by limited movement, or be present from birth.

Causes

Contractures result from anything that keeps a joint from moving fully or that damages the tissues around it:

• Prolonged immobility: Long bed rest, paralysis, or keeping a joint still after injury or surgery.
• Nervous system conditions: Stroke, cerebral palsy, spinal cord injury, and other disorders that cause muscle tightness (spasticity) or weakness.
• Muscle and joint diseases: Muscular dystrophy, arthritis, and inflammatory conditions.
• Scarring: Burns or deep wounds that heal with tight scar tissue.
• Congenital conditions: Some children are born with contractures, such as in clubfoot or arthrogryposis.
• Specific tissue conditions: Such as Dupuytren contracture of the hand.

Risk Factors

• Limited mobility or prolonged bed rest
• Paralysis or muscle weakness
• Conditions causing spasticity, such as stroke or cerebral palsy
• Burns or significant scarring near a joint
• Arthritis or other joint diseases
• Older age and reduced activity
• Inadequate stretching after an injury or surgery

Diagnosis

Contractures are usually identified through examination:

• Physical examination: The doctor measures how far the joint can move (range of motion) and assesses the tightness of muscles and tendons.
• Medical history: Identifying causes such as immobility, neurological conditions, or prior injury.
• Imaging: X-rays or other scans may be used to check the joint and rule out bone problems.
• Evaluation of underlying conditions: Tests to assess nerve or muscle disorders when relevant.

Treatment

Treatment aims to restore as much movement as possible and prevent worsening. The approach depends on the cause and severity.

• Physical and occupational therapy: Stretching exercises and range-of-motion work are the foundation of treatment.
• Splinting, casting, or bracing: Devices hold the joint in a better position and provide a gentle, sustained stretch.
• Treating the underlying cause: Managing spasticity (sometimes with medication or injections), arthritis, or other conditions.
• Serial casting: A series of casts can gradually stretch a tight joint, as used for some contractures and clubfoot.
• Surgery: For severe or fixed contractures, procedures may release or lengthen tight tendons and tissues.

Prevention

• Move and stretch joints regularly, especially during illness or after injury
• Reposition and provide range-of-motion exercises for people who are bedbound or paralyzed
• Use splints or braces as advised to keep joints in good positions
• Begin therapy early after surgery, injury, or stroke
• Manage conditions that cause muscle tightness
• Keep active to maintain flexibility and strength

When to See a Doctor

See a doctor if you or someone you care for has:

• A joint that is becoming harder to straighten or bend
• Increasing stiffness that limits daily activities
• A child born with a joint fixed in an abnormal position
• Tightness developing after a stroke, injury, burn, or long period of immobility

Early evaluation and therapy give the best chance of preserving or restoring movement before a contracture becomes fixed.

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). Spasticity.
4. American Physical Therapy Association (APTA).