Contracture and pain

Contracture associated with chronic spasticity involves the remodelling of soft tissues including muscles, connective tissue, and joint capsule around joints, so that there is loss of range of movement almost invariably with the joint in an abnormal posture. Severe contracture, especially flexion contracture of the distal upper limb, is more a feature of cerebral origin spasticity than of spinal origin spasticity. Severe wrist and finger flexor spasticity can lead to carpal subluxation and pain.

Contractures can affect just about any joint in the body. Shoulder adduction, elbow flexion, wrist and finger flexion (Figure 33.3) and thumb in palm contractures (adduction, flexion of the metacarpophalangeal joint, with or without flexion of the interphalangeal joint) all occur in the upper limb. Hip flexion, knee flexion, ankle equinus and equinovarus, and forefoot and toe flexion contractures occur in the lower limb.

Contractures lead to pain associated with joints and soft tissues and with skin breakdown in flexures or the development of pressure decubiti.

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