Hesperian Health Guides
Chapter 8: Contractures: Limbs That No Longer Straighten
What are Contractures?
When an arm or leg is in a bent position for a long time, some of the muscles become shorter, so that the limb cannot fully straighten. Or shortened muscles may hold a joint straight, so it cannot bend. We say the joint has a ‘contracture’. Contractures can develop in any joint of the body. For example:
| 1. Miguel spent the first years of his life crawling because one leg was paralyzed. | 2. In time, he could not straighten his hip or knee, or bend his foot up. He had developed a: | |
| Because he could not stand, he kept his hip and knee bent and his foot in a tiptoe position, like this. |
 hip contracture
knee contracture
“tiptoe” contracture of the ankle |
 You can feel the tight cord here,
when you push here |
 |
| 3. Because of the contractures, Miguel could not stand or walk, even with a brace |
 shortened muscles causing hip contracture
Shortened calf muscles cause a tight heel cord that keeps the foot in a ‘tiptoe’ position.
Shortened muscles that bend the knee cause tight cords behind the knee. This keeps it bent. | |
Contractures develop whenever a limb or joint is not moved regularly through its full range of motion. This is likely when:
|
ankle contracture |
|
hip contracture
knee contracture |
|
 hip contracture
knee contracture
ankle contracture |
|
contractures in: — neck — shoulders — back — elbow — wrists — fingers — hips — knees — ankles — feet — toes |
Why is it important to know about contractures?
- Most contractures can be prevented through exercise and other measures. Yet in many communities, at least half of the children with physical disabilities already have contractures.
- Contractures make rehabilitation more difficult. Often they must be corrected before a child can walk or care for himself.
- Correction of contractures is slow, costly, and often very uncomfortable or painful.
- It is best not to let contractures develop, and if they do begin to develop, to correct them as soon as possible. Early contractures often can be easily corrected at home, with exercises and positioning. Advanced, old contractures are much more difficult to correct, and may require gradual stretching with plaster casts, or surgery.
For all these reasons...
The family of every child with disabilities should understand how contractures develop, how to prevent them, and how to recognize and correct them when they first begin.
Muscle imbalance — a major cause of contractures
When the muscles that bend or pull a limb in one direction are much stronger than those that pull it in the opposite direction, we say there is a muscle imbalance. When paralysis, painful joints, or spasticity cause a muscle imbalance, contractures are much more likely to develop.
| WITHOUT MUSCLE IMBALANCE — CONTRACTURES LESS LIKELY | muscles equally weak on both sides | |
| A leg that is completely paralyzed is not very likely to develop contractures. The knee may even straighten more than is typical. |  |
|
| no contracture |
| WITH MUSCLE IMBALANCE — CONTRACTURES MORE LIKELY | ||
| If the muscles that straighten the knee and lift the foot are very weak, | Muscle imbalance causing contractures can result from spasms, or spasticity, that increase the pull of certain muscles (cerebral palsy and spinal cord injury). | |
 and the muscles that bend the knee and lower the foot are strong,
contractures are very likely to develop. |
 “knock-knee” contracture of hips |
For example, the bent elbow and crossed legs of this child with spastic cerebral palsy can lead to contractures so that his legs cannot be spread apart or his elbow straightened. |
To check for muscle imbalance, test and compare the strength of the muscles that bend a joint, and of the muscles that straighten it (see Muscle testing.)