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Examining the Child for Contractures

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HealthWiki > Disabled Village Children > Chapter 8: Contractures: Limbs That No Longer Straighten > Examining the Child for Contractures


This is done through testing the ‘range of motion’ of different joints, as described in Testing Range of Motion of Joints and Strength of Muscles. Most contractures will be obvious when you test for them. But hip contractures can easily be missed.

This child can lie with his right leg almost flat... But if you test him with his other knee bent up to his chest... Be sure to test for contractures with the leg lined up straight.
DVC Ch8 Page 79-1.png
DVC Ch8 Page 79-2.png
a child with his leg straight out
like this
not like this
...by arching his back. You might think he has little or no hip contracture. ... his back flattens and you can see the amount of contracture.

Also be sure joints do not dislocate when you test for contractures, because this can fool you, too. For example:

This child’s foot can rest on the ground, DVC Ch8 Page 79-4.png only because it dislocates sideways.
DVC Ch8 Page 79-5.png
tight heel cord
foot in tiptoe position
If you hold the foot so it does not dislocate, you will see that the ankle has a severe contracture.

How to tell contractures from spasticity

Spasticity (muscle tightening that the child does not control) is common when there is damage to the brain or spinal cord. It is sometimes mistaken for contractures. It is important to know the difference.

SPASTICITY of ankle joint DVC Ch8 Page 79-7.png If at first it resists under steady pressure,
and then it slowly yields, it is probably spasticity.
CONTRACTURES of ankle joint DVC Ch8 Page 79-8.png If it resists under steady pressure,
and does not yield, it is probably a contracture.


Spasticity often leads to contractures. For details, see "Preventing Contractures".

Measuring Contractures

This can be done by folding a paper and measuring the angle, as shown here,

This can be done by folding a paper and measuring the angle, as shown here,
a paper is folded to match the angle of the contracture
and then tracing that angle onto a record sheet.
DVC Ch8 Page 79-10.png
Or use a ‘compass’.
DVC Ch8 Page 79-13.png
Or make a simple instrument of 2 thin pieces of wood joined by a bolt or rivet, tight enough so that they move stiffly.
DVC Ch8 Page 79-14.png
You can record your measurements with stick figures.
DVC Ch8 Page 79-11.png
Or an easier, more fun way is to use a flexikin.
DVC Ch8 Page 79-12.png
By keeping a record of their child’s progress, a family can see the results and is more likely to keep working hard at exercises to correct a child’s contractures.
dated record of a child's contractures

Can a contracture be straightened in the village?

Contractures usually begin with shortening of muscles, causing tight cords (tendons). Later, the nerves, skin, and ‘joint capsule’ also can become tight. (A ‘joint capsule’ is the tough covering around a joint.)

Note: If you find the information on this page hard to understand, do not worry. Come back to it later, when you meet very stubborn contractures.


When a contracture is only in the muscles and cords, it can usually be straightened by exercises and casts at a village rehab center, although sometimes this may take months. But if the contracture also involves the joint capsule, it is often much more difficult or impossible to correct, even with many months of using casts. Surgery may be needed.

To Test the Knee Joint:

Check the range of motion of the knee with the hip straight and then bent. DVC Ch8 Page 80-1.png
Explanation: One of the main muscles that causes a knee contracture is the ‘hamstring muscle’, which runs all the way from the hip bone to the bone of the lower leg. This means that when the hip is bent, the tight muscles will bend the knee more.
DVC Ch8 Page 80-2.png
hamstring muscle
THE KNEE BENDS MORE: MUSCLE CONTRACTURE
If the knee straightens more when the hip is straight
DVC Ch8 Page 80-3.png
hip straight
than when the hip is bent,
probably this is a muscle contracture (a short hamstring muscle).
hip bent
This can often be corrected in the village.
THE KNEE BENDS THE SAME: JOINT CAPSULE CONTRACTURE
But if the knee straightens equally when the hip is straight or bent,
DVC Ch8 Page 80-4.png
probably there is contracture of the joint capsule.
This often requires surgery.

To Test the Ankle Joint:

Check the range of motion of the ankle with the knee straight and then bent.
DVC Ch8 Page 80-5.png
Explanation: One of the main muscles that pulls the foot to a tiptoe position runs from the thigh bone all the way to the heel. This causes the heel cord to pull more when the knee is straight than when the knee is bent.
DVC Ch8 Page 80-6.png
calf
muscle
heel cord
THE FOOT BENDS UP MORE: MUSCLE CONTRACTURE
If the foot pushes down more when the knee is straight
DVC Ch8 Page 80-7.png
knee straight
knee bent
than when the knee is bent, it is a muscle contracture.
This can often be corrected in the village.
THE FOOT BENDS THE SAME: JOINT CAPSULE CONTRACTURE
But if the foot angle is the same when the knee is straight or bent, DVC Ch8 Page 80-8.png
there probably is a contracture of the joint capsule.
This often requires surgery.

Joints That Do Not Move At All

If a joint moves only a little, the joint capsule may be very tight, or there may be a deformity in the bones. With exercises, try to gradually increase the movement.

If a joint does not move at all, the bones may be ‘fused’ (joined together). This often happens when there is a lot of pain and damage in the joint. When a joint has fused, exercise will usually not bring back motion. The only surgery that might help return joint motion is to put in an ‘artificial joint’ of metal or plastic. This surgery is very costly, and if the person is very active, the joint may not last more than a few years.


This page was updated:19 Jan 2018