Hesperian Health Guides
Correcting Contractures Caused by Arthritis
For general information on the cause, prevention, and correction of contractures, see Chapter 8. Range-of-motion and strengthening exercises will help prevent or correct early contractures (see Chapter 42). For severe contractures, stretching aids or casts may be needed (see Chapter 59). However, when using casts or other aids to straighten contractures, it is very important to continue exercises without motion to strengthen the muscles that straighten the limb.
PRECAUTIONS FOR CASTING AN ARTHRITIC LIMB
|1. First examine the joint for signs of dislocation. Try moving the bones forward and backward and from side to side.|
CAUTION! If the joint is partly dislocated or very loose, it is best not to use casts or stretching devices, as these can increase the dislocation. It is better to continue with the exercises, taking care not to force the joint.
|2. If there are no signs of dislocation, little by little straighten the joint as far as is possible without causing much pain.|
|LIKE THIS||NOT LIKE THIS|
|Lift with your hand behind the knee to keep the bones correctly in place, like this.||
CAUTION! Do not pull like this, or you may dislocate the joint.
|3. With the joint as straight as you can get it without too much pain, carefully cast the leg.|
|Until the cast dries, apply steady pressure here so that the bones keep their right locations and the joint stays straightened.|
|4. As long as the cast is in place, do without-motion exercises several times a day. This helps keep the straightening muscles strong.|
Tighten this muscle.
Look! When I tighten it, I can feel it jump here.
You can cut a hole above the kneecap to be sure it moves when she tightens her muscles.
|5. Every 2 days remove the cast, apply heat and do range-of-motion exercises, bending and straightening the leg little by little. Then gently stretch the leg a little more, and put on another cast.|
IMPORTANT! It is best to replace the cast completely rather than to use wedges with the same cast, because of the risk of dislocation.
|6. Continue straightening the leg with new casts every 2 days until it is completely straight or does not straighten more.
Keep a record of the progress like this (see Chapter 5). This way you can tell when the leg is no longer getting straighter and it is time to stop using casts.