Contractures: Causes, Symptoms, and Treatment Options for Joint Stiffness

Definition

A contracture is a fixed shortening of muscle, tendon, ligament, or joint capsule that limits passive and active range of motion.

Common Causes

• Prolonged immobilization (casting, bedrest, paralysis).
• Post-traumatic or post-surgical scarring (fibrosis).
• Burns (skin and soft tissue contracture).
• Neurological conditions (stroke, cerebral palsy, spinal cord injury → spasticity).
• Inflammatory arthritis (rheumatoid, juvenile idiopathic).
• Congenital (e.g., arthrogryposis).

Symptoms

• Joint stiffness, reduced ROM.
• Pain on attempted stretch.
• Functional impairment (gait, ADLs).
• Skin changes (tight, shiny).

Management

• Prevention: Early mobilization, positioning, splinting, range-of-motion exercises.
• Conservative: Physical/occupational therapy, serial casting, dynamic splints, botulinum toxin for spasticity.
• Surgical: Tenotomy, capsular release, Z-plasty, tendon lengthening for established contractures.