Official websites use. Share sensitive information only on official, secure websites. Correspondance to: Craig M. Phone: , FAX: Limb contractures are a common impairment in neuromuscular diseases NMD. They contribute to increased disability due to decreased motor performance, mobility limitations, reduced functional range of motion, loss of function for activities of daily living ADL , and increased pain. The pathogenesis of contractures is multifactorial. Myopathic conditions are associated with more severe limb contractures in comparison to neuropathic disorders.
Although the evidence supporting the efficacy of multiple interventions to improve ROM in NMD in a sustained manner is lacking, there are generally accepted principles with regard to splinting, bracing, stretching, and surgery that help minimize the impact or disability from the contractures.
Keywords: Contractures, range of motion, fibrosis, static positioning, splinting, bracing, stretching, therapy, surgery. Known contributing extrinsic factors include decreased ability to actively move a limb through its full range of motion, static positioning for prolonged periods of time, and agonist antagonist muscle imbalance. The rate of neuromuscular disease progression is also related to the frequency and severity of contractures with more rapidly progressive conditions resulting in earlier and more severe contracture formation.
A limb contracture is the lack of full passive ROM due to joint, muscle, or soft tissue limitations. Contractures in neuromuscular diseases develop due to intrinsic myotendinous structural changes and extrinsic factors. Weakness and inability to achieve active joint mobilization throughout the full normal range is the single most frequent factor contributing to the occurrence of fixed contractures. For example, less than antigravity knee extension strength places an individual at risk for knee flexion contractures, particularly if the patient no longer ambulates and spends the majority of their time seated with the knee joint positioned in flexion.
The position in which a joint is statically positioned influences the number of sarcomeres present in any given muscle. Contractures rapidly develop in many NMD after transitioning to a wheelchair.
