Contracture

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contracture

[kən′trak·chər]
(architecture)
The narrowing of a section of a column.
(medicine)
Shortening, as of muscle or scar tissue, producing distortion or deformity or abnormal limitation of movement of a joint.
Retarded relaxation of muscle, as when it is injected with veratrine.

Contracture

 

in physiology, prolonged, persistent, often irreversible contraction (rigidity) of the muscle fiber or of a section of it.

The cause of contracture is usually disruption of the processes of reconstitution (resynthesis) of adenosine triphosphoric acid (ATP). Contracture may be produced experimentally by many agents (electric current, change in the temperature or reaction of the medium, and certain biologically active or pharmacological substances, such as acetylcholine, veratrine, caffeine, and nicotine). In contrast to an ordinary muscle contraction, which extends in a wavelike manner along the muscle fiber, contracture is a prolonged, nonspreading contraction. During contracture the muscle develops tension and can perform mechanical work; heat production is increased in the area of contracture. The Russian physiologist N. E. Vvedenskii regarded contracture as a nonfluctuating stimulation of the muscle fiber.

In medical science, contracture is the limitation of mobility in a joint as a result of a pathological change in the joint surfaces or in the soft tissues that are functionally connected with the joint. One may distinguish flexor, extensor, abductor, adductor, and other contractures according to their predominant position; according to origin, a distinction is made between congenital and acquired contractures. At the root of congenital contracture is underdevelopment of the muscles and joints (torticollis, arthrogryposis, clubfoot, and so on) and of skin coverings (the cutaneous membranes between digits).

Acquired contractures may be dermatogenic (from Greek dermas, “skin”), which arise during healing, by means of the second intention of large defects in the skin after burns, wounds, inflammations, and so forth; desmogenic (from Greek desmos, “ligament”), which develop during corrugation of the fascies (connective-tissue membranes that surround the muscles), ligaments, and bursas after injury to them or inflammatory processes in them; myogenic (from Latin mys, myos, “muscle”), which are caused by traumas, acute and chronic inflammations of the muscles, and certain other pathological processes in the muscles; tendogenic (from Late Latin tendo, “tendon”), which arise as a result of injury or inflammation of the tendons and their sheaths; arthrogenic (from Greek arthron, “joint”), which are due to a pathological process in the joint—the disruption of the integrity of the joint surfaces or changes in the ligamentous apparatus; and neurogenic, which arise during illnesses of the central and peripheral nervous system.

Among these a distinction is made between reflex, spastic, and paralytic contractures. Reflex contractures develop during severe pain, prolonged protective tonic tension of the muscles (for example, flexor contracture of the hip joint with retroperitoneal abscesses). Reflex contracture gradually becomes myogenic as a result of changes that occur in the muscles. Spastic contractures arise as a result of irritation of the motor areas of the cerebral cortex and with affection of the central motor neuron, vascular diseases of the brain, inflammatory processes, traumas, and so forth. Paralytic contractures are often observed with poliomyelitis and are accompanied by loosening of the joints. Contractures caused by disruption of autonomic innervation develop after removal or irritation of a sympathetic trunk with a subsequent change in muscle tonus. The course of contracture is directly dependent on the degree of affection of the joint, the localization, and the cause of the contracture.

Prophylactic measures include timely splinting of the extremities and treatment of the primary cause. Treatment consists of the correction of the contracture by traction or on distraction apparatus, the use of plaster casts applied in stages, therapeutic exercise, massage, and physiotherapy. With persistent contractures that do not yield to conservative measures surgery is performed.

V. L. ANDRIANOV, L. O. BADALIAN, AND N. N. NEFED’EVA

References in periodicals archive ?
Xiapex (collagenase clostridium histolyticum), is a pharmacological treatment for Peyronie's disease and Dupuytren's contracture and may be an alternative to invasive and often complicated surgery for patients.
for the treatment of Dupuytren's contracture and Peyronie's disease in Japan upon receipt of applicable regulatory approvals.
The traditional treatment for Dupuytren's contracture has been to surgically remove shrunken tissue of the hand.
Peimer reviewed the charts of 302 patients with Dupuytren's contracture who were treated with collagenase injections at 10 U.
In February 2012, Auxilium entered into a collaboration agreement with Actelion for the long-term development and commercialization of XIAFLEX for the treatment of Dupuytren's contracture and Peyronie's disease in Canada, Australia, Brazil and Mexico upon receipt of the respective regulatory approvals.
Dupuytren's contracture is a condition of the hand and fingers, where the affected finger or fingers permanently bend inwards into the palm of the hand.
McIndoe was so certain of this predisposition that he stated, "The clinician who observes a patient to have knuckle pads may be quite sure that the patient either has a Dupuytren's contracture or that one will develop in the future" (17).
A common example is a condition known as Dupuytren's contracture of the hand.
XIAPEX[R] (collagenase clostridium histolyticum), a new non-surgical treatment option for Dupuytren's contracture in adult patients with a palpable cord, has been granted marketing authorization by the European Commission and is expected to be available for use in some European markets later this year.
0 million milestone revenue recognized in the 2015 period related to the first commercial sale of XIAFLEX by Asahi Kasei Pharma Corporation for the treatment of Dupuytren's contracture in Japan.
Xiapex/ Xiaflex is a first-in-class biologic approved in the US, EU, Canada and Australia for the treatment of adult Dupuytren's contracture patients with a palpable cord and in the US for the treatment of adult men with Peyronie's disease with a palpable plaque and curvature deformity of at least 30 degrees at the start of therapy.
A biologic drug that breaks down collagen and is injected directly into the cords involved in Dupuytren's contracture of the hand has been approved by the Food and Drug Administration, providing the first nonsurgical treatment for this condition, the agency announced.