Contractures in orthopaedic and neurological conditions: a review of causes and treatment.
OBJECTIVE
To examine the techniques used for the treatment of contracture in the context of current scientific knowledge of muscle.


METHODS
Synthesis of data available from MEDLINE, RECAL, EMBASE, the Cochrane Library and relevant texts.


RESULTS
The development of contractures through immobilisation, muscle weakness and spasticity is described. The effects of passive stretching, continuous passive movement, serial plastering, splinting, electrical stimulation, botulinum injections and surgical tenotomies in the treatment of contractures in persons with neurological and orthopaedic conditions are identified. The strengths and weaknesses of these modalities are discussed.


CONCLUSIONS
Predisposing factors persist after treatment of contractures thus for treatment to be effective long-term management programmes need to be developed. New treatment techniques, used in series or combined, offer the prospect of improved management of contracture. Scientific and clinical research is needed to investigate the effect of contracture treatment.
Farmer
S E
SE
Orthotic Research and Locomotor Assessment Unit, Robert Jones and Agnes Hunt Orthopaedic and District NHS Hospital Trust, Oswestry, Shropshire, UK. sybil.farmer@rjahoh-tr.wmids.nhs.uk
James
M
M
D000203:Activities of Daily Living; D001905:Botulinum Toxins / Q000627:therapeutic use; D002133:Calcium Sulfate; D003131:Combined Modality Therapy; D003286:Contracture / Q000209:etiology* / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D004599:Electric Stimulation Therapy / Q000379:methods; D005081:Exercise Therapy / Q000379:methods; D006801:Humans; D007103:Immobilization; D015915:Motion Therapy, Continuous Passive; D009128:Muscle Spasticity / Q000209:etiology / Q000628:therapy; D016059:Range of Motion, Articular; D013165:Splints
D001905:Botulinum Toxins; D002133:Calcium Sulfate