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Updated: May 6, 2025
Recovery is apt to be attended with impairment of movement due to adhesions, ankylosis, or contracture of the peri-articular structures. Caseous foci in the interior of the bones may become encapsulated, and a cure be thus effected, or they may be the cause of a relapse of the disease at a later date.
As the structures on the flexor aspect are more liable to undergo such shortening, contracture is nearly always associated with flexion. Contracture may result from disease of the joint, or from conditions outside it for example, disease in one of the adjacent bones, or lesions of the nerves.
"Exactly. And therefore you could. Now clasp your hands again. Press them together." When the right degree of pressure had been reached, Coué told him to repeat the words "I cannot, I cannot...." As he repeated this phrase the contracture increased, and all his efforts failed to release his grip.
Slight contracture of the fingers is usually the first sign of the malady; in time the muscles undergo further contraction, and this brings about a claw-like deformity of the hand. The affected muscles usually show the reaction of degeneration.
INJURIES: Contusion; Sprain; Rupture Hernia of muscle Dislocation of tendons Wounds Avulsion of tendon. DISEASES OF MUSCLE AND OF TENDONS: Atrophy; "Muscular rheumatism" Fibrositis; Contracture; Myositis; Calcification and Ossification; Tumours. DISEASES OF TENDON SHEATHS: Teno-synovitis.
The secondary changes in joints which are the seat of paralytic contracture are considered with the surgery of the Extremities. In cases of hysteria and other functional affections of the nervous system, an intermittent neuropathic hydrops has been observed especially in the knee.
The joints of the lower extremity are especially apt to suffer; the child is seriously ill, is delirious at night, develops bed-sores over the sacrum and, it may happen that, not being expected to recover, the legs are allowed to assume contracture deformities with ankylosis or dislocation at the hip and flexion ankylosis at the knees; should the child survive, the degree of crippling may be pitiable in the extreme; prolonged orthopædic treatment and a series of operations arthroplasty, osteotomies, and resections may be required to restore even a limited capacity of locomotion.
There is no actual swelling of the joint, although there may be an appearance of this from wasting of the muscles above and below. If the joint is kept rigid for long periods, secondary contracture may occur in the knee with flexion, in the hip with flexion and adduction.
In the milder forms recovery is the rule, with more or less complete restoration of function. In more severe forms the joint may be permanently damaged as a result of fibrous or bony ankylosis, or from displacement or dislocation. From changes in the peri-articular structures there may be contracture in an undesirable position, and in young subjects the growth of the limb may be interfered with.
They are due to reflex or involuntary contraction of the muscles acting on the joint, with the object of placing it in the attitude of greatest ease; they also disappear under anæsthesia. With the lapse of time they not only become exaggerated, but may become permanent from ankylosis or from contracture of the soft parts round the joint.
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