juvenile arthritis
CORRECTING CONTRACTURES CAUSED BY ARTHRITIS
For general information on the cause, prevention, and correction of contractures, see
Chapter 8. Range-of-motion and strengthening exercises will help prevent or correct
early contractures (see Chapter 42). For severe contractures, stretching aids or casts
may be needed (see Chapter 59). However, when using casts or other aids to straighten
contractures, it is very important to continue exercises without motion to strengthen
the muscles that straighten the limb.
147
PRECAUTIONS FOR CASTING AN ARTHRITIC LIMB
1. First examine the
joint for signs
of dislocation.
Try moving the
bones forward and
backward and from
side to side.
CAUTION: If the joint is partly dislocated or very
loose, it is best not to use casts or stretching devices,
as these can increase the dislocation. It is better to
continue with the exercises, taking care not to force
the joint.
2. If there are no signs of dislocation, little by little
straighten the joint as far as is possible without causing
much pain.
LIKE THIS
Lift with your
hand behind
the knee to
keep the bones
correctly in
place, like this.
CAUTION: Do not pull like this,
or you may dislocate the joint.
NOT LIKE
THIS
dislocated
joint
3. With the joint as straight as you can get it
without too much pain, carefully cast the
leg (see p. 560).
4. As long as the cast is in place, do without-motion exercises
several times a day. This helps keep the straightening muscles
strong.
Until the cast dries, apply steady pressure
here so that the bones keep their right
locations and the joint stays straightened.
You can cut a hole
above the kneecap
to be sure it moves
when she tightens
her muscles.
5. Every 2 days remove the cast, apply heat and
do range-of-motion exercises, bending and
straightening the leg little by little. Then gently
stretch the leg a little more, and put on another
cast.
(IMPORTANT: It is best to replace the cast
completely rather than to use wedges with the
same cast, because of the risk of dislocation.)
6. Continue straightening the
leg with new casts every 2
days until it is completely
straight or does not
straighten more.
Keep a record of the
progress like this (see
Chapter 5). This way you
can tell when the leg is no
longer getting straighter and
it is time to stop using casts.
Inez Sanchez
Nov. 4
Nov. 8
Nov. 12
Nov. 17
Nov. 22
disabled village children