80 chapter 8
Can a contracture be straightened in the village?
Contractures usually begin with shortening of muscles, causing tight
cords (tendons). Later, the nerves, skin, and ‘joint capsule’ also can
become tight. (A ‘joint capsule’ is the tough covering around a joint.)
When a contracture is only in the muscles and cords, it can usually be
straightened by exercises and casts at a village rehab center, although
sometimes this may take months. But if the contracture also involves
the joint capsule, it is often much more difficult or impossible to correct,
even with many months of using casts. Surgery may be needed.
TO TEST THE KNEE JOINT:
Check the range
of motion of the
knee with the
hip straight and
then bent.
Explanation: One of the main
muscles that causes a knee contracture
is the ‘hamstring muscle’, which runs
all the way from the hip bone to the
bone of the lower leg. This means that
when the hip is bent, the tight muscles
will bend the knee more.
Note: If you find the
information on this page
hard to understand, do
not worry. Come back
to it later, when you
meet very stubborn
contractures.
hamstring
muscle
If the knee
straghtens more
when the hip is
straight
hip
straight
than when the
hip is bent,
hip bent
probably this
is a muscle
contracture (a
short hamstring
muscle).
THE KNEE BENDS MORE:
MUSCLE CONTRACTURE
This can often be corrected in the village.
But if the knee
straightens equally
when the hip is
straight or bent,
probably there is
contracture of the
joint capsule.
This often requires surgery.
THE KNEE BENDS
THE SAME:
JOINT CAPSULE
CONTRACTURE
TO TEST THE ANKLE JOINT:
Check the range
of motion of the
ankle with the
knee straight
and then bent.
Explanation: One of the main
muscles that pulls the foot to a tiptoe
position runs from the thigh bone all
the way to the heel. This causes the
heel cord to pull more when the knee
is straight than when the knee is bent.
calf
muscle
heel cord
If the foot pushes
down more when the
knee is straight
knee
straight
But if the foot
angle is the same
when the knee is
straight or bent,
than when the
knee is bent,
it is a muscle
contracture.
knee bent
THE FOOT BENDS
UP MORE: MUSCLE
CONTRACTURE
This can often be corrected in the village.
there probably is
a contracture of
the joint capsule.
This often requires surgery.
THE FOOT BENDS
THE SAME:
JOINT CAPSULE
CONTRACTURE
JOINTS THAT DO NOT MOVE AT ALL
If a joint moves only a little, the joint capsule may be very tight, or there may be a deformity in the
bones. With exercises, try to gradually increase the movement.
If a joint does not move at all, the bones may be ‘fused’ (joined together). This often happens when
there is a lot of pain and damage in the joint. When a joint has fused, exercise will usually not bring
back motion. The only surgery that might help return joint motion is to put in an ‘artificial joint’ of metal
or plastic. This surgery is very costly, and if the person is very active, the joint may not last more than
a few years.
Disabled village Children