Learn About Contracture Deformity
Contracture deformity is a condition where muscles, tendons, ligaments, or skin become permanently shortened, leading to restricted joint movement and visible deformity. This loss of flexibility can greatly affect daily activities, mobility, and overall quality of life. Contractures often develop gradually and can result from various causes, including neurological conditions, burns, injuries, or prolonged immobility. Although they are preventable, contractures remain a major cause of disability worldwide.
Understanding contracture deformity is essential because early recognition and prevention can significantly improve outcomes. This article explores what contracture deformity is, its causes and symptoms, how it is diagnosed, and the treatment options available to help patients regain movement and independence.
A contracture deformity occurs when soft tissues around a joint—such as muscles or tendons—become stiff and permanently shortened. This prevents normal joint movement and may cause a noticeable deformity. Contractures can affect any part of the body and often worsen over time if not treated early.
There are several ways to classify contractures based on their characteristics:
- Location: Upper limb (elbow or wrist flexion contracture), lower limb (knee flexion or equinus foot deformity)
- Tissue involved: Myogenic (muscles), arthrogenic (joint capsules), dermatogenic (skin), tendinous (tendons), neurogenic (due to spasticity or paralysis)
- Mechanism: Spastic (from increased muscle tone, such as after stroke or cerebral palsy), paralytic (from nerve damage), fibrotic (from immobility), or burn-related (from scarring)
Each type has distinct underlying causes and requires targeted management, but all share the common feature of limiting mobility and impacting daily life.
A contracture deformity occurs when soft tissues around a joint—such as muscles or tendons—become stiff and permanently shortened. This prevents normal joint movement and may cause a noticeable deformity. Contractures can affect any part of the body and often worsen over time if not treated early.
Contracture deformities affect people across all age groups and medical conditions. Their prevalence varies depending on the underlying cause:
- Burn injuries: up to 80% of severe burn patients develop contractures without early therapy
- Cerebral palsy: 60–90% of children experience contractures as they grow
- Stroke: 20–50% of patients develop contractures after a stroke
- Spinal cord injuries: common cause of lower limb contractures
- Critical illness: immobilized patients in intensive care are also at risk
These statistics highlight the importance of early movement and rehabilitation to prevent contracture development.
Contracture deformities can develop from many different conditions that cause muscles, tendons, and connective tissues to shorten or stiffen over time. The main driving factors include prolonged immobility, muscle imbalance, scarring, and nerve damage. Often, these processes overlap, making prevention and treatment complex.
- Neurological conditions such as cerebral palsy, stroke, traumatic brain injury, and spinal cord injury are among the leading causes. These disorders can result in spasticity, where muscles tighten uncontrollably, or paralysis, where muscles lose strength and balance. Without active stretching and movement, the affected joints gradually lose flexibility. Nerve-related disorders like post-polio syndrome or peripheral nerve damage can also lead to muscle shortening and deformity.
- Musculoskeletal causes are also common, especially after injuries or surgeries that require prolonged immobilization. When a limb remains in a fixed position for too long—such as in a cast or splint—the surrounding tissues adapt to that posture. Joint stiffness, arthritis, or poor rehabilitation after fractures can all contribute to contracture formation.
- Burns and scar tissue can produce significant tightening around joints. Deep burns that extend through the skin layers may cause the healing tissue to contract as it matures, limiting motion. Hypertrophic scars, which are thick and raised, can also pull on the skin and underlying structures.
- Some individuals are born with conditions that predispose them to contractures, such as clubfoot (talipes equinovarus), arthrogryposis multiplex congenita, or congenital torticollis. These congenital forms typically appear early in life and often require long-term therapy or surgery to improve mobility.
- Systemic diseases like rheumatoid arthritis and scleroderma can gradually tighten skin or joint tissues, while surgery or chronic pain may restrict voluntary movement. People confined to bed or wheelchairs for long periods are particularly vulnerable to developing contractures if preventive care—such as repositioning, stretching, and physical therapy—is not provided.
Overall, contractures arise when joints are not moved through their normal range, allowing surrounding tissues to shorten and harden. Active movement, stretching, and consistent therapy remain essential to prevention and recovery.
Contractures develop gradually due to mechanical and biological changes in the body:
1. Muscle Imbalance
When some muscles remain tight and overactive (spastic), and opposing muscles weaken, the joint stays in a fixed position. Over time, this position becomes permanent.
2. Immobilization
Lack of movement causes collagen fibers in the muscles and connective tissues to stiffen and shorten, reducing flexibility.
3. Fibrosis and Scar Formation
After burns or deep injuries, scar tissue contracts during healing, pulling on nearby skin and joints.
4. Growth and Development
In children with cerebral palsy, spastic muscles fail to grow as bones lengthen, leading to deformity.
Microscopically, contractures involve:
- Collagen buildup and cross-linking
- Loss of normal muscle fibers (sarcomeres)
- Adhesions and joint thickening
These changes make contractures difficult to reverse without medical or surgical intervention.
The symptoms of contracture deformity can vary depending on the affected joint but often include:
- Visible deformity or abnormal limb posture
- Stiffness and restricted joint movement
- Difficulty with activities like walking, dressing, or bathing
- Pain or discomfort when stretching the limb
- Muscle wasting around the affected area
- Skin changes, tightness, or scarring
Common Examples:
- Elbow flexion contracture: difficulty straightening the arm
- Knee flexion contracture: inability to fully extend the leg
- Equinus foot deformity: walking on toes
- Dupuytren’s contracture: curled fingers due to thickened palm tissue
- Torticollis: neck twisting to one side
Examination Findings
Doctors assess range of motion, muscle tone, spasticity, and any associated neurological signs. They may use standardized scales, such as the Modified Ashworth Scale, to measure severity.
Diagnosis is primarily clinical, based on physical examination and patient history. Key steps include:
Clinical Evaluation
- Understanding when symptoms began and how they have progressed
- Assessing functional impact on daily life
- Measuring active and passive joint motion
- Evaluating gait or posture abnormalities
Imaging Tests
- X-rays: to rule out bone fusion or dislocation
- Ultrasound: to assess soft tissue thickness or muscle shortening
- MRI: to identify muscle fibrosis or fat replacement
Additional Tests
- Electromyography (EMG): helps distinguish between spastic and paralytic causes
Together, these evaluations guide treatment and help determine whether surgery may be needed.
Certain conditions can appear similar to contractures but require different treatments:
- Bony ankylosis: joint fusion
- Heterotopic ossification: abnormal bone growth in soft tissues
- Severe spasticity: without permanent tissue shortening
- Arthrogryposis: congenital contractures present from birth
A thorough assessment helps confirm a true contracture and tailor an appropriate care plan.
Preventive Measures
The best treatment is prevention. Early movement and positioning are critical in hospitals, after surgery, and during rehabilitation. Preventive strategies include:
- Frequent repositioning of patients
- Gentle stretching and range of motion exercises
- Proper splinting after burns or injuries
Non-Surgical Management
Physical Therapy
- Regular stretching and movement exercises
- Strengthening opposing muscles
- Postural correction and mobility training
Splints and Orthotics
- Static splints to maintain neutral joint position
- Dynamic splints that provide gradual stretching
- Night splints to prevent tightening during sleep
Medications
- Botulinum toxin injections: relax spastic muscles
- Muscle relaxants: such as baclofen or tizanidine
- Pain relief: for comfort during therapy
Surgical Management
When non-surgical treatments fail, surgery may be needed to restore movement and alignment.
Surgical Options Include:
- Soft tissue release: cutting or lengthening tight muscles and tendons
- Capsulotomy: loosening tight joint capsules
- Z-plasty: releasing scarred skin from burns
- Tendon transfers or osteotomy: correcting severe deformities
After surgery, rehabilitation is essential to prevent recurrence and maintain improvements.
If untreated, contractures can lead to:
- Permanent disability
- Skin breakdown or ulcers
- Pain and discomfort
- Difficulty maintaining hygiene
- Gait and balance problems
- Reduced independence and psychological distress
- Cause: neurological vs. orthopedic
- Severity: mild stiffness vs. fixed deformity
- Timing of treatment: earlier intervention leads to better outcomes
- Adherence: consistent exercise and splinting are key
Many mild contractures improve with therapy, while long-standing ones may require surgery. Early prevention and multidisciplinary rehabilitation often yield the best results.
Preventing contractures involves staying active, maintaining flexibility, and managing conditions that cause immobility or spasticity.
Key Strategies
- Early mobilization: begin movement soon after injury or surgery
- Proper positioning: avoid prolonged flexion postures
- Daily stretching: maintain joint range
- Spasticity management: medications or injections when needed
- Burn care: early physiotherapy and splinting after healing
- Education: teaching caregivers how to help with exercises
Living with a contracture can be challenging, but rehabilitation and adaptive tools can greatly enhance independence. A team-based approach is most effective, involving:
- Physiatrists and therapists for personalized treatment plans
- Assistive devices such as braces, wheelchairs, or adapted utensils
- Occupational therapy to improve daily living skills
- Home exercise programs to maintain flexibility
Emotional support and counseling can also help individuals and families cope with the condition and maintain motivation.
Contracture deformity is a preventable but disabling condition that affects movement, function, and quality of life. Early recognition, consistent preventive care, and rehabilitation are key to minimizing its impact. For more severe cases, surgical interventions combined with physical therapy can restore mobility and independence.
Ongoing research into regenerative medicine, advanced orthotics, and spasticity management offers hope for better treatments in the future. Education, awareness, and early action remain the most powerful tools for preventing contracture deformities.
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- Rose J, Haskell WL. Muscular contractures in cerebral palsy and spasticity: a review. Dev Med Child Neurol. 1990;32(11):913-918.
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Proliance Surgeons
Philip Yearian, DPM, is a board-certified surgeon specializing in the lower extremity treatment of the foot and ankle. He believes that staying on the forefront of treatment involves educating his patients, which leads to better outcomes.While competing as a Division I Track and Field athlete in the 3000 meters Steeplechase and Cross Country at the University of Portland, his own injuries introduced him to some of the very treatments he uses today to get patients back on their way to a non-painful walk or ultra-marathon.His training involved specializing in both bone and plastic reconstructive surgery. After over twenty years in practice in Gig Harbor and Tacoma, Dr. Yearian has improved some of these very techniques, which now allow some patients to shorten their recovery and return to play or work sooner.Dr. Yearian coaches basketball at St. Charles Borromeo Catholic School. He also enjoys running marathons, skiing, traveling and teaching for the Franciscan Foot and Ankle Reconstructive Residency program. Dr. Yearian is rated as an Advanced provider by MediFind in the treatment of Contracture Deformity. His top areas of expertise are Bunions, Flat Feet, Synovitis, and Tendinitis.
Proliance Surgeons
Michael K. Gannon, MD, is a board-certified and very experienced orthopedic surgeon. His practice over the last thirty years has emphasized hip and knee replacement and care of sports injuries including meniscal, ACL and rotator cuff tears. As he has treated emergency cases for decades and has repaired countless extremity injuries great and small.Dr. Gannon began his life in medicine at age sixteen as a hospital orderly and ambulance attendant. He was the second youngest in his state to pass the national EMT-A certification exam. During college he worked summers as an operating room technician plus a second job detasseling corn. He went to medical school in his home state at the University of Iowa. He received his specialty training in the highly regarded orthopedic surgery residency program at the University of Washington. After completing his orthopedic training, he had the honor to serve five years as “co-team physician” for multiple military units from smaller Special Forces and Ranger groups to infantry divisions with 12,000+ athletic members (of note such “teams” never have an off-season and are active on rough terrain day and night). Duties included work in Europe, Africa, and the Persian Gulf. Stateside, as a faculty member, he oversaw sports medicine and trauma training for orthopedic residents at Madigan Army Medical Center. He later served as civilian consultant for sports medicine for Madigan.Since 1993 he has been serving residents of Whatcom County as a member of a topflight orthopedic surgery group. Over the course of his career, he has had the privilege to treat patients and their families from amazingly diverse backgrounds, from remote Saharan herdsmen and villagers to national leaders and Rhodes scholars…. from angry enemy combatants and fierce criminals to Medal of Honor recipients and heroic first responders…. from the youngest backyard acrobats and trampolinists to past Olympians and hobbled NFL veterans. He has worked in world class medical centers to makeshift hospitals with no windows or beds but goats in the halls. Dr. Gannon has cared for patients of the innumerable combinations of races, countries of origin, life circumstances, faiths, orientations, and political beliefs. His lifelong approach has been to provide care for each person with the respect, compassion, and diligence he would wish for his own family members.Hobbies and adventures over the years have included climbing, backpacking, flying, scuba, skiing, and more recently snowshoeing and photography. His very favorite pastime is hanging out with his family. Dr. Gannon is rated as an Advanced provider by MediFind in the treatment of Contracture Deformity. His top areas of expertise are Osteoarthritis, Contracture Deformity, Frozen Shoulder, Bursitis, and Hip Replacement.
Proliance Surgeons
Alan B. Thomas, MD, is a board-certified orthopedic surgeon who specializes in upper extremity surgery. He has been practicing medicine since 2000, and he has a special interest in arthroscopy of the wrist, elbow and shoulder. He received a CAQ subspecialty certificate in orthopedic surgery of the hand from the American Board of Orthopaedic Surgery.He enjoys the challenges of restoring people to health through his practice. His doctorate work in biochemistry opened up new approaches for treating complex problems and made him a more detailed clinician.Dr. Thomas is a former vice president of St. Clare Hospital and has served on the operating and surgical committees for St Clare Hospital and the medical executive committee for Franciscan Health at St. Josephs Medical Center. He is a chairman for an outreach committee at his church and a member of the board of directors for The Health Project – Cambodia, which delivers medical supplies and equipment to underserved people in Southeast Asia and he travels to Cambodia each year to provide surgical care to those in need.Outside of his medical practice and volunteer work, he tries to keep up with his three children who are avid skiers, wakeboarders, and surfers. Dr. Thomas is rated as an Advanced provider by MediFind in the treatment of Contracture Deformity. His top areas of expertise are Carpal Tunnel Syndrome, Ganglion Cyst, Trigger Thumb, and Rhizarthrosis.