Clinic Speak: occurance of joint contractures is common

Do you have a joint contracture? Time to check and get active. #MSBlog #MSResearch #ClinicSpeak

“When you become disabled and immobile due to limited walking or being wheelchair or bed bound, you tend not put your joints through a full range of movement. Therefore the muscles and tendons shorten around the joint and this reduces the range of motion of the joint. These process results in the development of contractures. Contractures prevent MSers regaining mobility. Contractures are also associated with a large number of other problems, for  example spasticity, pain, bladder and bowel problems, pressure sores, dependency oedema (swelling of the legs), deep vein thromboses or DVTs and sleep problems to highlight the obvious ones. Therefore it is important to try and prevent them from developing by frequent exercises that put your joints through a full range of movement and results in adequate and full stretching of the muscles and ligaments.  The best person to help with this problem is a physiotherapist. Some contractures are reversible when detected and treated early. Once a contractures becomes fixed it may need other interventions to correct it, for example botox injections to weaken the muscle, optimisation of anti-spastic medication and occasionally surgical procedures to release or lengthen the tendons. Very rarely the joints may fuse and then the contracture becomes fixed; the latter is very rare in MSers and usually occurs in people with joint disease, for example rheumatoid arthritis.”

“In MSers with severe disability, who are typically bed-bound, get spasms of the muscles that cross the legs, which result in scissoring of the legs and hip contractures. These contractures make it very difficult to maintain proper hygiene below and is often the trigger for the use of more interventional treatments for example intrathecal phenol and the insertion of suprapubic catheters. Phenol works by destroying the nerves to and from the spinal cord and break the reflex arcs that drive the muscles spasms and spasticity. Phenol converts the legs from being stiff and difficult to move into being flaccid and easy to move. Intrathecal phenol can only be used when MSers have lost both their bladder and bowel function and is in general an irreversible treatment. When phenol is used in well selected MSers it can make a big difference to their nursing requirements and improve their quality of life.”

“If you are worried about having contractures bring it to the attention of your nurse, neurologist, or physiotherapist so that you be advised on a necessary treatment programme to reverse them. It will make a big difference to the quality of your life in the long-run.”

Epub: Hoang et al. Prevalence of joint contractures and muscle weakness in people with multiple sclerosis.Disabil Rehabil. 2013 Nov 18.

Objectives: To investigate the prevalence of joint contracture (limited passive range of joint motion) and muscle weakness in a population with multiple sclerosis (MS). A secondary aim was to establish normative data of functional tests of mobility and balance of people with MS who are still ambulant. 

Design: Cross-sectional study. 

Setting: People with MS living in metropolitan Sydney, Australia. 

Participants: 330 people with MS living in metropolitan Sydney, Australia were randomly sampled on 23 July 2009 from the MS Australia register and invited to participate. 

Main outcome measures: Passive range of motion of large joints of the limbs and muscle strength. Tests of walking and balance were also conducted. 

Results: 156 people (109 females, 47 males; mean age 54.2 years; mean time since diagnosis 14.9 years) agreed to participate and were assessed. Fifty-six per cent (56%) of participants had contracture in at least one major joint of upper or lower limb. The most common site of contracture was the ankle (43.9%). Seventy per cent (70%) of participants had muscle weakness in one or more muscle groups. As muscle weakness, joint contractures were present at early stage of MS and the prevalence was associated with the progression of the disease. 

Conclusions: These data show that in addition to muscle weakness joint contractures are highly prevalent among people with MS, especially in the ankle joint. This implicates that prevention of contracture is crucial in providing rehabilitation to people with MS. Implications for Rehabilitation Joint contractures are highly prevalent of people with MS, especially in the lower limb, even at an early stage. While many interventions such as stretching and serial casting have been implemented to reduce contractures, there is not yet strong evidence for their effectiveness.

About the author

Prof G

Professor of Neurology, Barts & The London. MS & Preventive Neurology thinker, blogger, runner, vegetable gardener, husband, father, cook and wine & food lover.

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