contratura

Contratura, or contractura, is a medical condition characterized by a permanent shortening of muscles, tendons, fascia, or other soft tissues around a joint, leading to reduced range of motion and, in some cases, deformity. It can be primary (idiopathic) or secondary to other conditions such as burns, scarring, immobilization, neuromuscular disorders, or aging. The most common causes include neurological injuries that produce spasticity with adaptive shortening, and local tissue injuries that heal with fibrosis.

Pathophysiology involves structural changes in the muscle-tendon unit and periarticular tissues, including loss of sarcomeres in series, increased collagen deposition, and decreased elasticity. Prolonged immobilization, repetitive contraction, or ongoing spasticity can promote fibrosis and adhesions that physically limit motion.

Presentation typically includes restricted passive and active range of motion, muscle stiffness, and sometimes joint deformity. Symptoms may include pain or functional impairment, depending on the affected joint and tissues.

Diagnosis is usually clinical, based on history and physical examination. Imaging is not routinely required but may be helpful in complex cases to evaluate soft tissue structures or associated deformities. Assessment of functional impact is important for planning treatment.

Management depends on the cause and severity. Approaches include physical therapy with regular stretching, heat, orthotic devices, and serial casting or splinting to progressively lengthen tissues. In neurological etiologies, pharmacologic agents such as botulinum toxin can reduce spasticity. Surgical options (release, tenotomy, or muscle lengthening) may be considered for persistent, functionally limiting contractures, followed by rehabilitation. Prevention focuses on early mobilization after injury, ongoing stretching, scar management, and control of underlying conditions to reduce recurrence. Prognosis varies with cause and tissue involvement.