Contracture of the elbow joint – the restriction of his movements. It is observed with any motion of the elbow joint – flexion, extension, turn the forearm inwards or outwards. Sometimes manifestations of this disease is meaningless, therefore, its detection is necessary to carry out functional tests, but often contracture develops before complete immobilization.
In the “construction” of the elbow joint involves three bones, the violation of any of these can lead to contracture.
Because of contractures of the elbow of the Statute of the disabled person deteriorates significantly, and this affects opportunities for socialization and General life of comfort.
Most commonly affected are the male part of the working-age population – aged 25 to 45 years.
Features of the structure of the elbow joint
This is a complex type of joint in his education involved the articular surface of the humerus, ulna and radius bones. The elbow motion is possible thanks to the movements in the beam-elbow, the shoulder radius and shoulder and elbow joints, which are combined into a single structural whole common articular capsule and articular cavity.
Due to its complex “device” elbow joint can produce a whole set of movements is:
- supination – turning the forearm palm side forward;
- pronation – turning the forearm with the back forward.
In normal condition in the elbow joint may extend up to 180 degree angle, and the bent – up angle of 40 degrees. If a person has expressed the muscle mass of the upper limb, sometimes there is an insignificant limitation of flexion that the quality of life of virtually no effect.
The range of motion in the joint during supination and pronation can be very different – from the 140 degrees in people with normal level of exercise or completely untrained to 180 degrees or more in athletes (e.g., gymnasts).
The violation of at least one of the movements of the elbow joint (flexion, extension, supination, pronation) means a contracture.
Causes of contractures
Contracture of the elbow joint may develop because:
In the first case, a cause of a violation of movements in the elbow joint is a congenital disorder of his structural elements. Most often it is:
- radiolyarii the synostosis is a continuous connection of the radius and ulna through bone tissue;
- congenital dislocation of head of radial bone;
- hypoplasia (underdevelopment) of the shoulder, elbow and/or radiation to the bones;
- improper formation of the joint capsule
and some others.
Contracture of the elbow joint because of acquired disorders often develops. They were divided into groups:
- arthrogenic – violations directly to the elbow joint (deformation, osteoarthritis, arthritis, joint mouse in the form of bone fragments or cartilage);
- myogenic pathology of the muscles that move the elbow (myositis, shortening);
- dermatogenic – disorders of the skin that covers the elbow joint (the formation of massive scarring);
- diskogennye – development of connective tissue scarring in the area of the elbow joint;
- immobilization – long artificial immobilization of the elbow joint with the purpose of treatment (traction, long stay in plaster cast);
- neurogenic – disorders of the peripheral and Central nervous system.
In turn, arthrogenic, myogenic, dermatogenic and neurogenic factors in the development of contractures may have the character of:
The most common cause of contractures of the elbow joint are:
- the lack of reduction (mapping) of bone fragments in periarticular fractures and perelomova;
- they are not enough accurate comparison.
Common traumatic factors that lead to contracture of the elbow joint is:
- hemarthrosis – bleeding into a joint;
- the joint capsule rupture, after which it is very often the formation of scar adhesions (tie) and often develops inflammation of the periarticular soft tissues;
- immobilization. Immobilization contractures develop in fractures of the arm and forearm, even if such fractures occurred remotely from the elbow.
Less common causes of development of contractures of the elbow joint are:
- purulent arthritis;
- extensive burns;
- soft tissue injuries of the shoulder and forearm.
As described neurogenic causes pathology are disorders of the Central and peripheral nervous system, which affect the innervation of the structures of the elbow joint. When it comes crashing “nervous” commands the elements involved in the movement at the elbow joint (primarily muscles), causing the joint ceases to perform the movement.
Such neurogenic disorders most often:
- vascular (stroke);
- inflammatory (encephalitis);
- traumatic (injury of the motor centers of the brain).
A condition in which can occur neurogenic contracture of the elbow joint is:
- paresis – partial immobilization of the muscle due to the failure of their innervation;
- paralysis – the complete immobilization of the muscles that move the elbow joint, due to the termination of their innervation;
- a number of mental disorders (attack of hysteria).
Depending on the causes of neurogenic contractures of the elbow joint when disorders of peripheral nerves are:
- irritative-paretic (in violation of metabolism in the nerve branches);
The development of the pathology
Depending on the species restriction of movements contracture of the elbow can be:
- flexor – limited extension;
- extensor – is not fully can be bent;
- promociona – reversal is limited to the Palmar side;
- Spinalonga – restricted u-turn the back side forward.
The most common of all types of contractures of the elbow joint – flexion.
Depending on the degree of restriction of movements distinguish 4 degrees of contracture of the elbow joint:
- 1 – it is possible to hold the extension not less than 170 degrees;
- 2 – possible extension of up to 130-170 degrees;
- 3 – it is possible to implement extension to 90-130 degrees;
- 4 – extension in the joint is less than 90 degrees.
Separately there are 3 stages of contracture after injury. This takes into account some features of the pathological processes that have developed. The characteristics of these stages are the following:
- 1 – is the time interval to 1 month after injury of the elbow joint. Limitation of motion develops due to pain, prolonged fixation, and often due to psychological factors. With timely proper treatment in most cases of contracture at 1 stage pretty easily docked;
- 2 – develops after a month or more after the injury. Limitation of movement is observed due to adhesion processes and the formation of scars;
- 3 – develops few months after injury of the elbow joint. Scar tissue transformirovalsya in the fibrous scar contracts.
Also contracture of the elbow joint are divided into:
- active – the patient with the help of structures of the same elbow joint (in other words, applying an external force) labour had movement in it (or not able to do it at all);
- passive movement at the elbow joint is difficult or even impossible to implement when applying external force (picking up the shoulder and forearm of the patient and attempting to perform bending or other movement in the joint).
The main feature that manifestirutaya contracture of the elbow joint, a limitation of it:
There may also be other symptoms, but they are signs not directly contractures and pathologies that led to it. This:
- the deformation of the joint;
- swelling of the soft tissues;
- the inability to use the upper limb as a support;
- shortening of the upper limb;
- its a forced situation.
Often detected deformation do not the elbow joint and the entire hand.
If the contracture of the elbow there is swelling, he is often wearing a jet nature, although it may also occur as a symptom of pathology, which is the direct reason of development of contractures.
Violation of the supports of the upper limb is less critical, as people often use the hand for another purpose, but such violation may be one of the signs of severe pathology, which has led to the development of contractures of the elbow joint.
Characteristics of pain:
- localization – unable to cover the entire joint and the adjacent sections of bones;
- distribution radiating (give) to the next area, but rarely;
- nature – nagging, aching;
- the expression – tolerant. If it was an attempt to forcibly perform the movement at the elbow joint, can cause severe and even unbearable pain;
- for occurrence, depending on the pathology that led to the development of contractures of the elbow joint can develop practically immediately with the development of contractures or after some time.
Shortening hands with contracture of the elbow joint occurs when flexion contracture.
The diagnosis of contracture of elbow joint to deliver not heavy – it is important are the patient’s complaints, details of anamnesis (history of disease) and the results of the inspection of the joint.
But the findings of the pathology is not enough – more important is determining the causes that led to the development of contractures. For this you will need a consultation of a vascular surgeon, neurosurgeon, neurologist, dermatologist, psychiatrist or psychotherapist. You must remember that the violation that caused the occurrence of contracture of the elbow joint that may lead to the defeat not only him, but also neighboring areas. Therefore, diagnostics should be as wide as possible.
From all parts of history, the most important are the following:
- when the first signs of movement in the elbow joint;
- that, in the opinion of the patient could be a cause (fracture, inflammation, etc.);
- disappeared whether contracture – if Yes, alone or in the background of any treatment;
- tolerated if the patient has any pathology of the upper limb in General and the elbow joint in particular.
The physical examination evaluated the following characteristics:
- during the inspection – position the injured hand, the presence or absence of shortening or deformation, the condition of the skin in the region of the joint;
- palpation (feeling) to the presence or absence of pain, tension, swelling.
Also carried out the determination of the amount of motion in the joint:
Measurements of active movements conducted in the following manner: the patient does flexion, extension, Michaud, supination in the elbow joint, the doctor measures the angle between the forearm and the shoulder.
Measurements of passive movements are carried out similarly, but the elbow motion are not performed by the patient and physician that takes in one hand and the patient’s forearm, the other hand fixes the shoulder and gently tries to perform flexion, extension, supination and Michaud in the elbow joint. The movement in this exercise as much as possible, how can the condition of the joint, but before the appearance of pain syndrome. If the patient complains of expressed pain, testing was stopped and measurements are performed on the basis of to what level managed to promote movement in the joint.
In the diagnosis of contracture of the knee joint use of methods such as:
- fluoroscopy and -graphy allows to identify the problem from the side of the elbow, triggering the development of contractures. When the x-ray method of studying the image of the elbow joint on the monitor, when x-ray – take pictures and study them;
- computed tomography (CT) – computer sections you can get more detailed than in the x-ray examination, information about bony structures of the knee joint;
- magnetic resonance imaging (MRI) has a high informative value in the study of soft tissues;
- arthroscopy the cavity of the elbow joint introduce the arthroscope (a type of endoscopic equipment with an optical system and illumination), examine it from the inside.
Laboratory methods used for differential diagnosis of pathologies that can lead to the development of contractures of the elbow joint. This techniques such as:
- General blood test – it allows to detect inflammatory processes, which provoked the development of this disease. About inflammation is evidenced by the increase in the number of leukocytes and ESR;
- rheumatology test;
- biochemical analysis of blood determination of level of sodium, potassium, calcium, chlorine will help to assess the muscles that support the motor activity of the elbow joint, and the nerve endings that provide the activity of these muscles.
Differential diagnosis of
Differential (distinctive) diagnosis is carried out between those diseases and pathological conditions that could lead to contractures of the elbow joint. First and foremost, it is important to differentiate the type of disease (inflammatory, traumatic, neoplastic and so on), as this determines the further medical tactics.
The main complication is contracture of the elbow joint is the inability to perform certain movements at the elbow joint.
If contracture of the elbow joint is observed for a long time, you may develop atrophy of muscles of the forearm and shoulder.
The treatment of contractures of the elbow joint
The treatment of contractures of the elbow joint often conservative. It is most effective in fresh contractures.
Surgical correction is recommended in such cases as:
- the ineffectiveness of conservative treatment;
- further deterioration of motor activity of the elbow joint;
- improper fusion of the bone fragments;
- rude and/or massive skin and connective tissue scarring in the joint.
Because contracture of the elbow joint can occur due to diseases that differ from each other the causes and mechanisms of development, treatment of this pathology are very different.
In General, apply methods such as:
- bloodless correction of position of the limb;
- Physical therapy (exercises in contracture of the elbow joint);
Bloodless correction of position of the limb is carried out by landmark of plaster casts. The elbow result in a physiological position gradually, stage by stage, each time applying to a certain time of plaster bandage to the joint “used” to this situation.
Traction is used for contracture of the elbow joint occurred on the background of cerebral or spinal paralysis. To do this, use a special fixture with the loads.
Good are the results in the application of physiotherapeutic methods of treatment is:
- ozokeritnye applications;
- laser therapy;
- the impact diadynamic currents
and so on.
When contracture of the elbow joint operation carried out on any of the elements, violation of which led to the development of described pathology. This:
- the carving connective tissue scarring in the joint and the skin that covers it. The formation of defects they replace the auto – or allograft (in the first case use patient’s tissue and the second artificial hypoallergenic fabrics);
- removal of mice from the cavity of the joint;
- lengthening the muscles, resulting in joint movement
- removal of bone fragments that interfere with the movements at the elbow joint
and so on.
Surgical intervention is carried out:
- open method;
- using the arthroscope.
In severe or advanced cases to restore the normal form of the severely damaged elbow joint can not, therefore, apply arthroplasty – replacement of the destroyed joint with an artificial. Also it is practiced with significant cicatricial degeneration of the joint fragments.
After surgery, prescribe conservative treatment that will help to restore the disturbed function of the elbow joint and to reduce the time of rehabilitation.
The basis of therapy following purposes:
- physiotherapeutic methods of treatment.
Drug therapy is also used in the treatment of contractures of the elbow joint, but as a subsidiary of the conservative method.
The appointment of drugs such as:
- nonsteroidal anti-inflammatory drugs (NSAIDs) – used if medical manipulations carried out on the elbow, there is pain and inflammation;
- local anesthetics – they are injected into the tissue of the joint when expressed pain syndrome (conduct of the blockade);
- sedative drugs are prescribed in hysterical contractures. The ineffectiveness of the use of drugs with more pronounced effects on the Central nervous system;
- vitamin complexes used by mouth or parenterally (by injection) to improve reparative (replacement) processes in tissues of the elbow joint.
We should not forget about the effectiveness of sanatorium-resort treatment, but it is prescribed if the disease that provoked the contracture of the elbow joint are in remission.
To prevent contracture of the elbow joint easier than to cure. Preventive measures are:
- the prevention of any illnesses that can disrupt the mechanics of the elbow joint and when it occurs – early detection and treatment;
- protect elbow joint from mechanical damage – the use of special tools, if there is a risk of trauma (elbow pads when in-line skating, skateboarding or riding a motorcycle, playing hockey and other traumatic sports);
- avoidance of prolonged immobilization of the upper limb (in this connection it is expedient to apply surgical methods of treatment);
- if immobilization is unavoidable, an early appointment exercise therapy and massage.
The prognosis of contracture of elbow joint is different, but often complex – as a rule, it occurs as a complication of a disease, the duration of the current.
As with the defeat of this pathology in other joints, with chronic contractures of the elbow joint of any origin, the prognosis worsens, because in the joint gradually formed scars and adhesions (and, amazed not only damaged but also healthy tissue).