Prevention and management of limb contractures in neuromuscular diseases

Abstract

Limb contractures are a common impairment in neuromuscular diseases. They contribute to increased disability from decreased motor performance, mobility limitations, reduced functional range of motion, loss of function for activities of daily living, and increased pain. The pathogenesis of contractures is multifactorial. Myopathic conditions are associated with more severe limb contractures compared with neuropathic disorders. Although the evidence supporting the efficacy of multiple interventions to improve range of motion in neuromuscular diseases in a sustained manner is lacking, there are generally accepted principles with regard to splinting, bracing, stretching, and surgery that help minimize the impact or disability from contractures.

Copyright © 2012 Elsevier Inc. All rights reserved.

Figures

Figure 1

Cumulative percentages of DMD subjects with ≥5° contractures (dashed line) and ≥15° contractures (solid line) versus years to and from wheelchair reliance: a) Knee Flexion; b) Elbow Flexion; c) Hip Flexion; d) Ankle Plantarflexion (From McDonald CM, Abresch RT, Carter GT, Fowler WM Jr, Johnson ER, Kilmer DD, Sigford BJ. Profiles of neuromuscular diseases. Duchenne muscular dystrophy. Am J Phys Med Rehabil. 1995 Sep–Oct;74 (5 Suppl):S70–92. PubMed PMID: 7576424; with permission)

Figure 2

A) The calcaneal inclination angle is increased in the cavus foot since the hindfoot is already calcaneus despite the forefoot equinus. B) Normal calcaneal inclination angle.

Figure 3

The dorsal osteotomy improves the forefoot equinus without worsening the hindfoot calcaneus.