What is knee contracture, causes and treatment methods. Flexion-extension contractures of the knee joint as a consequence of femoral fractures Treatment of contractures of the knee joint with folk remedies

Contracture of the knee joint is a pathology of the lower limb, in which the knee does not straighten or bend completely. It is considered a subsequent symptom of the disease. Any type of stiffness in the knee joint, whether congenital or resulting mechanical damage, requires contacting a specialist. To avoid complete immobility of the joint, it is necessary to carry out timely and thoughtful treatment. In case of inattention to one's health, such a pathology has very disastrous consequences.

Contracture refers to a temporary or permanent limitation of mobility in a joint. The connections of both the upper and the lower limbs. Especially unpleasant illness is a contracture of the knee joint, which is accompanied by strong and sharp pains. If treatment is not undertaken on time, it usually leads to partial or complete disability. The term "contracture" has Latin roots, meaning "tightening." Such an interpretation can easily and clearly explain the essence of the disease. Pathology occurs when soft tissues change, the degeneration of which causes tightening and compression of the knee joint or, more simply put, completely limiting its mobility. The destructive process begins with its prolonged inactivity. During this period, the muscle tissue is practically paralyzed, which causes a fixed position of the joint. This condition causes changes in soft tissue, after which the ligaments and tendons become less elastic.

Reasons for appearance

Most experts do not consider contracture to be a specific diseases and believe that it is a consequence of some illness or injury. And it’s hard to disagree with them on this. As a rule, after any injury or damage to the tissue, a scar remains that does not have elasticity. Similar feature and leads to limitation of movements, a decrease in the length of the ligament and further deformation of the knee joint.

The following reasons can cause contracture:

  1. knee injuries and inflammation in it;
  2. arthrosis, arthritis, causing gradual destruction of the elements of the knee joint and bone deformation;
  3. decreased elasticity and decreased length muscle tissue and ligaments;
  4. congenital pathology of the knee joint;
  5. mechanical damage;
  6. with lesions of the central nervous system.

Also, the patient’s activity has a huge impact on the occurrence of stiffness. The risk group includes professional athletes and people whose work requires increased physical activity.

Types of pathology

Loss of movement in the knee joint is classified by experts depending on the cause of its occurrence:

  • arthrogenic. They are a consequence of degenerative processes in the joint, on its surface and in the ligament system;
  • dermatogenic. Such a disorder is a consequence of serious skin defects, which result in extensive injuries (burns, inflammation, wounds) involving the periarticular area;
  • desmogenic. This type of contracture is characterized by wrinkling of the periarticular tissues. Contracture develops after mechanical damage or inflammatory process in fascia, ligaments and articular capsule;
  • myogenic. Formed after prolonged compression of muscle tissue, and are also a consequence of muscle ischemia and myositis of various forms;
  • tendogenic. Occur as a result of inflammatory or traumatic changes in tendon ligaments;
  • neurogenic. Impaired mobility in the knee joint can appear after paralysis, cerebral hemorrhages and central nervous system disease.

Limitation of joint mobility can be in the following directions:

  1. flexion;
  2. extension;
  3. limitation of rotational movements;
  4. inability to move the joint to the right or left side.

Temporary contracture

As a rule, temporary contracture is a consequence of insufficient development of the articular joint after injury or disease. In such a condition, the blame should be placed not only on the patient who allowed the knee to become stiff, but also on the doctor who should have told about possible consequences pathologies and give recommendations on how to carry out joint rehabilitation.

Temporary contracture usually occurs during a reflex contraction of muscle tissue to hold the joint in the position that is least painful at the moment. After pain decreases, blood circulation in the affected area is restored, and the scars gradually resolve. If the disease requires maintaining the immobility of the articular joint for a long time, then the pathology becomes combined form and is difficult to cure.

Persistent contracture

As treatment practice shows, persistent creatosis can occur after 3 weeks of immobilization of the knee joint. Moreover, each week of forced position helps to reduce the strength of muscle tissue by 20%. And within 6 weeks, the elasticity of the joint capsule decreases 10 times.

Persistent contractures also include congenital pathologies. Most often they appear when there are violations of the natural position of individual elements of the lower limb and their shapes. A striking example of this type is clubfoot in a child.

Therefore, the treatment of persistent creatures has always been particularly difficult, requiring patient compliance with all the doctor’s instructions. The patient's inactivity and deviations from the prescribed course of joint rehabilitation only contribute to the deterioration of the condition. Forcing the limb to straighten or bend leads to an expansion of the affected area.

Failure to follow the doctor’s instructions or evasion of prescribed therapy may result in ankylosis (complete loss of knee mobility).

Symptoms of contracture

In some cases, after the main course of treatment, an increasing limitation of movements in the knee joint becomes noticeable. The lower limb at the knee bends and straightens differently than before the injury, and its fixation becomes more and more noticeable in one position.

If the development of temporary contractures is accompanied by sharp pain, then the persistent type of pathology is little noticeable: the patient may not be bothered at all painful sensations. The resulting immobility of the articular joint on initial stage practically doesn't bother me. And only when the pathology has a significant impact on the gait and the person begins to limp, the patient decides to consult a specialist.

As for the obvious symptoms, in most cases they are expressed by the following signs:

  • swelling in the affected area;
  • violation of support;
  • joint pain;
  • shortening of the limb;
  • curvature of the lower leg;
  • feeling of an uncomfortable position of the leg.

Other manifestations of contracture largely depend on the underlying disease. The presence of this pathology for a long time usually reveals the presence of arthrosis processes in the knee.

Diagnosis of the knee joint

Determining the pathology at the initial stage has a positive effect on treatment, which will allow the knee joint to be completely restored. The reason for contacting a specialist should be any unnatural positions of the leg, changes in the shape of the knee joint, as well as the impossibility of habitual movements in this area.

In order to obtain a correct diagnosis, a specialist must examine the leg and take x-rays. MRI and computed tomography (CT) scans may also be needed. In some cases, depending on the cause of the pathology, you may need to obtain additional consultation from a neurosurgeon, neurologist or psychiatrist.

Knee joint reconstruction

In many ways, the treatment and restoration of lost functions of the knee joint depends on the time and effort expended on the part of the patient. Therapy can be either conservative or surgical.

Conservative treatment therapy

Treatment of this type is carried out in trauma centers medical institution or at the patient's home. The main goal of conservative therapy is to restore the natural range of motion of the knee, eliminate pain, and improve blood supply to the damaged area. This result can be achieved by carrying out the following activities:

  1. appointment medications(analgesics, NSAIDs and hormones);
  2. administration of intra-articular injections;
  3. physiotherapeutic procedures;
  4. massage and exercise therapy.

Surgical intervention

In case of scar degeneration of periarticular tissues, it is necessary to use surgery, which allows you to effectively restrain further formation of subcutaneous nodules. Good result can be achieved by replacing healed areas with healthy tissue. Other methods can also be used in surgery, such as tenotomy, capsulotomy, fibrotomy and arthrolysis.

The prognosis for treatment of the pathology generally depends on the type of underlying disease, its duration and the general condition of the patient. But as treatment practice shows, early diagnosis contractures and the patient’s efforts make it possible to achieve complete restoration of mobility of the knee joint.

Contracture of the knee joint is a pathological condition in which the range of motion in this joint is impaired. The severity of the disease can vary from slight limitation of mobility to complete absence of flexion and/or extension.

Can cause illness a large number of factors, which are almost all associated with previous injuries or the presence of other diseases.

The disease has specific and pronounced symptoms, which greatly simplifies the diagnostic process. The main symptoms are considered to be joint deformation.

To make a correct diagnosis, it is necessary to conduct an objective examination of the affected area and instrumental examinations. Contracture can be treated in several ways - conservatively and surgically.

The International Classification of Diseases allocates a separate meaning for such a disorder of the musculoskeletal system. The ICD-10 code is M24.5.

Etiology

The fundamental factor in the formation of the disease is injury or a degenerative-dystrophic process.

Other sources of the formation of knee joint contracture are considered to be:

  • direct damage to the joint, which occurs with intra-articular fractures;
  • shortening of the quadriceps muscle - this occurs due to the fact that the leg for a long time was in an extension position;
  • disruption of the structure of articular cartilage - often this occurs due to prolonged immobilization. However, clinicians argue that contracture can form even after three weeks of limb immobilization;
  • transferred earlier ;
  • extensive burns;
  • decreased elasticity of the knee ligaments;
  • deep lacerations in the area of ​​the knee joint, on the front or back of the thigh, as well as on the lower leg. This is one of the rarest causes of the disease.

Besides this, this serious illness may be congenital. In such cases, the predisposing factors are considered to be:

  • congenital form of dislocation of the knee joint;
  • hypoplasia or aplasia of this anatomical region.

It is extremely rare that the disease develops against the background of a lesion nervous system, contracture is often mechanical in nature.

The main risk group consists of professional athletes, as well as those whose work involves heavy physical activity.

Classification

Depending on the factors of occurrence, such pathology of the limbs can be:

  • arthrogenic– is a consequence of a degenerative process directly in the joint, less often in the ligament system;
  • dermatogenic– develops against the background of the presence of serious skin defects. This includes wounds and burns, as well as the occurrence of inflammatory processes, after which scar formation is noted;
  • desmogenic– wrinkling of the periarticular tissue occurs, which occurs after inflammation or mechanical damage to the knee. Such processes cause the development of connective tissue scars;
  • myogenic– such a contracture is formed due to prolonged compression of muscle tissue. In addition, muscle and various forms can be a factor, which can lead to muscle shortening;
  • tendogenic– represents a change in ligaments and tendons of traumatic or inflammatory origin;
  • neurogenic– is a consequence of paralysis and pathologies affecting the nervous system.

Because of its occurrence, neurogenic contracture of the knee joint is divided into:

  • peripheral– develops in cases of damage to peripheral nerves;
  • central– against the background of brain and/or spinal cord injuries
  • psychogenic.

Based on the nature of the flow, the following forms are distinguished:

  • flexion contracture of the knee joint– there is a disruption in the process of bending the leg, i.e. the patient simply will not be able to bend the leg at the knee;
  • extension contracture– characterized by the fact that a person cannot straighten a limb that is bent at the knee;
  • mixed- is different complete absence joint mobility. The combined type of contracture is considered the most dangerous form such a disease that is characterized serious condition patient and the inability to cure the disease conservative methods or exercise.

In addition, contracture of the knee joint can be chronic or acute.

Symptoms

The first and main clinical manifestation is the inability to flex or extend the limb. Against the background of the main symptom, the following symptoms may occur:

  • joint deformity;
  • swelling of the affected area;
  • strong and It's a dull pain in the knee;
  • shortening of the affected leg;
  • a forced position that a person occupies in order to reduce discomfort;
  • curvature of the lower leg;
  • violation of support;
  • change in gait.

Vivid manifestation of signs is characteristic of acute form diseases, while chronic course Only moderate pain and impaired motor function are noted. The second form of the disease often leads to disability of the patient.

Diagnostics

Establishment correct diagnosis requires an integrated approach, but is based on instrumental examinations.

Before prescribing an examination, the doctor must:

  • clarification of patient complaints;
  • study of medical history and life history;
  • an objective examination of the patient - to assess the condition of the affected limb, as well as determine the volume of active and passive movements of the limb.

To finally determine the diagnosis of “knee joint contracture,” the doctor prescribes instrumental examinations of the patient, including:

  • radiography of the limb;
  • arthroscopy;
  • CT and MRI of the affected area.

In addition, consultations with specialists from the field are often prescribed:

  • neurology;
  • neurosurgery;
  • psychiatry.

Treatment

Depending on the severity of the disease, either conservative or surgical techniques may be required to eliminate it.

Non-surgical treatment of knee contracture includes:

  • physiotherapeutic procedures;
  • taking medications;
  • mechanotherapy - in which gymnastics to develop the affected limb is carried out using special devices;
  • non-surgical correction of the position of the affected limb - this is done using plaster casts and special clamps;
  • Exercise therapy - physical therapy for contracture of the knee joint plays main role in therapy;
  • using recipes traditional medicine- indicated only in the early stages of pathology development and with the permission of the attending physician.

Physiotherapeutic procedures involve performing:

Exercise therapy for knee joint contracture is aimed at performing the following exercises;

  • alternately bending the knees and pulling them towards the stomach;
  • lifting a bent leg, straightening it and lowering it to the floor;
  • “bicycle” - with each leg in turn;
  • flexion of the lower limbs and straightening upward;
  • straight leg raise;
  • circular movements of the lower leg;
  • pressing with your foot on a gymnastic ball;
  • bending the limbs with a ball sandwiched between them;
  • rolling the ball away from you and towards you with your feet placed on it;
  • placing the ball under the knees and pressing on it with the heels;
  • lifting the bent leg and straightening it in the swing - this exercise is performed while lying on your side;
  • raising the leg and holding it suspended - the starting position is similar to that indicated above;
  • bending the knees while lying on your stomach;
  • lifting a straight leg - you also need to lie on your stomach;
  • abduction of the straight leg to the side - the starting position does not change.

The development of contracture of the knee joint is carried out under the strict supervision of the attending physician, however, if the patient’s condition improves, such treatment at home is not prohibited.

If conservative methods are ineffective, as well as with severe deformation of the knee joint, surgical removal contractures. Operations are performed using several methods:

  • through open access;
  • through the use of arthroscopic equipment.

The objectives of surgical therapy are:

  • normalization of the shape of articular surfaces;
  • excision of scar tissue;
  • muscle lengthening.

If the joint is severely damaged, endoprosthesis replacement or arthrodesis of the joint is used.

The recovery period after surgery includes physical therapy, massages and physical therapy.

Prevention and prognosis

In order to avoid problems with the formation of contracture of the knee joint, it is necessary to avoid injuries and promptly seek treatment. qualified help when the above signs of illness appear.

The outcome of the disease depends on several factors:

  • source motor disorders;
  • degree of expression pathological changes not only in the joint, but also in the tissues surrounding it;
  • the period of time that elapsed from the onset of the first symptoms to the start of treatment.

Acute contractures have more favorable prognosis, in comparison with the chronic form of pathology, which can lead to human disability.

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Owners of patent RU 2338503:

The method relates to the field of medicine and can be used in the rehabilitation of patients with post-traumatic contractures of the knee joint. The method of rehabilitation of patients with contractures of the knee joint includes physical therapy, exercises with objects, mechanotherapy, and positional treatment under the control of angular measurements. Before physical therapy sessions, a femoral nerve block is performed on the side of the injured limb by injecting 20 ml of a 1% lidocaine solution and 0.3 ml of a 0.1% adrenaline solution. The blockade is carried out 2-3 times after 10 days for a course of physical therapy for 30 days, and classes begin 1 hour after the blockade. Mechanotherapy is carried out by performing exercises on a passive apparatus developed “ARTROMOT”. On blockade days, post-isometric relaxation is additionally performed. The entire rehabilitation process takes place under the control of rheovasography and Dopplerography. The method allows by removing muscle spasm achieve a painless increase in the range of motion in the knee joint, improve blood circulation in the affected area, and this, in turn, leads to a reduction in the incidence of complications and shortens the time rehabilitation treatment more than 2 times. 1 table

The invention relates to the field of medicine and can be used in the rehabilitation of patients with post-traumatic contractures of the knee joint.

Complexity anatomical structure knee joint, its multicomponent nature, and significant physical loads placed on it determine the diversity pathological conditions this joint (injuries and diseases). Damage to the knee joint as a cause of disability is becoming a socio-economic problem.

If we take into account that data from the specialized literature indicate that in 24% of cases, patients with injuries in the knee joint develop severe and persistent stiffness, this gives the problem important medical, social and economic significance.

Contractures of the knee joint are one of the most frequent complications injuries musculoskeletal system, leading to dysfunction of the limb and loss of ability to work of the victims. The pathomorphological basis for the formation of such contractures is cicatricial degeneration and fusion of soft tissue formations and bone, which leads to the loss of the sliding properties of the quadriceps femoris muscle.

There are myogenic contractures that arise as a result of prolonged immobilization during conservative and surgical treatment of fractures femur, and arthrogenic - after intra-articular fractures, surgical interventions on the knee joints and inflammatory diseases the latter. Degenerative-dystrophic processes, starting from the knee joint, gradually spread to the periarticular tissues and muscles of the thigh.

One of the problems that one has to face in the process of restoring motor function is the elimination of contracture of the knee joint with the help of physical training, which is accompanied by pain. Pain prevents the achievement of a full range of movements, allowing one to perform active exercises of a general strengthening nature, special exercises up to the pain threshold, the patient is guided by subjective sensations.

In this regard, there was a need to develop a methodology for conducting physical therapy in more comfortable conditions.

There are a number of physical therapy techniques for treating knee joint contractures.

There is a known method of rehabilitation according to the method of A.V. Chantsev, E.A. Raspopova (Altai State Medical University, 1999, “Differentiated approach to the treatment of persistent contractures of the knee joint”). The technique includes exercise therapy, massage, mechanotherapy and intra-articular administration of medicinal mixtures by one-stage redressal.

But redressing is a rather traumatic manipulation, it is carried out blindly and is accompanied by a harsh effect on the periarticular tissues, pain, reactive edema, and soft tissue damage occurs. Intra-articular administration of medicinal mixtures is also accompanied by a certain risk to the joint.

In the complex treatment of patients with contractures, the method of redressal, exercises with weights, exercises on mechanotherapy devices, positional treatment using traction through block devices are also used, and all this against the background of joint swelling and pain, which is a limiting factor (T.N. Kukushkina, M .Dokish, N.A. Chistyakova Guide to the rehabilitation of patients who have partially lost their ability to work (M.: Medgiz, 1984, pp. 68-74).

This complex method of contracture treatment can lead to microtraumatization of muscles and an increase in their tone.

The objective of the invention is effective and painless functional restoration of the knee joint in a short time.

The solution to this problem is achieved by the method of rehabilitation of patients with contractures of the knee joint, including physical therapy, exercises with objects, mechanotherapy, treatment by position under the control of angular measurements. Therapeutic gymnastics exercises are used by performing movements using an inertially moving lower leg and exercises for the knee joint in combination with movements in other joints. The objects used are a medicine ball to roll it with the foot of the sore leg and a roller cart to perform flexion and extension in the knee joint. Positional treatment is carried out lying on the stomach by fixing the thigh with a cuff attached to the foot and by means of a fishing line connected through a block to a stand for the load with gradual flexion at the knee joint due to increasing the load. Before physical therapy sessions, a femoral nerve block is performed on the side of the injured limb by injecting 20 ml of a 1% lidocaine solution and 0.3 ml of a 0.1% adrenaline solution. The blockade is performed 2-3 times after 10 days for a course of physical therapy for 30 days, and physical therapy classes begin 1 hour after the blockade. Mechanotherapy is carried out by performing exercises on a passive apparatus developed “ARTROMOT”. On days when there is no blockade, post-isometric relaxation is additionally performed, taking into account the applied resistance against the direction of contraction of the shortened muscles. The entire rehabilitation process is performed under the control of rheovasography and Dopplerography.

Novelty of the invention:

Therapeutic gymnastics exercises are used by performing movements using an inertially moving lower leg and exercises for the knee joint in combination with movements in other joints. These exercises increase functionality mechanism of the knee joint.

The objects used are a medicine ball to roll it with the foot of the sore leg and a roller cart to perform flexion and extension in the knee joint.

Positional treatment is carried out lying on the stomach by fixing the thigh with a cuff attached to the foot and by means of a fishing line connected through a block to a stand for the load with gradual flexion at the knee joint due to increasing the load.

Before physical therapy sessions, a femoral nerve block is performed on the side of the injured limb by injecting 20 ml of a 1% lidocaine solution and 0.3 ml of a 0.1% adrenaline solution. The blockade is performed 2-3 times after 10 days for a course of physical therapy for 30 days, and physical therapy classes begin 1 hour after the blockade. Anesthesia can relieve muscle hypertension, pain syndrome; improve blood supply to the affected area. Anesthesia using the proposed method using lidocaine has shown that it is considered ideal local anesthetic for a number of reasons: a short latent period in the onset of conduction anesthesia, which indicates its high permeability in tissues, significant duration and controllability of the depth of pharmacological effects on nerve trunks. In 99% of patients, sensory block of the anesthetized limb developed. Classes begin 1 hour after the blockade, this is the time of onset of anesthesia, which makes the exercise therapy procedure as safe and painless as possible.

Mechanotherapy is carried out by performing exercises on a passive apparatus developed “ARTROMOT”. A modern device that allows you to develop the range of motion in a joint with the greatest amplitude.

On days when there is no blockade, post-isometric relaxation is additionally performed, taking into account the applied resistance against the direction of contraction of the shortened muscles. This allows you to reduce the pain of movement in the knee joint and increase the length of previously spasmodic shortened muscles.

The entire rehabilitation process is performed under the control of rheovasography and Dopplerography. As objective criteria for assessing the effectiveness of the rehabilitation treatment before the start of the course of treatment and at the end, angularometry and electrophysiological methods - rheovasography and Dopplerography - were used. Measurements of the range of motion were performed every 10 days additionally. With a method such as rheovasography, rheovasograms of the lower extremities were recorded. Of the many quantitative indicators, amplitude ones were used:

A. Rheovasographic index (I)

b. Relative volumetric pulse (Pr)

When performing Doppler sonography, the hemodynamics of the vessels of the injured limb - the femoral artery - were studied. Systolic velocity and pulsation index, which characterizes circulatory resistance, were taken into account.

The combination of all these features of the method allows, by relieving muscle spasm, to achieve a painless increase in the range of motion in the knee joint, improving blood circulation in the affected area, and this, in turn, leads to a reduction in the incidence of complications and reduces the time of rehabilitation treatment by more than 2 times.

In complex rehabilitation activities, aimed at restoring the functions of the knee joint, physical exercises of therapeutic gymnastics play a certain role. However, the technique complex application means of physical therapy in combination with femoral nerve blocks are not covered in the literature. The issues of rehabilitation of this category of patients remain unresolved in full.

The proposed method of restorative treatment of patients with post-traumatic contractures of the knee joint has significant differences from analogues and prototypes, because it involves the implementation of exercise therapy techniques against the background of a femoral nerve block.

One of the important reasons for movement limitation is myogenic restrictions. In addition, damage to the articular surfaces is possible, in pathological process The tissues of the joint capsule, its ligaments, tendons, muscles and nerve endings are involved. Particularly indicative in this regard are the processes of scarring, leading to the adhesion of tissues to muscles, ligaments, and tendons. No less important reason is a pronounced pain syndrome.

And therefore, one of the conditions for increasing the range of motion in the knee joint is the elimination of muscle hypertension and pain. This is only possible with anesthesia before performing exercise therapy.

We believe that pharmacological effects on the femoral nerve before sessions of therapeutic exercises will not only eliminate pain. Denervation of the tissues of the injured limb under the influence of anesthesia affects the vascular drainage system in the area of ​​pain relief.

Treatment of knee joint contractures is a complex and lengthy process. IN postoperative period, and also at the final stage conservative treatment injuries of the knee joint in most cases it is necessary to ascertain the presence of flexion-extension contractures in it.

The method is carried out as follows.

To eliminate pain and fear of performing physical exercise The anesthesiologist performs preliminary anesthesia: femoral nerve block with 20 ml of a 1% lidocaine solution and 0.3 ml of a 0.1% adrenaline solution 1 hour before the procedure.

The blockade is carried out as follows.

The position of the neurovascular bundle is determined by palpation by the pulsation of the femoral artery, lateral from which a thin short needle is inserted subfascially 1-1.5 cm through a pre-infiltrated skin nodule to a depth of 3-4 cm. After the appearance of parasthesia or muscle fibrillation in the area inside thighs, 20 ml of a 1% lidocaine solution and 0.3 ml of a 0.1% adrenaline solution are injected through the lumen of an injection needle. The latent time for the onset of autonomic denervation is 1 hour. The blockade is performed 2-3 times every 10 days for a course of physical therapy for 30 days.

Restoring the range of motion and strengthening the muscles of the injured limb is the main goal of physical therapy. In addition to various types gymnastic exercises of a general strengthening nature and various generally accepted movements of the knee and lower leg, therapeutic gymnastics exercises are used that increase the functionality of the knee joint mechanism (bones, cartilage, ligaments, blood vessels, etc.) by performing movements due to the inertial energy of the moving lower leg. This is done as follows: before starting the exercises, massage the knees for 3-5 minutes, then perform the following exercises.

Exercise 1: i.p. - sitting on a chair (couch, sofa, etc.), legs relaxed, extended with heels on the floor. Grab your patellas with your fingers and move them to the limit: up and down and back; from left to right and back - 10 times in each direction.

Exercise 2: i.p. - Same. Gently tap the bent phalanges of your fists on kneecaps: left, right, bottom - 10 blows on each side.

Exercise 3: i.p. - Same. Legs relaxed, straightened, heels on the floor. Without lifting your heels from the floor, alternately raise your knees and sharply straighten your legs to a moderate stop at the knee joint. Repeat with each leg 6 times.

Then you need to perform the complex special exercises for the knee joint in combination with movements in other joints and against the background of general strengthening exercises.

I.p. - lying on your back, arms along your body.

1 - dorsiflexion and plantar flexion of the feet 6-8 times.

1. I.p. - hands in front of the chest.

1 - spread your arms to the sides - inhale.

2 - i.p. - exhale.

2. Circular movements of the feet 8-10 times.

3. Alternately flexion and extension of the legs at the knee joint, sliding the foot along the surface of the couch 6-8 times.

4. I.p. - hands to shoulders, elbows forward.

1 - spread your elbows to the sides - inhale.

2 - i.p. - exhale.

5. Alternate abduction and adduction of the leg - 6-8 times.

6. I.p. - hands to shoulders.

1-4 - circular movements of the arms forward 4-6 times.

1-4 - circular movements of the arms back.

7. Imitation of walking on the couch 6-8 times.

8. 1 - hands up - inhale.

2. - I.p. - exhale.

10. Alternating straight leg raises 4 times with each leg.

11. I.p. - hands to the side.

Circumferential hand movements.

12. Tension of the quadriceps femoris muscle on the diseased and healthy limb (alternately and simultaneously).

13. I.p. - hands to the side.

Alternate rotation of the body to the right and left (hands are connected 2-3 times in each direction when turning).

I.p. - lying on your side (on the side of the healthy leg).

14. Bending the legs at the knee joint 4-6 times.

15. Abduct the affected leg to the side 6-8 times.

16. 1 - abduction of the sore leg to the side,

2 - forward,

17. 1 - abduction of the sore leg to the side,

2 - attach a healthy one to it,

3 - hold,

I.p. - lying on your stomach.

18. Alternate flexion and extension of the legs at the knee joint.

19. Leaning on your hands, flexion and extension of the body and return to the position.

20. Alternating straight leg raises 4-6 times.

21. Alternate abduction and adduction of straight legs 6-8 times.

22. Leg movements, as when swimming in the breaststroke style, 6-8 times.

23. Simultaneously bending the legs at the knee joint 6-8 times.

24. Flexion and extension of the affected leg at the knee joint with the help of the healthy leg 6-8 times.

I.p. - sitting on a couch or chair.

25. Rolling the foot of the sore leg with a medicine ball.

26. Performing flexion and extension at the knee joint with the healthy leg using a roller cart.

27. Exercises on an exercise bike.

IN last decades the practice of restorative treatment of injuries and diseases of the musculoskeletal system is increasingly being introduced complex treatment manual manipulation techniques - post-isometric relaxation (PIR). It restores the length and elasticity of not only shortened muscles, but also wrinkled ligamentous apparatus, mucous bags and is effective method relaxation of adhesions. Postisometric muscle relaxation is the active relaxation of muscles following isometric contraction, followed by passive stretching of soft tissues (muscles, tendons, fascia, bursal-ligamentous apparatus, connective tissue adhesions) to pre-tension (spring resistance). It is performed on days when the blockade is not performed. When performing PIR, the main rule must be observed: resistance must be applied against the direction of contraction of the shortened muscles.

The PIR effect is manifested by a direct increase in volume and a decrease in pain in passive and active movements in the knee joint, as well as in a decrease in pain tension and an increase in the length of previously spasmodic shortened muscles. FIR is carried out on days when there is no blockade.

The procedure is carried out by a doctor or physical therapy methodologist in combination with other effects on the knee joint.

Considering that the presence of pain still inhibits the performance of movements in the knee joint, a method of physical therapy in combination with preliminary anesthesia has been developed and implemented at KUZNIITR and OKOHBVL in order to improve the results of functional-restorative treatment of patients with post-traumatic contractures.

Once anesthesia is achieved, it is possible to use manual manipulations:

1. Postisometric relaxation.

2. Treatment by position. From the initial position lying on the stomach, by fixing the thigh, using a cuff attached to the foot, and using a fishing line connected through a block to a stand for the load, gradual flexion is carried out at the knee joint by increasing the load.

At the end of the procedure, the result is secured by positional correction (laying in flexion or extension, depending on the type of contracture).

These days, before block therapy, it is also recommended to apply paraffin to the knee joint for 30 minutes, temperature 50°.

In addition to all of the above manipulations, flexion and extension of the knee joint are performed using a passive apparatus developed “Artromot-K2”. The patient is in the initial position lying on his back on the couch, the limb is placed on the cuffs of the device and secured with straps. The control panel sets the device in motion and performs alternating flexion and extension at the knee joint (Fig. 1-2).

All means of physical therapy are used in combination with physiotherapy.

Patient S., medical history No. 308123, was in the orthopedic department with a diagnosis of flexion contracture of the left knee joint after a fracture of the lateral condyle of the left femur, osteosynthesis of the left femoral condyle. Objectively: complaints of pain and limitation of movements in the left knee joint.

On March 12, 2006, angular measurements were carried out. Range of motion in the knee joint: flexion 140°, extension - 180°.

On March 14, 2006, a femoral nerve block was performed. 1 hour after the blockade, physical therapy and mechanotherapy were performed using a passive device developed “ARTROMOT”.

In the period from March 15 to March 21, physical therapy, exercises with objects, mechanotherapy, treatment with a position on a block installation, and post-isometric relaxation were performed.

On March 22, 2006, the second blockade and angular measurements were performed. Range of motion in the knee joint - flexion angle - 120°, extension - 180°. 1 hour after the blockade, physical therapy and mechanotherapy were performed using a passive device developed “ARTROMOT”.

In the period from March 23 to March 29, physical therapy, exercises with objects, mechanotherapy, treatment by positioning on a block installation, and post-isometric relaxation were performed.

On March 30, 2006, angular measurements were performed - flexion angle - 100°, extension - 180°.

In the period from 01.04 to 10.04, physical therapy, exercises with objects, mechanotherapy, treatment with a position on a block installation, and post-isometric relaxation were carried out.

On April 11, 2006, goniometry was performed. Range of motion in the knee joint - flexion angle - 75°, extension - 180°. Rheovasography and ultrasonography were performed.

Patient F., medical history No. 322431, was in the traumatology department with a diagnosis of flexion-extension contracture of the right knee joint after a fracture of the patella. Objectively: complaints about sharp pains, restriction of movements in the knee joint.

On 02/08/2006, angular measurements were performed to determine the range of motion in the right knee joint at the beginning of the course of treatment: flexion angle - 125°, extension - 150°.

Rheovasography and ultrasonography were performed.

On February 9, 2006, a femoral nerve block was performed. 1 hour after the blockade, physical therapy and mechanotherapy were performed using the ARTROMOT apparatus.

In the period from 10.02 to 17.02, physical therapy, exercises with objects, mechanotherapy, treatment by positioning on a block installation, and post-isometric relaxation were carried out.

On February 18, 2006, angular measurements were carried out. Range of motion in the knee joint - flexion angle - 115°, extension - 160°. A repeat femoral nerve block was performed. 1 hour after the blockade, physical therapy and mechanotherapy were performed using the ARTROMOT apparatus.

In the period from 19.02 to 28.02, physical therapy, exercises with objects, mechanotherapy, treatment by positioning on a block installation, and post-isometric relaxation were carried out.

On February 29, 2006, angular measurements were carried out. Range of motion in the right knee joint - flexion angle - 95°, extension - 170°. In the period from 30.02 to 05.03, physical therapy, exercises with objects, mechanotherapy, treatment with a position on a block installation, and post-isometric relaxation were carried out.

On 03/06/2006, angular measurements were carried out. Range of motion in the right knee joint: flexion angle - 80°, extension - 170°.

Rheovasography and ultrasonography were performed.

The table shows the results of electrophysiological studies.

An increase in the rheographic index at the end of the course of treatment indicates an increase in peripheral blood flow, proving the effectiveness of sympathetic blockade. Low value relative volumetric pulse Pr at the beginning of treatment is explained by increased vascular tone as a result of excessive sympathetic impulses, decreased drainage function of lymphatic vessels and limb edema. At the end of the course of treatment, an increase in Pr is observed. This fact can be regarded as an effect of autonomic denervation, with a decrease vascular tone and improvement of peripheral blood circulation of the anesthetized limb against the background of the blockade.

Indicators of PI - resistance index - at the end of treatment decreased significantly compared to the indicator at the beginning of the course of treatment, which indicated a decrease in the circulatory resistance of the vessels of the anesthetized limb due to effective blockade of sympathetic innervation.

An algorithm for calculating the medical and socio-economic effectiveness of a new method of rehabilitation of patients with knee joint contractures is presented.

Efficiency was considered as the sum of the following components:

Preventing patients from becoming disabled and saving costs on disability pensions;

Prevention of lost working days due to temporary disability (temporary loss of ability to work);

Preventing drug costs.

Five victims who were treated with the new method were at risk of becoming disabled. It was prevented as a result of treatment.

In 15 people, treatment time with the new method was reduced by 2 times compared to traditional method treatment.

10 people no longer needed medications.

1. Annual cost savings on disability pensions (X 1):

X 1 -12k 1i (1),

where k 1 is the number of patients with prevented disability (there are 5 patients),

i is the amount of the average disability pension (it is equal to 1.5 thousand rubles).

12 is the number of months in a year,

X 1 =1.5×12×5=90,000 rub.

2. The effect of preventing the loss of working days per year according to VUT (X 2);

X 2 =νsνk2 (2),

where ν is the average number of working days according to VUT per year per patient during treatment with the traditional method;

number of days = 60.

sν - average value payment for one day according to VUT for one patient.

It is equal to 170 rubles.

k2 is the number of working patients who no longer need sick leave.

7899 1

When treating limb fractures, temporary therapeutic immobilization: skeletal traction, plaster cast, osteosynthesis.

Immobilization is carried out in order to create conditions for the consolidation of bone parts. However, complications arise due to immobility.

Thus, contractures of the knee joints can be observed extremely often after leg fractures.

It is the immobility of the leg during this period that mainly causes the appearance of contractures.

Therefore, when recovering patients with leg injuries, one of the main tasks is to combat this phenomenon.

Reasons why contracture may occur

Contracture can be caused by various reasons.

The beginning of the disorder can be inflammation, injury, changes in the articular bones due to arthritis or arthrosis, loss of elasticity of the ligaments, and shortening of the muscles. “Arthrogenic” contracture occurs due to a dislocation in or near a joint, a bone fracture, a sprain, or a bruise.

This disorder affects people with joint diseases, but sometimes it can also occur in healthy joints.

Knee contracture is not a disease - it is the result of a previous illness, injury or congenital abnormality.

Almost any serious injury entails this problem. A scar forms on the affected tissue. It is not elastic, and therefore interferes with the normal functioning of the joint.

Lesions of varying severity appear with any damage to the musculoskeletal system. Such disorders, likewise, can also cause pathology.

It may occur due to damage to the nervous system. But often the nature of joint damage is mechanical.

To recover from any injury, the damaged area needs rest.

But the longer the affected area remains at rest, the higher the risk of contracture and the more difficult it is to get rid of it.

Types of contractures

The joint can be reduced:

  • during extension;
  • when bending;
  • when brought;
  • during abduction;
  • during rotation.

Extensor and flexion types of pathology

The main types of impairment are flexion (impaired flexion) and extensor (impaired extension); restrictions and other movements - rotational, lateral.

Symptoms of occurrence

The main manifestation is limitation of flexion or extension. Basically, there is severe deformation of the joint.

The following symptoms may be observed:

  • edema;
  • violation of support;
  • joint pain;
  • shortening and awkward position of the leg.

The rest of the manifestations depend on the provoking disease. If contracture persists for a long time, signs of knee arthrosis are usually detected.

To assess the severity of contracture, range of motion measurements are taken.

Treatment and development of knee contracture

Doctors pursue the goal of eliminating inflammation, pain and restoring joint mobility. Modern medicine has achieved some success in this.

The prognosis depends entirely on the type and extent of the lesion, on the amount of time from the moment of appearance, on the age of the patient and his condition, on the time from which treatment began.

The sooner you start it, the higher the likelihood of positive dynamics, and ultimately, an absolute cure.

Today, conservative and surgical treatment violations.

To develop a joint using conservative treatment:

  • physical training;
  • massotherapy;
  • physiotherapy;
  • shock wave therapy;
  • electrophoresis;
  • manual therapy;
  • thermal procedures;
  • medicinal treatment.

The drugs used include hormones and painkillers (novocaine, lidocaine). They are injected into the diseased joint, the pain subsides, because of this the muscles regain healthy tone, and the process slows down significantly.

When performing a massage when the mobility of the knee is limited, it is necessary to actively influence weak muscles and carefully act on antagonistic muscles. Exercise therapy is performed carefully. First they perform calm movements, then active ones.

Only after a certain period are elements of resistance introduced. There are a number of fairly effective exercises:

  • alternately bend your knees, pulling them towards your stomach;
  • lift the bent leg, then straighten it, lowering it to the floor;
  • perform movements similar to riding a bicycle with one leg, then change legs;
  • bend your legs and straighten them up;
  • move your legs like on a bicycle;
  • raise a straight leg;
  • bend the leg at the knee, holding it in weight;
  • then perform circular rotations with the shin;
  • put your straight leg on the gymnastic ball and press on it;
  • bend your legs with a ball sandwiched between them;
  • placing your limbs on the ball, roll it away from you and towards you, trying to pull your legs;
  • placing the ball under your knees, press on it with your heels;
  • hold the ball between your thigh and shin and lift it;
  • carry out cycling movements with your leg while lying on your side;
  • lying on your side, raise your bent leg and straighten it, performing an upward swing;
  • in the same position, raise your leg, holding it in weight;
  • alternately bend your knees while lying on your stomach;
  • lying on your stomach, bend both legs;
  • in the same position, raise the straight leg;
  • and, again on your stomach, bend your knee;
  • then - rotating the shin in a circle;
  • on your stomach - move your straight leg to the side.

All exercises are performed 10 times. You should exercise regularly - three times a week, or better yet, daily. But certainly under the supervision of a doctor.

Also used thermal baths, starting from 36 degrees, paraffin and mud treatments are added over time.

Conservative methods in combination are aimed at restoring normal mobility and limb function.

When using them, the disease is not aggravated by complications, pain is neutralized, the joint becomes mobile, muscles are strengthened, and the joint receives nutrients.

Blood flow is restored, stagnation processes stop, adhesions disappear. At the recovery stage, mechanotherapy is used, combining therapeutic, restorative exercises with the use of special devices and simulators.

Surgery

If contracture is not treated with conservative methods, surgical intervention is performed.

It is used to excise scars, restore the length of muscles and tendons, release them from scars, perform transplantation, osteotomy, etc.

If the tendon is significantly damaged, tissue preserved or made from a special material is used.

Various corrective bone tissue surgeries can be performed.

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Consequences and complications

Without timely and competent treatment, joint contracture leads to immobility. The disease at this stage can only be treated surgically, so at the first signs you need to contact a specialist.

An advanced lesion does not allow the patient to move normally and causes deformation of the limb, preventing the person from living normally and reducing his physical activity to a minimum.

conclusions

Thus, provided regular classes, physical therapy for contracture of the knee joint will help the diseased joint restore function and will subsequently contribute to its strengthening.

The prognosis depends significantly on the underlying disorder, the severity of changes in the joint and adjacent tissues. Fresh contractures with proper treatment and regular exercise therapeutic exercises, generally respond well to conservative treatment.

When the process is running, the prognosis is less positive, because over time, changes in the joint worsen, scar degeneration appears not only of the affected, but also previously healthy tissues, and secondary arthrosis appears.

What causes knee joint contracture and how to get rid of it? When treating leg fractures, temporary immobilization is performed using plaster casts, traction, or. Immobilization is necessary for proper healing of bone fragments. However, it contributes to the emergence of various. The most common among them is flexion contracture of the knee joint. It is the immobilization of the legs that is considered its main cause. Knee dysfunction can be observed after endoprosthetics, as well as arthroscopy. The treatment plan for lower extremity injuries should include measures aimed at preventing the formation of contracture.

Causal factors

The reasons why this pathological condition occurs may be different. Functional and organic disorders in the joint appear with prolonged inflammation, injuries, arthritis or arthrosis, decreased elasticity of ligaments, and shortening of muscles. Arthrogenic contracture is formed when a bone is dislocated or fractured, bruised or sprained. This problem is faced by people suffering from joint diseases. However, it can also occur in a completely healthy person.

Contracture is not considered a full-fledged disease; it is classified as a post-traumatic and postoperative complication. Congenital forms of pathology are less common.

Almost any complex fracture contributes to dysfunction of nearby joints. The affected tissues begin to scar and lose their elasticity. This interferes with the movements of one or another part of the musculoskeletal system. Post-traumatic type of contracture occurs with injuries of any severity. The destruction of cartilage tissue can also contribute to its occurrence.

Other causes include damage to nerve endings. However, most often contracture is of mechanical origin. Recovering from any injury requires reducing stress on the knee. The longer it remains in an immobilized state, the higher the risk of complications.

Signs of contractures

The joint can be fixed in an extended or bent state, during rotation and abduction. The main types of disorders are flexion and extension contractures of the knee joint. Its combined appearance is characterized by complete immobility of the affected area. This is the most severe complication, practically not amenable to conservative therapy.

Based on the origin of the violation, it can be:

  1. Desmogenic. Their appearance is promoted by tissue scarring due to trauma and inflammatory processes.
  2. Tendogenic. Appear when ligaments are damaged.
  3. Myogenic. The cause of the development of such contractures is considered to be acute and chronic myositis, ischemia or tissue compression.
  4. Arthrogenic. Evolve in the background long term destructive processes in the joint.
  5. Neurogenic. Their occurrence is facilitated by paresis and paralysis of the limbs. Occur less often in pathologies of the spinal cord.
  6. Dermatogenic. Their appearance is associated with thermal and chemical burns, as well as injuries to the skin and underlying tissues.
  7. Conditioned reflex. This type of contracture is formed under the influence of adaptive reactions.

The main symptoms of these pathological conditions are decreased joint mobility and deformation. Additionally there are:

Other manifestations depend on the cause of the disease. People with arthrogenic forms of contractures almost always show signs of destruction of cartilage tissue. To determine the type of pathology, range of motion is measured.

Methods of treating pathology

In order to improve the condition of the joint after arthroscopy or injury, it is necessary to relieve inflammation and pain and restore mobility. Modern therapeutic techniques allow you to get rid of contracture without surgery. Recovery time largely depends on the type and severity of the disorder and the amount of time that has passed since the injury. The sooner treatment begins, the higher the chances of a full recovery.

To develop the joint, the following are used:

  • physiotherapy;
  • massage;
  • physiotherapeutic procedures (electrophoresis, thermal effect, UVT).

Treatment at home involves the use of non-steroidal anti-inflammatory drugs and analgesics. In a hospital setting, they inject into the knee joint hormonal agents. They eliminate pain, increase muscle tone, and slow down the processes of tissue destruction.

Massage of the knee joint should be performed according to a certain pattern. An active effect is exerted on weakened muscles and a careful effect on those that are in increased tone. First, soft movements are performed, then active ones. Only after some time are elements of resistance introduced.

Exists exercise therapy complex, aimed at improving the condition of the joint in the presence of contractures. The legs are pulled towards the stomach and they begin to bend them at the knees one by one. The bent limb is lowered to the floor and then straightened. The bicycle exercise is performed first for one leg, then for the second. It is useful to hold the bent leg suspended for a long time. The straightened limb is placed on a gymnastic ball and pressure is applied to it. After this, perform rotational movements of the lower leg.

Squats are done with a ball held between the legs. The same object is placed under the knees and the heels begin to press on it. Lying on your side, bend your leg and lift it up. The limb should be held suspended in the same position. Lying on your stomach, bend both legs. In the same position, the straightened limb is raised. All actions are performed at least 10 times. Classes should be held regularly, at least once every 2 days. Constant supervision by an experienced instructor is required.

To treat neurogenic and post-traumatic forms of contracture, warm baths are used, which are supplemented over time paraffin applications and mud therapy. The development of contracture allows you to restore mobility and function of the joint. In this case, the disease does not lead to complications, the discomfort disappears, the muscles are strengthened, and the nutrition of the cartilage tissue is restored.

During the recovery period, it is indicated, which includes therapeutic and supportive exercises, exercises on simulators.

When is surgery required?

Operations are used when drug treatment contracture of the knee joint is ineffective. Surgical intervention involves:

  • dissection of scars;
  • restoration of muscle and tendon volume;
  • decompression.

In case of significant tissue damage, artificial or natural implants. Surgeries to correct bones may be prescribed.

Long-term development of knee joint contracture can lead to immobilization. Advanced forms of diseases are treated exclusively surgically. Therefore, if you detect the first signs of dysfunction of the joint, you should contact an orthopedist. Mixed contracture does not allow the leg to be used as a support or to walk or run normally. In severe cases, joint deformation is detected, making the person unable to work and significantly worsening his quality of life.

Alternative ways to eliminate pathology

Treatment folk remedies appears to be effective only on early stages development of degenerative phenomena. For this purpose, rubbing and infusions based on medicinal plants. They enhance the effectiveness of drug therapy and allow drug dosages to be reduced.

You can relieve muscle tension with warm compresses or baths. Add to water essential oils coniferous plants. Baths with salts Dead Sea have a healing effect, restore blood supply to tissues. With their help, you can treat post-traumatic or postoperative contractures.

All folk remedies must be used with the permission of the attending physician. This will help you get the best result and avoid the development of allergic reactions.

Contracture of the knee joint in most cases has a favorable prognosis. With timely initiation of therapy, the mobility of the affected area is completely restored.