Contracture

Overview

A contracture happens when soft tissue becomes tight, short, or stiff. This tissue can be skin, muscle, tendon, or the tissue around a joint. Tendons are tough cords that connect muscle to bone. A contracture can stop a joint from bending or straightening fully. It is not a disease on its own. It is a change in tissue that can happen after injury, long rest, scarring, or some health conditions.

Contractures are fairly common in people who cannot move a joint normally for weeks or months. They are less common in people who stay active and mobile.

They can affect people of all ages. They are seen more often after stroke, brain or spinal cord injury, burns, serious injury, long casts, or conditions that cause muscle tightness. Some babies are born with contractures.

Symptoms

Common symptoms

• A joint does not straighten or bend as far as it used to.
• A tight band, pulling feeling, or stiffness around a joint or scar.
• Trouble with daily tasks such as dressing, walking, reaching, or holding objects.
• Stiffness that does not improve with normal movement.
• Skin or a scar that feels tight, shiny, or hard.
• Pain or discomfort when the tight area is stretched or used.
• A body part may rest in a bent or unusual position.

Symptoms in children

• A baby or child may hold one arm or leg in a bent position.
• A child may not use one side of the body as much during reaching, crawling, or walking.
• Trouble with fine hand skills, such as picking up small objects.
• A tight heel cord or stiff ankle may make walking or standing harder.
• A child may fuss when a joint is moved or when a splint is put on.

Symptoms in older adults

• Stiffness after a stroke, fall, surgery, or long bed rest.
• Tightness in the hand, shoulder, hip, or ankle that makes washing, dressing, or walking harder.
• Skin in tight areas may break down or become sore.
• Weakness and stiffness together can raise the risk of falls.
• Contractures may add to loss of independence if not managed.

Causes

Main causes

• Not moving a joint for a long time, such as during a cast, bed rest, or recovery from surgery.
• Scar tissue after a burn, injury, or surgery that pulls the skin tight.
• Brain or spinal cord problems, such as stroke or spinal cord injury, that change muscle control.
• Muscle tightness or spasm from conditions that affect the brain or nerves.
• Joint damage or inflammation that makes movement painful and limited.
• Genetic or connective tissue conditions that affect how skin, muscle, or joints form.
• Being born with a joint or limb that is tight or in a fixed position.

Risk factors

• Long periods of bed rest or a cast.
• A previous burn, serious injury, or surgery with scarring.
• Stroke, brain injury, spinal cord injury, or other nerve conditions.
• Conditions that cause lasting muscle tightness or spasm.
• Painful joints that make a person avoid movement.
• Limited access to physiotherapy or occupational therapy after an injury or illness.
• A family history of tight hand tissue or similar problems.
• Being very unwell or in intensive care for a long time.

When to see a doctor

See a doctor urgently if:

• A joint or limb becomes hot, red, very swollen, or very painful.
• You notice new numbness, weakness, or loss of movement.
• Skin over a tight area breaks down, blisters, or looks infected.
• Tightness is getting worse quickly.
• A child suddenly stops using an arm or leg, or cries when it is moved.

Book a routine appointment if:

• Stiffness lasts more than a few weeks or does not improve.
• You cannot straighten or bend a joint as far as before.
• You have had a cast, burn, injury, or stroke and notice tightness.
• A scar feels tight or limits movement.
• A child is not using a limb in the usual way.
• Daily tasks are becoming harder because of tightness.

Diagnosis

A healthcare provider will ask about your movement, injuries, treatments, and daily activities. They will look at the joint, skin, and scars, and check how far you can move. They may also check strength and feeling. You may be referred to a physiotherapist or occupational therapist for a fuller movement assessment.

Tests that may be done

• Measuring how far a joint bends and straightens.
• Checking skin, scars, strength, and feeling.
• Imaging such as X-ray, ultrasound, or MRI in some cases.
• Blood tests if inflammation or infection is suspected.
• Nerve tests in rare cases if a nerve problem is suspected.

What to expect at your appointment

There is no single test for contracture. The visit is usually a physical exam and a talk about your movement and daily needs. You may be asked to try different movements. The provider will explain what they find and whether therapy or another assessment may help.

Treatment

The goal is to keep or restore movement, reduce tightness, and protect the skin. Treatment often starts with therapy, stretching, splints, and changes to daily routines. Some people need medical procedures or surgery. A healthcare provider will help choose what is safe for you.

Self-care at home

• Do the stretches and exercises your therapist teaches you.
• Use splints, supports, or positioning aids as advised.
• Change position often and keep other joints moving.
• Keep skin clean, dry, and moisturized. Check tight areas for redness or sores.
• Use warm packs before stretches only if your provider says it is safe, and avoid burns.
• Make daily tasks easier with helpful tools and ask for an assessment if needed.
• Keep follow-up appointments and tell your provider if things change.

Medical treatments

Treatment may include physiotherapy and occupational therapy to improve movement, strength, and daily function. Splints, casts, or special supports can hold a joint in a better position. Doctors may use injections in selected cases to relax tight muscles or soften scar tissue. Other medicines may be used for pain or muscle tightness as advised by a healthcare provider. No single treatment fits everyone.

When is surgery considered?

Surgery may be an option if tight tissue blocks important movement and other treatments have not helped enough. It can involve releasing tight bands, lengthening tendons, revising scars, or freeing tissue around a joint. Not everyone needs surgery. A specialist will discuss the possible benefits, risks, and recovery time with you.

Living with this condition

Contractures can make everyday tasks harder, so planning helps. Pace activities and use aids that make tasks safer. Keep up with home exercises and splints. Check your skin often, especially in tight areas. Ask your therapist for changes if something is not working.

Lifestyle tips

• Stay as active as your provider advises.
• Avoid staying in one position for long periods.
• Set reminders for stretches, splints, and position changes.
• Arrange your home to reduce reaching, tripping, and strain.
• Involve family or carers in your therapy plan when helpful.
• Ask about work, school, or travel adjustments if movement is limited.

Diet and exercise

Regular movement and stretching as advised can help keep joints flexible. A balanced diet supports general health and tissue healing. If you need to lose or gain weight, ask your healthcare provider for safe advice. A therapist can suggest exercises that match your ability and avoid injury.

Mental health and emotional wellbeing

It is common to feel frustrated, tired, or low when movement is limited. These feelings matter. Talk with your healthcare provider or therapist if sadness, worry, or stress is affecting daily life. If you have thoughts of harming yourself, seek urgent help from your local emergency services or a crisis support service.

Prevention

Many contractures can be prevented or reduced. Move joints early after injury or illness when it is safe. Work with a physiotherapist or occupational therapist after stroke, burns, casts, or long hospital stays. Use splints and good positioning as advised. Care for scars and check skin often.

Vaccines

There is no vaccine for contractures.

Screening programmes

There is no routine screening test for contractures. After a long cast, hospital stay, burn, or stroke, ask your healthcare team to check your movement and skin.

Complications

If left untreated

• Permanent loss of movement in a joint.
• Joint or limb deformity.
• Pain and muscle strain.
• Skin breakdown, pressure sores, or infection.
• Falls or trouble with walking and balance.
• Loss of independence in daily tasks.
• Sleep problems and emotional strain.

Long-term outlook

Many people improve with early therapy, splints, and support. Even long-standing contractures can often be helped. Treatment aims to improve comfort, movement, and daily function. Ask your healthcare provider what is realistic for you.

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