Limitation of the amplitude of movements is observed in lesions of the musculoskeletal system, including injuries, inflammatory, degenerative, infectious diseases. It occurs in nervous diseases, some other pathologies. It can be temporary or permanent. Partial stable restriction of movements is called contracture, almost complete – rigidity, complete – ankylosis. To determine the diagnosis, a survey, physical examination, visualization techniques, laboratory tests are used. Treatment depends on the reason for the limitation of the amplitude of movements.
Why is there a limitation of the amplitude of movements
The symptom is almost always observed with injuries, in most cases it is temporary, it is eliminated after healing. The more severe the traumatic injury, the more the amplitude of movements is limited. The cause is the following conditions:
- Bruising. Movements are limited moderately or slightly, the support is preserved.
- Ligament damage. When stretching, the restrictions resemble a bruise, when tearing and tearing, there is an almost complete lack of mobility due to pain.
- Fractures. The symptom is pronounced, with intra-articular and periarticular injuries, it is caused not only by pain, but also by the loss of congruence of articular surfaces.
- Dislocations. There are no movements, spring resistance is noted.
Amplitude limitations are also observed in wounds, burns, frostbite, caused by pain syndrome, tissue damage. With tendon injuries, a certain movement (flexion, extension, less often abduction and reduction) becomes impossible due to a violation of the integrity of the structure that pulls the limb segment in the right direction.
In the knee joint, the symptom may be associated with damage to the menisci. Along with a painful decrease in mobility, this injury is characterized by blockages – temporary fixation of the joint in a forced position due to the infringement of the torn meniscus between the articular surfaces. Accompanied by sharp pain, eliminated immediately after reduction.
Temporary restriction of limb mobility due to pain syndrome is observed in most purulent lesions of bones, soft tissues. It is more pronounced with intra-articular and periarticular localization of the process, a significant amount of lesion. It is detected in the following pathologies:
- purulent arthritis;
Consequences of injuries, infectious processes
Persistent limitation of the amplitude of movements is noted after injuries to bones, joints, soft tissues, some purulent diseases. The following types of contractures are distinguished:
- Arthrogenic. They are formed in the outcome of purulent arthritis, after intra-articular fractures, especially unreposed ones.
- Dermatogenic, myogenic, desmogenic. Provoked by extensive scars after burns, large lacerations and bruised wounds. There are phlegmon, abscesses in the outcome.
- Ischemic. They develop due to violations of the local blood supply in fractures. More often diagnosed in children with injuries to the humerus, forearm bones.
In addition, after prolonged fixation of the limb due to injuries, purulent processes, immobilization contractures may form. In some patients, ossifying myositis becomes the cause of amplitude limitation in the long-term period.
The amplitude of movements decreases with inflammatory and degenerative diseases, secondary joint lesions:
- Arthrosis. Movements are limited slowly, gradually. The process is observed in the final stages of the disease, several years or even decades after the appearance of the first signs of arthrosis. Contractures can occur in any joint, have the greatest clinical significance in coxarthrosis and gonarthrosis.
- Arthritis. In reactive arthritis, the symptom appears for a short period of time. In gouty, rheumatoid, psoriatic, and other chronic arthritis, the function of the joints is gradually disrupted, ranging from mild contractures to ankylosis.
- Arthropathy. Most arthropathies occur without reducing the volume of movements. A persistent decrease in amplitude can be observed in diabetic arthropathy, HIV infection, Kawasaki syndrome, Reiter’s syndrome.
- Synovites. Caused by injuries, exacerbations of chronic joint diseases. The symptom is expressed slightly, movements are restored after puncture, the disappearance of inflammatory phenomena.
- Tuberculosis of the joints. Restriction of movements in tuberculosis is initially sparing. Subsequently, it turns into persistent pain, and with significant destruction of the joint – into arthrogenic contracture.
Soft tissue lesions
Most often, significant limitations of the amplitude of movements are determined with shoulder periarthritis, which unites a group of diseases of the periarticular tissues of the shoulder joint. Provoked by the following pathologies:
- adhesive capsulite;
- bursitis of the shoulder joint;
- impeachment syndrome;
- calcifying tendinitis;
- shoulder rotator compression syndrome;
- tendinitis of the biceps muscle of the shoulder.
Limitations of movement in other joints may be caused by enthesopathy, tendinitis, tendovaginitis. Usually expressed indistinctly, aggravated during the period of exacerbation. Persistent restriction of the flexion of the ring finger, less often of other fingers, is observed with Dupuytren’s contracture. In de Quervain’s disease, the movements of the thumb are limited due to pain, but persistent contractures are not formed.
Diseases of nerves and spine
The cause of the development of joint contractures are the following pathological conditions:
- encephalitis of various etiologies;
- ischemic and hemorrhagic stroke;
- severe traumatic brain injuries;
- cerebral palsy;
- disorders of cerebrospinal circulation;
- spinal cord injuries;
- neoplasms of the brain and spinal cord;
- traumatic injuries of peripheral nerves.
Less persistent decreases in the range of motion in the joints of the extremities, due to compression and inflammation of the nervous tissue, are observed in neuritis and neuropathies. The mobility of the spine is temporarily limited with the exacerbation of diseases such as:
- protrusion and herniated disc;
Limitation of the amplitude of movements develops due to lesions of the skeleton and soft tissues, is found in the following cases:
- Mucopolysaccharidoses. Contractures are formed first of the shoulder and elbow joints, then of the joints of the lower extremities. The spine bends, its mobility also decreases.
- Ollier’s disease. There is a shortening or a change in the shape of one or more segments. The cause of contractures are periarticular deformities, the number of affected joints ranges from 1 to dozens. Lesions of small joints of the hands are especially severe.
- Primary myopathies. Contractures are formed in the late stages of the disease, are a consequence of the restriction of active movements. They are observed in juvenile Erb myopathy, pseudohypertrophic Duchenne myopathy, and other forms.
Osteochondropathies and other aseptic necrosis
Limitations of the amplitude of movements are found in some osteochondropathies in children and adolescents. Especially pronounced in Perthes’ disease. At the height of the disease, the volume of movements in the affected hip joint decreases. With the formation of the mushroom-shaped femoral head, the symptom may persist to some extent throughout life, aggravated by the development of secondary deforming arthrosis.
Aseptic necrosis in adults includes femoral head lesion and Kinbeck disease. The course is less favorable than in childhood. Limitation of mobility appears at the stage of bone destruction, complete recovery is rarely observed even against the background of adequate timely treatment. In patients with dissecting osteochondritis, there are no persistent contractures, repeated blockages occur when the bone section is separated.
Limitations of the amplitude of movements arise primarily due to underdevelopment or violation of the configuration of articular surfaces, soft tissue defect, changes in the relationship between bone structures. The following etiological factors are considered:
- congenital hip dislocation;
- hip dysplasia;
- varus deformity of the hip;
- congenital dislocation of the patella;
- congenital dislocation of the lower leg.
Along with the conditions listed above , the following pathologies can become the reasons for limiting the amplitude of movements:
- Deformities of the foot: horse foot, heel foot, clubfoot, Hallux valgus and hammer-like toes with transverse flat feet.
- Endemic diseases: Kashin-Bek disease.
- Mental disorders: hysteria.
Orthopedic traumatologists are engaged in the diagnosis of diseases that cause amplitude limitation. According to the indications of patients, they are referred to a surgeon, rheumatologist, neurologist, and other specialists. The examination program includes a survey, an external examination and a number of diagnostic procedures:
- Measuring the volume of movements. It is part of a physical examination, plays an important role in assessing the severity and nature of violations. It includes the determination of the volume of active and passive movements, the calculation of the severity of restrictions, taking into account the norms for various joints.
- Radiography. It is carried out for most pathologies with the exception of wounds, burns, superficial frostbite. Allows you to detect signs of fracture, dislocation, inflammation, degeneration, to clarify the cause of persistent movement restriction.
- Ultrasound. Sonography is used to study the condition of soft tissues in case of limb damage, to assess the condition of the vessels of the spinal cord and brain in case of circulatory disorders.
- Other visualization techniques. CT is prescribed for a detailed study of the state of solid structures, and MRI is prescribed for the study of soft tissues. The methods are widely used in the study of joints, spine, brain.
- Electrophysiological studies. They are indicated for patients with neurological disorders. Electromyography, electroneurography, and the study of evoked potentials can be carried out.
- Laboratory tests. They are produced to confirm the inflammatory process, determine the microflora, and identify specific markers of rheumatic diseases.
Assistance at the pre-hospital stage
Persistent limitations develop gradually, are not subject to independent treatment. With a sudden decrease in the volume of movements, rest is required. Patients with traumatic limb injuries are splinted and given an analgesic. When exacerbating chronic degenerative diseases, local anti-inflammatory and analgesics are effective. Deterioration of the general condition, sharp pain, significant swelling are indications for immediate treatment to a specialist.
The tactics of treatment of transient disorders is determined by the nature of the underlying pathology. In case of injuries, fractures are repositioned, dislocations are corrected, immobilization is carried out. With synovitis, a puncture is performed. According to the indications, the blockade is eliminated. Depending on the cause of the development of diseases, antibiotics, NSAIDs, and other medications are prescribed. Non-drug methods are used. With persistent amplitude limitations , the following methods are used:
- Physical therapy. It includes passive and active exercises, muscle relaxation complexes. At the initial stages of treatment or in parallel with physical therapy, mechanotherapy is carried out.
- Physical therapy. With minor contractures, diadynamic currents and medicinal electrophoresis are prescribed. With a more pronounced limitation of the amplitude of movements, applications of ozokerite and paraffin are effective. Patients are shown massage.
- Stage dressings. The arm or leg is sequentially fixed in several positions, which increases the volume of movements, improves the functions of the limb.
The tactics of surgical intervention is determined taking into account the peculiarities of pathology:
- Injuries of solid structures: osteosynthesis of the neck of the shoulder, resection of the head of the humerus, osteosynthesis of the condyles of the shoulder, osteosynthesis of the ulnar process, osteosynthesis of the condyles of the thigh, osteosynthesis of the femoral neck, osteosynthesis of the ankles.
- Soft tissue injuries: suturing of wounds, suture or tendon plasty, skin plasty, stitching of thigh and lower leg muscles.
- Infectious processes: arthrotomy, sequestrectomy, opening of an abscess, phlegmon.
- Nerve lesions: suturing, autoplasty or decompression of nerve trunks.
- Consequences of injuries and diseases: redressation, imposition of Ilizarov apparatus, excision of scars, tenotomy, tendon elongation, capsulotomy, arthrolysis, arthroplasty.
With significant destruction of the joint, endoprosthetics or arthrodesis in a functionally advantageous position may be indicated. In the postoperative period, antibiotics and analgesics are prescribed, rehabilitation measures are carried out.