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Chapter 56: Joint Contractures in a Child

Cassandra Sanders-Holly; Cheri Kay Sessions

Description of the Symptom

Contracture has been defined as "a condition of fixed high resistance to passive stretch of a muscle, resulting from fibrosis of the tissues supporting the muscles or the joints, or from disorders of the muscle fibers." It is an abnormal, often permanent shortening of the muscle or scar tissue that results in distortion or deformity. This chapter describes possible causes of joint contractures in a child.

Special Concerns

  • Joint erythema

  • Joint warmth

  • Sudden onset of joint contracture

  • Increased pain within the joint

  • Changes in bony configuration

CHAPTER PREVIEW: Conditions That May Lead to Joint Contractures in a Child
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CHAPTER PREVIEW: Conditions That May Lead to Joint Contractures in a Child
T Trauma
COMMON

Brachial plexus injury (Erb's palsy, Klumpke's palsy) 1091

Third-degree burns 1097

Traumatic brain injury 1097
UNCOMMON
Surgical interventions (eg, limb lengthening) 1096
RARE
Not applicable
I  Inflammation
COMMON

Aseptic

Juvenile rheumatoid arthritis 1094

Systemic lupus erythematosus 1097

Septic

Not applicable
UNCOMMON

Aseptic

Juvenile ankylosing spondylitis 1093

Psoriatic arthritis 1095

Reactive arthritis 1095

Scleroderma 1095

Septic

Human immunodeficiency virus encephalopathy 1092
RARE

Aseptic

Juvenile dermatomyositis 1093

Septic

Poliomyelitis 1095
M  Metabolic
COMMON
Not applicable
UNCOMMON
Not applicable
RARE
Not applicable
Va  Vascular
COMMON
Not applicable
UNCOMMON
Not applicable
RARE
Not applicable
De  Degenerative
COMMON
Immobilization and prolonged bedrest 1093
UNCOMMON
Spinal muscular atrophy 1096
RARE
Not applicable
Tu  Tumor
COMMON
Not applicable
UNCOMMON

Malignant Primary:

Not applicable

Malignant Metastatic:

Not applicable

Benign, such as:

• Syringomyelia 1097
RARE
Not applicable
Co  Congenital
COMMON

Duchenne muscular dystrophy 1092

Talipes equinovarus (clubfoot) 1097
UNCOMMON
Arthrogryposis 1091
RARE

Epidermolysis bullosa 1092

Infantile spasms 1093

Lesch-Nyhan syndrome 1094

Sjögren-Larsson syndrome 1096
Ne  Neurogenic/Psychogenic
COMMON

Cerebral palsy 1091

Hydrocephalus 1093

Immobilization and prolonged bedrest 1093

Myelodysplasia 1094

Seizure disorders 1096
UNCOMMON
Tethered cord syndrome 1097
RARE

Lennox-Gastaut syndrome 1094

Leukodystrophies 1094

Pelizaeus-Merzbacher disease 1095

Subacute sclerosing panencephalitis 1096

Note: These are estimates of relative incidence because few data are available for the less common conditions.

Common Ages at Which Joint Contractures Present in a Child
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Common Ages at Which Joint Contractures Present in a Child
APPROXIMATE AGE CONDITION
Birth to 3 Years

Brachial plexus injury

Burns

Cerebral palsy

Hydrocephalus

Immobilization

Juvenile rheumatoid arthritis

Lesch-Nyhan syndrome

Leukodystrophies

Myelodysplasia

Pelizaeus-Merzbacher disease

Poliomyelitis

Seizure disorders

Sjögren-Larsson syndrome

Traumatic brain injury
Preschool (3–5 Years)

Burns

Cerebral palsy

Hydrocephalus

Immobilization

Juvenile rheumatoid arthritis

Pelizaeus-Merzbacher disease

Poliomyelitis

Seizure disorders

Traumatic brain injury
Elementary School (6–11 Years)

Burns

Cerebral palsy

Hydrocephalus

Juvenile dermatomyositis

Juvenile rheumatoid arthritis

Immobilization

Pelizaeus-Merzbacher disease

Poliomyelitis

Seizure disorders

Systemic lupus erythematosus

Traumatic brain injury
Middle School (12–14 Years)

Burns

Cerebral palsy

Duchenne muscular dystrophy

Hydrocephalus

Immobilization

Juvenile dermatomyositis

Juvenile rheumatoid arthritis

Pelizaeus-Merzbacher disease

Poliomyelitis

Seizure disorders

Systemic lupus erythematosus

Traumatic brain injury
High School (15–18 Years)

Burns

Cerebral palsy

Duchenne muscular dystrophy

Hydrocephalus

Immobilization

...

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