Contracture: Symptoms, Types, Causes and Treatment

Contractures are a common yet often misunderstood medical complication characterized by a permanent limitation in the movement of a joint. Whether developing due to injury, neurological conditions, or congenital disorders, contractures can significantly impact a person's mobility and quality of life. In this article, we break down the key symptoms, types, causes, and treatments of contracture, synthesizing up-to-date scientific evidence to provide a comprehensive overview.

Symptoms of Contracture

Recognizing the symptoms of contracture is essential for early detection and management. Contractures manifest as a reduction in the normal movement of joints, but the presentation can vary depending on the underlying cause and affected body part.

Symptom	Description	Common Contexts	Source(s)
Reduced Mobility	Limited range of motion in joint	Neurological & orthopedic	4 7 9
Joint Stiffness	Feeling of tightness or rigidity	Immobilization, injury	1 7
Deformity	Abnormal joint position	Congenital, severe cases	1 8
Pain/Discomfort	Soreness with movement or rest	Acute or chronic phases	9 11

Table 1: Key Symptoms

Understanding the Symptoms

Contractures often begin subtly with a reduction in joint range of motion. Over time, this can progress to visible deformity and persistent stiffness.

Reduced Mobility

The hallmark of contracture is a loss of passive movement in the affected joint. This means that even when someone else tries to move the joint, its motion is restricted. The limitation can be mild at first but often worsens without intervention, impacting daily activities such as walking or grasping objects 4 7 9.

Joint Stiffness and Deformity

Patients might initially report a feeling of tightness or resistance when moving the joint. As the condition progresses, the joint may become fixed in an abnormal position, resulting in visible deformity. For example, in amyoplasia (a form of congenital contracture), specific joint angles and hand positions are classic features 1.

Pain and Discomfort

While contractures are often painless in their early stages, pain or discomfort can develop, particularly if the underlying tissues are inflamed or if attempts to move the joint stretch shortened tissues. However, pain is not always a prominent feature and may depend on the cause and duration of the contracture 9 11.

Types of Contracture

Contractures are not a one-size-fits-all problem. They can vary based on origin, affected tissues, and clinical presentation. Understanding the different types enables targeted management and better outcomes.

Type	Key Features	Typical Context	Source(s)
Congenital	Present at birth, often multiple	Arthrogryposis, clubfoot	1 8
Immobilization	Follows prolonged immobility	Casting, injuries	7 4
Neurological	Linked to nervous system disorders	Stroke, spinal injury	4 5 6
Fibrotic	Irreversible tissue contraction	Wound healing, fibrosis	3

Table 2: Types of Contracture

Exploring the Main Types

Congenital Contractures

These are present at birth and may involve one joint (isolated) or multiple joints (as seen in arthrogryposis). Arthrogryposis itself is not a single disease but a group of over 300 disorders characterized by multiple joint contractures. Examples include clubfoot and distal arthrogryposis, which can be caused by genetic, neuromuscular, or connective tissue abnormalities 1 8.

Immobilization Contractures

Often occurring after injuries that require casting or splinting, immobilization contractures arise when a joint is kept in a fixed position for a prolonged period. Lack of movement leads to changes in muscles, tendons, ligaments, and even joint cartilage, resulting in a progressive loss of mobility 7.

Neurological Contractures

Seen in conditions like stroke, cerebral palsy, or spinal cord injury, these contractures develop due to muscle imbalance, spasticity, or weakness. They are common complications following central or peripheral nervous system damage, which disrupts the normal balance of muscle activity around a joint 4 5 6.

Fibrotic Contractures

Fibrotic contractures result from excessive scar tissue formation, as seen in burns, chronic wounds, or after certain surgeries. This leads to the physical shortening and stiffening of tissues, often making these contractures particularly resistant to non-surgical treatments 3.

Causes of Contracture

Understanding why contractures develop is vital for both prevention and effective treatment. The underlying causes are multifactorial, often combining mechanical, neurological, and genetic factors.

Cause	Mechanism	Common Example	Source(s)
Immobilization	Lack of movement, tissue changes	Casted limb, bed rest	7 4
Neurological Injury	Spasticity, paralysis	Stroke, SCI	5 6 4
Congenital Factors	Genetic mutations, fetal crowding	Arthrogryposis	1 8
Fibrosis	Excessive scar tissue	Burns, chronic wounds	3
Abnormal Mechanotransduction	Overactive nerve signaling	Distal arthrogryposis	8

Table 3: Main Causes of Contracture

Unpacking the Causes

Immobilization and Disuse

When a joint is immobilized (e.g., by casting or due to injury), the lack of movement disrupts normal tissue nutrition, blood flow, and muscle activity. Over time, this leads to muscle shortening, thickening of joint capsules, and changes in cartilage and synovial fluid. Even from the first days of immobilization, tissue remodeling begins, progressively worsening if not addressed 7.

Neurological Injury

Damage to the central or peripheral nervous system can cause muscle imbalance — some muscles become overactive (spasticity), while others weaken. The resulting abnormal forces across the joint lead to contracture. For example, after a spinal cord injury, the risk is higher in patients with severe lesions, pressure ulcers, or associated head injuries 5 4 6.

Congenital and Genetic Factors

Congenital contractures can be due to reduced fetal movement or genetic mutations affecting muscle or joint development. In some rare disorders, mutations in mechanosensory genes (e.g., PIEZO2) cause excessive signaling in sensory neurons, disrupting normal joint formation and leading to contractures from birth 1 8.

Fibrosis and Scarring

Any condition that causes excessive scar tissue — such as burns or chronic wounds — can restrict tissue flexibility. The fibrotic process physically shortens tissues, making movement difficult or impossible. Experimental models highlight the biological differences between 'bulk' fibrotic contractures (as in wound beds) and 'interfacial' contractures (as seen around implants) 3.

Abnormal Mechanotransduction

Emerging research shows that not only muscles and joints, but also overstimulated sensory neurons (due to genetic mutations) can cause joint contractures by disrupting the normal development of musculoskeletal tissues 8.

Treatment of Contracture

Effective management of contractures depends on early recognition, the underlying cause, and a multidisciplinary approach. Treatments may range from conservative therapies to surgical interventions.

Treatment	Approach/Method	Effectiveness/Limitations	Source(s)
Stretching	Manual or mechanical stretch	Little to no long-term benefit	9 10 11 12
Splinting/Bracing	Maintains joint position	May help prevent worsening	4 7
Physical Therapy	Mobility exercises, rehab	Essential for prevention, limited reversal	4 7
Medications	Botox, anti-spasticity drugs	Useful in neurological contractures	4 8
Surgery	Tenotomy, release procedures	For severe/irreversible contractures	4
New Therapies	Novel drugs, combined methods	Under investigation	3 4 8

Table 4: Treatment Modalities

Exploring Treatment Options

Stretching

Stretching has long been a mainstay for both prevention and treatment of contractures. However, high-quality evidence indicates that, when performed for up to seven months, stretching has little to no clinically significant effect on joint mobility, pain, or quality of life in both neurological and non-neurological conditions 9 10 11 12. The marginal benefit observed (1–3 degrees of increased range) is not considered functionally meaningful.

Splinting and Bracing

Splints and braces are used to maintain the joint in a functional position and prevent worsening. While these methods may help slow progression, they rarely reverse established contractures. Their greatest value lies in early application, especially during immobilization or after injuries 4 7.

Physical Therapy

Targeted exercises and rehabilitation are critical for maintaining joint mobility and muscle strength. Early and regular physical therapy can help prevent contractures, especially in high-risk populations (e.g., after stroke or spinal cord injury), but is rarely effective in reversing long-standing contractures 4 7.

Medications

For contractures related to spasticity or abnormal neural activation, medications such as botulinum toxin (Botox) or anti-spasticity drugs may offer temporary improvement. Newer research suggests that modulating abnormal mechanotransduction in sensory neurons could become a therapeutic avenue in genetic forms of contracture 4 8.

Surgery

When conservative measures fail, surgical intervention may be necessary. Procedures such as tendon release (tenotomy) or capsulotomy can restore joint mobility in severe or irreversible cases. Surgery is often followed by intensive rehabilitation to maintain the gains achieved 4.

Emerging and Combined Treatments

Recent models and studies suggest that combining several interventions — such as medications, physical therapy, and novel biological therapies — may improve outcomes. Scientific and clinical research is ongoing to refine these approaches and develop new strategies, particularly for fibrotic and congenital contractures 3 4 8.

Conclusion

Contractures are complex, multifactorial conditions that can significantly impact function and quality of life. Early recognition, prevention, and a team-based approach are crucial for optimal management. Here are the main takeaways:

• Symptoms: Reduced joint mobility, stiffness, deformity, and sometimes pain are the key features of contracture 1 4 7 9 11.
• Types: Contractures can be congenital, immobilization-related, neurological, or fibrotic 1 3 4 5 6 7 8.
• Causes: They arise from immobilization, neurological injury, congenital/genetic factors, fibrosis, or abnormal nerve signaling 1 3 4 5 6 7 8.
• Treatment: While stretching alone offers little benefit, combined approaches — including rehabilitation, medications, splinting, and sometimes surgery — are currently the mainstay, with research into new therapies ongoing 3 4 7 8 9 10 11 12.

A comprehensive understanding of contracture — its symptoms, types, causes, and treatments — is essential for healthcare providers and patients alike, paving the way for better prevention and improved quality of life.