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. May 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, imaging techniques, and laboratory tests are used. Treatment depends on the cause of the limited range of motion.
Why there is a limitation of the range of motion
The symptom is almost always observed with injuries, in most cases it is temporary, it is eliminated after treatment. The more severe the traumatic injury, the more limited the range of motion. The following conditions are the cause:
- Injury. Movements are moderately or slightly limited, support is maintained.
- Ligament damage. When stretched, the restrictions resemble a bruise; when torn and torn, there is an almost complete lack of mobility due to pain.
- Fractures. The symptom is pronounced, with intra-articular and peri-articular injuries due not only to pain, but also to the loss of congruence of the articular surfaces.
- Dislocations. There are no movements, there is a springy resistance.
Amplitude limitations are also observed in wounds, burns, frostbite, caused by pain, tissue damage. With tendon injuries, a certain movement (flexion, extension, less often abduction and adduction) 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 blockades - 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 and soft tissues. It is more pronounced with intraarticular and periarticular localization of the process, a significant amount of damage. Detected in the following pathologies:
- purulent arthritis;
Consequences of injuries, infectious processes
A persistent limitation of the amplitude of movements is noted after injuries of bones, joints, soft tissues, and some purulent diseases. There are the following types of contractures:
- Arthrogenic. Formed as a result of purulent arthritis, after intra-articular fractures, especially unrepaired ones.
- Dermatogenic, myogenic, desmogenic. They are provoked by extensive scars after burns, large lacerated and bruised wounds. Occur in the outcome of phlegmon, abscesses.
- Ischemic. Develop as a result of violations of local blood supply in fractures. More often diagnosed in children with injuries of the humerus, bones of the forearm.
In addition, after prolonged fixation of the limb due to injuries, purulent processes, immobilization contractures may form. In some patients, myositis ossificans becomes the cause of amplitude limitation in the long-term period.
Limitation of range of motion
The amplitude of movements decreases in inflammatory and degenerative diseases, secondary lesions of the joints:
- Arthrosis. Movements are limited slowly, gradually. The process is observed in the final stages of the disease, several years or even decades after the first signs of arthrosis appear. 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. With gouty, rheumatoid, psoriatic, and other chronic arthritis, the function of the joints is gradually impaired, ranging from mild contractures to ankylosis.
- Arthropathy. Most arthropathies occur without a decrease in range of motion. A persistent decrease in amplitude can be observed with diabetic arthropathy, HIV infection, Kawasaki syndrome, Reiter's syndrome.
- Synovitis. Caused by injuries, exacerbations of chronic diseases of the joints. The symptom is expressed slightly, the movements are restored after the puncture, the disappearance of inflammation.
- Tuberculosis of the joints. Restriction of movements in tuberculosis is initially gentle. Subsequently, it turns into persistent pain, and with significant destruction of the joint - into arthrogenic contracture.
Soft tissue lesions
Most often, significant limitations in the amplitude of movements are determined in case of humeroscapular periarthritis, which unites a group of diseases of the periarticular tissues of the shoulder joint. Provoked by the following pathologies:
- adhesive capsulitis;
- bursitis of the shoulder joint;
- impingement syndrome;
- calcific tendonitis;
- shoulder rotator compression syndrome;
- tendinitis of the biceps brachii.
Limitations of movements in other joints may be due to enthesopathy, tendinitis, tendovaginitis. Usually expressed unsharply, aggravated during the period of exacerbation. Persistent restriction of flexion of the ring finger, less often of other fingers, is observed with Dupuytren's contracture. In de Quervain's disease, the movement of the thumb is limited due to pain, but persistent contractures do not form.
Diseases of the 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 injury;
- cerebral palsy;
- disorders of the spinal circulation;
- spinal cord injury;
- neoplasms of the brain and spinal cord;
- traumatic injuries of peripheral nerves.
Less persistent reductions 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 neuropathy. The mobility of the spine is temporarily limited during exacerbation of diseases such as:
- protrusion and hernia of the 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 in the shoulder and elbow joints, then in the joints of the lower extremities. The spine is bent, its mobility is also reduced.
- Ollie's disease. There is a shortening or change in the shape of one or more segments. Contractures are caused by periarticular deformities, the number of affected joints ranges from 1 to tens. Damage to the small joints of the hands is especially severe.
- primary myopathies. Contractures are formed in the later stages of the disease, are a consequence of the restriction of active movements. Observed in Erb's juvenile myopathy, Duchenne's pseudohypertrophic myopathy, and other forms.
Osteochondropathy and other aseptic necrosis
Limitations in the amplitude of movements are found in some osteochondropathy in children and adolescents. Especially pronounced in Perthes disease. At the height of the disease, the range of motion in the affected hip joint decreases. With the formation of the mushroom head of the femur, the symptom can to some extent persist throughout life, aggravated by the development of secondary deforming arthrosis.
Aseptic necrosis in adults includes femoral head involvement and Kienböck's disease. The course is less favorable than in childhood. Restriction 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 osteochondritis dissecans, there are no persistent contractures, and repeated blockades occur when a bone section is separated.
Anomalies of development
Restrictions on the amplitude of movements occur primarily due to underdevelopment or violation of the configuration of the articular surfaces, soft tissue defects, changes in the relationship between bone structures. As etiological factors consider:
- congenital dislocation of the hip;
- hip dysplasia;
- varus deformity of the hip;
- congenital dislocation of the patella;
- congenital dislocation of the leg.
Along with the conditions listed above, the following pathologies can become the causes of limitation of the amplitude of movements:
- Foot deformities : horse foot, calcaneal foot, clubfoot, Hallux valgus and hammer toes with transverse flat feet.
- Endemic diseases : Kashin-Beck disease.
- Mental disorders : hysteria.
Orthopedic traumatologists deal with the diagnosis of diseases that cause amplitude limitation. According to the indications, patients 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:
- Measurement of the volume of movements . It is part of the physical examination and plays an important role in assessing the severity and nature of the disorders. It includes determining the volume of active and passive movements, calculating 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, and superficial frostbite. Allows you to detect signs of fracture, dislocation, inflammation, degeneration, to clarify the cause of persistent limitation of movement.
- ultrasound . Sonography is used to study the state of soft tissues in case of damage to the limbs, to assess the state of the vessels of the spinal cord and brain in case of circulatory disorders.
- Other Imaging Techniques . For a detailed study of the state of solid structures, CT is prescribed, for the study of soft tissues - MRI. Methods are widely used in the study of joints, spine, brain.
- Electrophysiological Research . Indicated for patients with neurological disorders. Electromyography, electroneurography, the study of evoked potentials can be performed.
- Laboratory tests . Produced to confirm the inflammatory process, determine the microflora, identify specific markers of rheumatic diseases.
Help at the prehospital stage
Persistent restrictions develop gradually, are not subject to self-treatment. With a sudden decrease in range of motion, rest is required. Patients with traumatic limb injuries are splinted and given an analgesic. In case of exacerbation of chronic degenerative diseases, local anti-inflammatory and analgesic agents are effective. Deterioration of the general condition, sharp pains, significant swelling are an indication 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, reposition of fractures, reduction of dislocations, and immobilization are performed. With synovitis, a puncture is performed. According to the indications, the blockade is removed. Depending on the cause of the development of diseases, antibiotics, NSAIDs, and other drugs are prescribed. Non-pharmacological methods are used. With persistent amplitude limitations, the following methods are used:
- Physiotherapy. Includes passive and active exercises, muscle relaxation complexes. At the initial stages of treatment or in parallel with exercise therapy, mechanotherapy is carried out.
- Physiotherapy. With minor contractures, diadynamic currents, drug electrophoresis are prescribed. With a more pronounced limitation of the range of motion, applications of ozocerite and paraffin are effective. Patients are shown massage.
- Stage bandages . The arm or leg is sequentially fixed in several positions, which increases the range of motion, improves the function of the limb.
The tactics of surgical intervention is determined taking into account the characteristics of the pathology:
- Injuries of hard structures : osteosynthesis of the shoulder neck, resection of the head of the humerus, osteosynthesis of the condyles of the shoulder, osteosynthesis of the olecranon, osteosynthesis of the femoral condyles, osteosynthesis of the femoral neck, osteosynthesis of the ankles.
- Soft tissue injuries : suturing of wounds, suture or tendon plasty, skin plasty, suturing of the muscles of the thigh and lower leg.
- Infectious processes : arthrotomy, sequestrectomy, opening of an abscess, phlegmon.
- Nerve injuries : Stitching, autoplasty or decompression of the nerve trunks.
- Consequences of injuries and diseases : redressing, imposition of the Ilizarov apparatus, excision of scars, tenotomy, tendon lengthening, capsulotomy, arthrolysis, arthroplasty.
With significant destruction of the joint, arthroplasty or arthrodesis in a functionally advantageous position may be indicated. In the postoperative period, antibiotics and analgesics are prescribed, and rehabilitation measures are taken.