This study guide is about contractures, diagnosis of contractures, treatment of contractures, and 4 nursing care Plans for contractures. Use it to create educational nursing care plans for contractures.
What are contractures?
Contractures are characterized by the presence of stiffness in the patients’ muscles, tendons, ligaments, and skin. Contractures may also develop in the patients’ joints, thereby restricting natural movement. The affected region prohibits the patient from moving naturally, having the otherwise normal tissues be replaced with inelastic tissues brought about by injury, inflammation, or any other conditions. “Contracture” is an umbrella term, indicating any form of movement disorder that causes shortening and tightening of the tissues of the musculoskeletal system.
What are the signs and symptoms of contractures?
The classic manifestation of contractures is reduced ability in movement. Pain may or may not be present in contractures. Since contractures affect the musculoskeletal system, movement difficulties may manifest on different parts of the body:
- Moving of hands
- Stretching of the lower limbs
- Straightening of fingers
- extending of another part of the body
Contractures can manifest on any part of the musculoskeletal system.
- Muscles – the muscles would be shortened, thereby limiting movement
- Joints – range of motion will be limited on the affected joint/s, e.g. shoulder joint
- Skin – If there is an injury in the skin (e.g. the arms), fibroid tissue replaces the skin, thereby limiting movement in the forearm.
What are the causes of contractures?
The musculoskeletal system is composed of the skeleton, muscles, and other connective tissues (tendons, cartilage, ligaments, joints, etc.) that work together to bind and support the body, thus allowing for motion. It also acts as a barrier for the vital parts of the body for any untoward injuries. Severe stiffening of the muscles, ligaments, and/or tendons in the musculoskeletal system can be diagnosed as contracture.
Causes and risk factors of contractures could either be from the following reasons:
- Prolonged inactivity – Patients who experienced prolonged hospital stays, particularly in the Intensive care unit, will have their muscles and joints tighten. Patients who suffered from stroke have a higher risk for contractures.
- Secondary to injuries – Scarring injuries, either by burn or injury, will inhibit movement of the affected area due to the replacement of elastic tissues with fibroid tissue.
- Secondary to disease process – Disease or conditions that prohibit normal movements and range of motions, either developed or inherited, can be a cause for contracture deformity. Examples of these conditions are: Arthritis (inflammation of joints), muscular dystrophy (degradation of muscle fibers), Cerebral palsy (motor disability originating from the brain), and other Central nervous system conditions (Parkinson’s, Multiple sclerosis, etc.)
What happens when contractures are left untreated?
Delayed treatment of contractures will result in a long time of disability, making recovery of a normal range of motion and mobility more impossible to regain. Stiff muscles and joints will interfere with the patients’ activities of daily living, making them more dependent on their families or caregivers. Postponing treatment for the cause of contractures (e.g. muscular dystrophy) may shorten the therapeutic window in resolving the condition, consequently limiting the benefits of early treatment.
Diagnosis of Contractures
How do you diagnose contractures?
- Comprehensive Medical history – Acquiring a complete history of signs and symptoms will aid in the appropriate course of action for the cause of the contracture. This includes data regarding:
- Specific location of immobility
- Intensity or severity of symptoms
- range of motion left with the affected part
- the onset and duration that the contracture is experienced
- Physical Examination – To assess the extent of deformity, particularly the range of motion of the musculoskeletal system.
- Radiologic approach – Done to assess the structures for extent of the condition.
- X-rays – x-rays of the joints will reveal opacities indicating damage, eg. Osteoarthritis
- CT-scans – CT scans will reveal deeper and detailed structures than x-rays. These are useful in diagnosing causes of contractures arising from diseases processes, such as muscular dystrophy
- MRI – a specialized imaging technique utilizing magnets to visualize lesion opacities on the regions of the nervous system to assess for extent of disease
Treatment of Contractures
What are some of the available treatment options for contractures?
Treatment guidelines for contractures will depend on the cause of the deformity. The following are utilized in general:
- Physical therapy and occupational therapy. The most common treatment for contractures. Involves use of exercises (either passive or active) with the end goal of increasing the range of motion and regaining lost muscle strength from prolonged inactivity.
- Medical Devices. Supportive devices such as splints and casts will be applied to stretch the tissues of the affected body part. Assisted devices, such as crutches or walkers, will be required for patients with contractures due to secondary injuries and conditions (e.g. osteoarthritis) to allow patients to ambulate around.
- Medications. Some causes of contractures are related to inflammatory processes (e.g. Osteoarthritis). Corticosteroids and NSAID’s (non-steroidal anti-inflammatory drugs) will be beneficial for such conditions. Botulinum toxin injections has been proven to give benefits for patients with Cerebral palsy for it relaxes the muscle tensions and spasms associated with the disease.
- Surgery. Surgical intervention maybe warranted for some cases of contractures. In burn patients, wherein the fibroid covered skin inhibits movement, reconstructive surgery is done to release the contracture and to regain range of motion. In patients suffering from degenerative diseases of the joints (e.g. osteoarthritis), replacement surgery is done to regain mobility for activities of daily living.
4 Nursing Care Plans for Contractures
What are some of the available nursing care plans for contractures?
Nursing Care Plan 1
Impaired physical mobility related to the stiffness of muscles secondary to contractures as acute pain upon movement, shortening of muscles, evidenced generalized weakness, inability to do activities of daily living (ADLs) as normal, and verbalization of overwhelming tiredness/ fatigue
Desired Outcome: The patient will be able to perform activities of daily living within the limits of the disease.
|Assess the patient’s level of functional mobility and ability to perform ADLs.||To assist in creating an accurate diagnosis and monitor the effectiveness of treatment and therapy.|
|Assist the patient during exercises and when performing activities of daily living.||To encourage the patient to perform muscle-strengthening exercises and promote dignity by allowing the patient to perform their ADLs while maintaining safety.|
|Ensure the safety of the environment. Check that the call bell is within reach, the bed rails are up when the patient is on the bed, the bed is in the lowest level, the room is well-lit, the floor is not slippery, and that important things like phone and eyeglasses are easy to reach.||To maintain patient safety and reduce the risk of falls.|
|Encourage the patient to perform a range of motion (ROM) exercises in all extremities.||To improve venous return, muscle strength, and stamina while preventing stiffness and contracture deformation.|
|Refer to the physiotherapy and occupational therapy team.||To provide specialized care for the patient to gain physical and mental support in performing ADLs and mobilizing.|
Nursing Care Plan 2
Nursing Diagnosis: Fatigue related to muscular stiffness secondary to contractures as evidenced by generalized weakness, irritability, and verbalization of overwhelming tiredness
Desired Outcome: The patient will demonstrate active participation in necessary and desired activities and demonstrate an increase in activity levels.
|Assess the patient’s degree of fatigability by asking to rate his/her fatigue level (mild, moderate, or severe). Explore activities of daily living, as well as actual and perceived limitations to physical activity. Ask for any form of exercise that he/she used to do or wants to try.||To create a baseline of activity levels, degree of fatigability, and mental status related to fatigue and activity intolerance.|
|Encourage activity through self-care and exercise as tolerated Alternate periods of physical activity with rest and sleep. Encourage enough rest and sleep, and provide comfort measures.||To help the patient balance his/her physical activity and rest periods. To reserve energy levels and provide optimal comfort and relaxation.|
|Teach deep breathing exercises and relaxation techniques. Provide adequate ventilation in the room.||To allow the patient to relax while at rest. To allow enough oxygenation in the room.|
|Refer the patient to the physiotherapy / occupational therapy team as required.||To provide more specialized care for the patient in terms of helping him/her build confidence in balancing daily physical activity and rest periods.|
Nursing Care Plan 3
Nursing Diagnosis: Acute Pain related to contractures, as evidenced by pain score of 10 out of 10 upon movement, guarding sign on the affected limb or body region, restlessness, and irritability
Desired Outcome: The patient will report a pain score of 0 out of 10.
|Assess the patient’s vital signs. Ask the patient to rate the pain from 0 to 10, and describe the pain he/she is experiencing.||To create a baseline set of observations for the patient. The 10-point pain scale is a globally recognized pain rating tool that is both accurate and effective.|
|Administer analgesics/ pain medications as prescribed.||To provide pain relief to the patient.|
|Ask the patient to re-rate his/her acute pain 30 minutes to an hour after administering the analgesic.||To assess the effectiveness of treatment.|
|Provide more analgesics at recommended/prescribed intervals.||To promote pain relief and patient comfort without the risk of overdose.|
|Reposition the patient in his/her comfortable/preferred position. Encourage pursed lip breathing and deep breathing exercises.||To promote optimal patient comfort and reduce anxiety/ restlessness.|
|Refer the patient to a pain specialist as required.||To enable to patient to receive more information and specialized care in pain management if needed.|
Nursing Care Plan 4
Nursing Diagnosis: Self-Care Deficit related to musculoskeletal impairment and physical limitations secondary to contractures as evidenced by inability to bathe, get dressed, and perform toileting activities as normal
Desired Outcome: The patient will be able to demonstrate optimal performance of ADLs or activities of daily living.
|Assess the patient’s limitations to self-care by asking open-ended questions.||To explore the patient’s self-care limitations and needs while allowing him/her to express his/her personal thoughts and feelings related to ADLs.|
|Offer appropriate pain medication as prescribed at least 30 minutes before the patient performs self-care activities.||Pain might discourage the patient to mobilize and carry out self-care activities.|
|Educate the patient’s carer or significant other on providing appropriate assistance to the patient while he/she performs self-care tasks.||To provide learning to the carer or significant other and to ensure that the patient has a good amount of support while doing ADLs at home. Skilled home services might be needed if there is no available significant other to care for the patient.|
|Refer the patient to an occupational therapist.||Occupational therapists are skilled professionals in helping clients achieve optimal performance in their daily activities like bathing, dressing, and personal hygiene tasks.|
|Coordinate with the physical therapy team on how to create and initiate an exercise program for the patient.||A customized exercise plan can help the patient in terms of increasing his/her endurance and strength which he/she will need when doing self-care activities.|
|Encourage the patient to use assistive devices and grooming aids as needed.||To promote autonomy when performing self-care activities.|
Other possible nursing diagnoses:
- Alteration in Comfort
- Risk for Fall
- Risk for Constipation
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.