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Range of motion and contractures

LTC Nursing Assistant Trainer, January 26, 2012

Assessment of joint range of motion is an important part of restorative nursing. You must have some type of baseline knowledge of the resident’s joint motion to show you have maintained or improved function.

Contractures caused by trauma or surgery form scar tissue consisting of thick collagen fibers. These differ from contractures that often develop in the facility, which result from immobility. The contractures are a shortening and deformity of muscles from lack of use. There are no thick collagen fibers. Because of this, treatment differs. Collagen fibers can be surgically released. Contractures resulting from immobility respond best to slow, gentle stretching and massage.

Other contracture facts include:

• Residents can begin to develop contractures in as little as four days. Most nurses do not recognize a contracture until it limits joint movement to 45 degrees. Reversing a contracture at this point often takes months but can take years. Most contractures can be reversed if detected before the joint is immobilized completely.
• Contractures occlude the capillaries in the joint.
• Contractures are often painful, feeling much like cramps that athletes get from overexertion. As a result, contractures make caring for and positioning the resident much more difficult and painful.

This is an excerpt from the HCPro book, The Long-Term Care Nursing Desk Reference, Second Edition, by Barbara Acello, MS, RN.

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