Contracture
A contracture is a permanent tightening and shortening of muscles, tendons, or other tissues around a joint, resulting in limited range of motion and a fixed, often painful position. Contractures develop when joints are immobilized for prolonged periods without range-of-motion exercises.
Exam Tip
Contractures are caused by immobility and are often irreversible. Prevention: ROM exercises, repositioning every 2 hours, supportive devices (hand rolls, foot boards, trochanter rolls). Report decreased ROM to the nurse immediately.
What Is a Contracture?
A contracture occurs when the soft tissues around a joint (muscles, tendons, ligaments, skin) shorten and become rigid due to lack of movement. Once a contracture forms, it may be irreversible without surgical intervention. Prevention through regular repositioning and range-of-motion exercises is a critical CNA responsibility.
Common Types of Contractures
| Type | Joint Affected | Typical Position |
|---|---|---|
| Flexion contracture | Elbow, knee, hip | Joint stuck in bent position |
| Extension contracture | Knee, fingers | Joint stuck in straight position |
| Plantar flexion (foot drop) | Ankle | Foot pointed downward permanently |
| Wrist drop | Wrist | Wrist flexed downward |
| Claw hand | Fingers | Fingers curled inward |
Risk Factors
- Immobility (bed-bound, wheelchair-bound patients)
- Stroke (paralysis on one side)
- Burns/scarring (scar tissue contracts)
- Arthritis (chronic joint inflammation)
- Spinal cord injury (paralysis)
- Prolonged bed rest without proper positioning
Prevention (CNA Responsibilities)
- Range-of-motion (ROM) exercises as ordered (passive, active-assistive, or active)
- Repositioning every 2 hours to prevent tissue shortening
- Proper positioning with supportive devices: hand rolls, trochanter rolls, foot boards, splints
- Report decreased mobility or resistance during ROM exercises to the nurse
- Encourage patient participation in self-care and movement
Positioning Devices to Prevent Contractures
| Device | Purpose |
|---|---|
| Hand roll | Keeps fingers slightly flexed (prevents claw hand) |
| Trochanter roll | Prevents external hip rotation |
| Foot board/boots | Prevents foot drop (plantar flexion) |
| Splints | Maintains joint in functional position |
| Pillows | Supports alignment between joints |
Exam Alert
Contracture prevention is a key CNA responsibility. Know that contractures develop from LACK OF MOVEMENT and are often irreversible. ROM exercises and repositioning every 2 hours are the primary prevention strategies. Hand rolls prevent claw hand, foot boards prevent foot drop. Always report any decrease in range of motion to the nurse.
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Related Terms
Range of Motion (ROM)
Range of Motion (ROM) refers to the full movement potential of a joint, measured in degrees. ROM exercises are nursing interventions performed to maintain or improve joint flexibility, prevent contractures, and promote circulation in patients with limited mobility.
Body Mechanics
Body mechanics refers to the coordinated use of body position, movement, and alignment to prevent injury during patient care activities such as lifting, transferring, and repositioning. Proper body mechanics protect both the nurse and the patient from musculoskeletal injury.
Activities of Daily Living (ADLs)
Activities of Daily Living (ADLs) are the fundamental self-care tasks that individuals perform daily, including bathing, dressing, eating, toileting, transferring (mobility), and continence. Assessing ADLs helps nurses determine a patient's functional status and care needs.
Ambulation
Ambulation is the act of walking or moving from one place to another, either independently or with assistance. In healthcare, ambulation refers to helping patients walk safely using proper body mechanics, gait belts, and assistive devices such as walkers, canes, or crutches.
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