Post Traumatic Joint Stiffness

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Post Traumatic Joint Stiffness

Introduction

Post traumatic joint stiffness is the inability to move a joint or the movement performed is painful. After an injury or surgery to a joint there are chances that the movement of a joint may be restricted. The restriction in the movement are the result of the formation of scar tissue near or around the joint. This is often termed as arthrofibrosis or frozen joint. Can affect any joint in the body but, more common with shoulder, elbow and knee.

Diagnosis :

The patient presents with the complaint of inability to move the joint or presence of pain while performing a movement and history of injury and/or surgery.

Arthrofibrosis can be diagnosed by proper history and physical examination but may require MRI in few cases.

Causes

The cause of joint stiffness can be :
  • Injury near or around the joint which heals with scar tissue (fibrosis).
  • Joint is involved with infection/ disease which also cause pain/ scar tissue
  • Post-operative
  • RSD (Reflex Sympathetic Dystrophy) / CRPS (Complex Regional Pain Syndrome).

RSD / CRPS :

  • Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome is a chronic condition that causes burning pain in the extremities of the limbs.
  • It is also known as Sudeck atrophy, when affects the wrist joint.
  • Can be a cause of sympathetic disturbance or seen after a fracture.
  • The joints in RSD become tender, stiff and oedematous.

Treatment :

Therapeutic Treatment :

  • Sympathetic block injection by the anesthetic near the sympathetic ganglion in the axilla.
  • Cervical sympathectomy

Physiotherapy Treatment :

  • Cryotherapy or TENS (Transcutaneous Electrical Nerve Stimulation) for pain relief (thermotherapy is contra-indicated).
  • Support and resting orthosis.
  • Maintaining range of motion of the affected joint.
  • Pain free movement to improve the range.

Treatment :

Planning a treatment for joint stiffness depends on the cause, severity and experience of the treating doctor. The treatment for joint stiffness is as follows :

Surgical Treatment :

For instant and fast relief.
  • The patient can opt for manipulation under general anesthesia to break the adhesions.
  • Wedge POP
  • Keyhole surgery (arthroscopy)
  • Done for knee and shoulder joint
  • Open surgery, the joint is opened and then the adhesions are removed. After this the patient has to undergo vigorous physiotherapy treatment to prevent recurrence and again normal range and strength of the joint.

Physiotherapy Treatment :

  • The therapist helps the patient to gain full range of motion by breaking the adhesion using glides (joint mobilisation) and stretch and hold (MET- Muscle Energy Technique).
  • Vigorous mobility exercises.
  • Continuous passive movements.
  • Thermotherapy for pain relief.
  • MFR - MyoFascial Release (use to loosen the soft tissues).
  • Once the adhesions are broken the therapist helps the patient with gaining strength of the joint.

Post-operative care (After surgery care) :

After surgery of the peri prosthetic fractures, early movement of the adjacent joint is encouraged to avoid stiffness and improve local circulation and reduce swelling and enhance bone healing.

Ice packs, pain medications are given for pain relief.

Results :

Upto 95% success rate with surgery can be expected in patients with peri prosthetic fractures.

Complications :

Rate of complication in peri prosthetic fractures is higher than routine fracture due to :
  • Presence of weak bones due to old age or bone diseases.
  • Poor blood supply to the bone due to fracture.
  • Higher chances of infection.
  • Presence of certain medical conditions like diabetes delays the healing process.
The common complications associated with peri prosthetic fractures are :
  • Infection
  • Joint stiffness in the adjacent joint
  • Absence of healing of the fractured bone – non union
  • Bone heals in altered alignment – mal union