What Is Soft Tissue Release of Contracture?

A contracture is when your muscles, tendons, or other soft tissues harden or stiffen around a joint. That can make it difficult to move your fingers, ankles, and other body parts. It also can leave your joints stuck in strange positions.

Many conditions can cause contractures. Sometimes surgery can loosen, or release, them.

Rheumatoid Arthritis

With rheumatoid arthritis (RA), your body’s immune system attacks your joints. It can swell the soft tissue in your hands and fingers. That can affect your joints in different ways.

Swan neck deformity. This is when the joint closest to the end of your finger pulls the fingertip downward. At the same time, the middle joint dips down to resemble a bird’s long neck. To repair it, your surgeon will release and realign the soft tissue that has gotten snagged. You’ll start physical therapy after 3-6 weeks. Fully recovery can take about 6 months.

Boutonniere deformity. This looks like the opposite of swan neck. The joint in the middle of your finger may curve up and become stiff and swollen. Soft tissue surgery may not completely fix the curled finger. If you do have the operation, you’ll need to work with a physical or occupational therapist to follow a strict exercise plan for your fingers.

Tendon rupture. These bands connect the muscles to the bones. RA can make tendons break down and scrape against a bone. When this happens, a surgeon may be able to take another tendon from the hurt finger and connect it to the next finger. So you could, for example, wiggle your pinkie by moving your ring finger.

Deformed joints. RA can affect the joints where your fingers meet the palm of your hand -- the site of your biggest knuckles. This can make your fingers twist at an odd angle and make it hard or impossible to touch your thumb to your index or middle finger. If they’re not too far bent, your surgeon might be able to rearrange the tendons so they pull the fingers back toward the right place.

Stiff wrists or elbows. Culprits may include joint damage, swelling, or misalignment. Surgery may be able to help.

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Other Conditions

Rheumatoid arthritis isn’t the only condition that can cause soft tissue stiffness.

Dupuytren’s contracture. This usually grows slowly and affects mainly men. Doctors don’t know why, but cords of tissue form under the skin and tighten over time. The cords eventually pull on your fingers, usually, the pinkie and ring finger, and make them curl under. A surgeon can remove the cords and other problem tissue. After the operation, your medical team may give you a splint to wear.

Cerebral palsy. Some children are born with this disorder, which causes problems with balance, movement, and muscle tone. The hamstring muscles in the lower leg may pull too hard. That makes the knee bend too much. Surgery can help straighten the leg.

Equinus. This limits movement in your ankle joint so you can’t lift the top of your foot toward the front of your leg. It can lead to plantar fasciitis (arch or heel pain), calf cramps, flatfoot, and other problems. It often comes from tightness in the Achilles tendon or calf muscles. Sometimes surgery can help if the problem is a tightened tendon or a bone that blocks the ankle motion.

After the Operation

Your doctors will guide you on what to do as you recover. You may need to:

  • Avoid exercises and heavy lifting for several weeks.
  • Wear a splint at night or other times to support your joint.
  • Stick to your scheduled physical therapy.
WebMD Medical Reference Reviewed by David Zelman, MD on March 06, 2020

Sources

SOURCES:

Journal of Hand Surgery: “Current Concepts in the Management of the Rheumatoid Hand.”

University of Kansas Research and Training Center on Independent Living: “Contractures.”

Canadian Cancer Society: “Anatomy and physiology of soft tissue.”

PubMed Health Glossary: “Tendons,” “Ligaments,” “Synovial membrane.”

Winchester Hospital Health Library: “Tenolysis.”

Mayo Clinic: “Rheumatoid arthritis.”

Houston Methodist: “Swan neck deformity of the finger,” “Boutonniere deformity of the finger.”

Current Opinion in Rheumatology: “Outcomes of Hand Surgery in the Patient with Rheumatoid Arthritis.”

Current Reviews in Musculoskeletal Medicine: “Elbow rheumatoid elbow: surgical treatment options.”

Royal Manchester Children’s Hospital: “Management of knee flexion contractures in patients with Cerebral Palsy.”

University Hospital of Bonn: “The general method for contractures.”

American College of Foot and Ankle Surgeons Foot Health Facts: “Equinus.”

Podiatry Management: “Surgical Treatment of Ankle Equinus Contracture.”

Foot Health Facts: “Equinus.”

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