Intrinsic Contracture

 
ICD-9 Classification / Treatment
Etiology / Natural History Associated Injuries / DDx
Anatomy Complications
Clinical Evaluation Follow-up Care
Xray / Diagnositc Tests Review References

synonyms:

Intrinsic Contracture ICD-9

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Intrinsic Contracture Etiology / Epidemiology / Natural History

  • Intrinsic tightness may occur after severe crush injury to the hand or unrecognized compartment syndrome or trauma or distal joint malalignment due to RA

Intrinsic Contracture Anatomy

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Intrinsic Contracture Clinical Evaluation

  • painless hand stiffness with limited grip strength 
  • limited PIP flexion while the MP joints are fully extended, with greater PIP flexion with the MP joints flexed.
  • Bunnell test=MCP hyperextension puts intrinsics on stretch and causes decreased IP flexion with intrinsic tightness. This is due to the displacement of the lateral bands which occurs due to many reasons.
  • MCP joint flexion and IP extension resting posture.

Intrinsic Contracture Xray / Diagnositc Tests

  •  Hand films generally normal. 

Intrinsic Contracture Classification / Treatment

  • Nonoperative: passive stretching
  • Operative: distal intrinsic releases followed by supervised hand therapy

Intrinsic Contracture Associated Injuries / Differential Diagnosis

  •  CRPS

Intrinsic Contracture Complications

Intrinsic Contracture Follow-up Care

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Intrinsic Contracture Review References

  • Smith RJ: Non-ischemic contractures of the intrinsic muscles of the hand. JBJS 1971;53:1313-133
  • BUNNELL S. Ischaemic contracture, local, in the hand. J Bone Joint Surg Am. 1953 Jan;35-A(1):88-101.
  • HARRIS C Jr, RIORDAN DC. Intrinsic contracture in the hand and its surgical treatment. J Bone Joint Surg Am. 1954 Jan;36-A(1):10-20.