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Stiff joints and deformity of the hand
or arm are often the result of abnormal
scarring or healing. This can occur in the
skin, around the tendons and ligaments, or
can result from poor healing and alignment
of fractured bones.
 Skin
Scarring
Skin scarring compromises the
distensibility of the skin, thereby
tethering and limiting the normal motion
of joints. Such tethering can occur as a
result of poorly aligned lacerations, or
excessive scarring after burns.
Excessive skin scarring can only be
corrected by surgical realignment of scars
or by excising wide scarred areas and
replacing them with skin grafts obtained
from other areas of the body
Dupuytren's
contracture represents a special type
of "skin" contracture. It actually
involves a tissue layer just beneath the
skin called the palmar fascia. The
thickening and shortening of the palmar
fascia results in the gradually
progressive flexed posturing of the
fingers, particularly the ring and little
fingers.
When these finger deformities begin to
develop, the only recourse is to
surgically excise the diseased, thickened
portion of the palmar fascia. Poorly
planned surgery for Dupuytren's disease
can result in nerve damage and significant
wound complications.
Tendon
Adherence
Tendon scarring eliminates the normal
gliding function of the involved tendons.
This not only prevents bending the joints
in the desired direction, but can also
tether a joint and prevent it from being
moved in the opposite direction.
For instance, scarring of the tendons
that allow the joints in the fingers to be
flexed will not only prevent the finger
from being bent, but will also prevent it
from straightening out completely. Minimal
scarring or scarring of short duration can
often be overcome with aggressive hand
therapy.
When therapy is unsuccessful,
surgically releasing the scar tissue about
the tendon is often quite useful. In the
more severely scarred tendon, restoration
of motion may only be accomplished through
a two-staged surgical procedure to replace
the scarred tendon with a normal smooth
tendon obtained from another area of the
body.
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