How common are joint contractures among people with multiple sclerosis?


Joint contractures, usually defined as limited passive range of joint motion, are common in people with neurological conditions such as stroke, spinal cord injury or multiple sclerosis (MS).  To date, there are no studies of the incidence and prevalence of contracture in a population with MS.  A recent systematic review of the epidemiology of contracture failed to identify any studies of people with MS (Fergusson et al. 2007).

This large epidemiological study is the first shows the prevalence and characteristics of muscle joint contractures and muscle weakness in a representative sample of people with MS (in Australia). This study also provides normative data of mobility and balance in people with MS at different stages of the disease.

Muscle weakness is considered one of the most common problems in MS (e.g. Kent-Braun et al. 1997).  However, data on prevalence of weakness in MS populations are scarce.  Also, previous studies on muscle weakness in MS failed to provide a definition of weakness (McDonald et al. 2005; El-Salem et al. 2006).  Here, we tested 156 people with MS randomly chosen from registry of MS Australia ACT/NSW/VIC. Main outcome measures included passive range of motion of large joints of the limbs and muscle strength. Tests of walking and balance were also conducted.

An important finding is that about 44% of the sample developed contracture in the ankle. This is a distinctive feature of MS population (vs. other populations at risk of contracture such as stroke and spinal cord injury). Seventy per cent (70%) of participants had muscle weakness, defined as manual muscle test score of 3 or less, in one or more muscle groups. The coexistence of weakness in the lower limbs with ankle contracture, and spasticity – another common problem in MS, can have serious consequences on independent mobility and increase the risk of falls.

 

WHAT DID WE FIND?

Joint contractures are quite common in people with MS, even in the early stage of the disease when a person is still independently ambulant. Nearly half of the contractures actually occurred in the ankle joints.

 

SIGNIFICANCE AND IMPLICATIONS:

In addition to muscle weakness joint contractures are highly prevalent of people with MS, especially in the lower limb, even at an early stage.

While many interventions such as stretching and serial casting have been implemented to reduce contractures, there is not yet strong evidence for their effectiveness. Further research is required.

Dr Hoang preparing to test balance

Dr Hoang preparing to test balance

PUBLICATION:

Hoang PD, Gandevia SC, Herbert RD (2013). Prevalence of joint contractures and muscle weakness in people with multiple sclerosis. Disability & Rehabilitation, in press.

 

KEY REFERENCES:

Fergusson D, Hutton B & Drodge A. The epidemiology of major joint contractures: a systematic review of the literature. Clin Orthop Relat Res 456, 22-9.

Kent-Braun JA, Ng AV, Castro M, Weiner MW, Gelinas D, Dudley GA, et al. (1997) Strength, skeletal muscle composition, and enzyme activity in multiple sclerosis. J Appl Physiol 83, 1998-2004.

McDonald I & Compston A. The symptoms and signs of multiple sclerosis (page 299), in McAlpine’s Multiple Sclerosis, A. Compston, Editor: Philadelphia, PA: Churchill Livingstone/Elsevier, 2005, pp 299-346.

El-Salem K, Al-Shimmery E, Horany K, Al-Refai A, Al-Hayk K & Khader Y (2006). Multiple sclerosis in Jordan: A clinical and epidemiological study. J Neurol 253, 1210-6.

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