You’re trying to help Mr. Henderson wash his hands, but his fingers are curled into a tight fist that simply won’t open. That is a contracture, and understanding how to prevent it is one of the most important ways you protect your residents’ comfort and dignity.
What is a Contracture?
Contracture (kon-TRAK-cher) is the permanent shortening and tightening of muscles, tendons, or other tissues. This causes the joints—like fingers, elbows, knees, or wrists—to become stiff and stuck in a bent position. Essentially, the tissue shrinks so much that the joint can no longer move through its full range of motion, leading to deformity and rigidity. Think of it like a rubber band that has dried out and lost its stretch.
Why Contracture Matters in Your Daily Care
Once a contracture sets in, it is usually irreversible. This means a resident may permanently lose the ability to feed themselves, walk, or perform hygiene tasks. Beyond loss of function, contractures are painful and can lead to skin breakdown because you cannot clean properly under tight folds of skin. Your daily consistency with movement and positioning is the primary defense against this debilitating condition.
What You’ll See During Your Shift
You will typically see contractures in residents who are bedbound or use wheelchairs for long periods. You might notice a hand permanently clenched, a “peg leg” that won’t straighten at the knee, or an arm held tight against the chest. When performing Range of Motion (ROM) exercises, you may feel significant resistance or the joint simply won’t budge.
“Nurse, I was doing Mrs. Alvarez’s range of motion exercises, and her right elbow is really stiff today. I couldn’t straighten it past 90 degrees without her wincing. It feels much tighter than last week. I think we need to check her positioning.”
Common Pitfall & Pro Tip
⚠️ Pitfall: Leaving residents in one position for too long or propping knees up with pillows for hours. Shortened muscles will “set” in that position.
Pro Tip: Think “Neutral is Natural.” Whenever possible, keep limbs in a neutral, straight alignment. Change positions every two hours and perform full Range of Motion exercises on every resident, not just the ones currently in therapy. Even gentle movement counts.
Memory Aid for Contracture
Think: “C is for Cramp and Can’t Move.” It feels like a permanent, intense cramp, and the joint Can’t Move freely. This reminds you that the goal is to keep things moving so they don’t get stuck.
State Test Connection
Expect questions on the CNA exam regarding Range of Motion (ROM) and proper positioning. You will be graded on supporting the joint and moving it gently to its full range to prevent contractures.
Related Care Concepts
Preventing contractures is directly tied to performing Range of Motion (ROM) exercises daily and utilizing correct body mechanics when moving residents. It also connects to skin integrity; contractures create deep skin folds where moisture can get trapped, leading to pressure ulcers.
Quick Reference
✓ Key signs/steps: Joints that won't straighten, tight muscles, pain during movement
✓ When to report: New stiffness, sudden loss of movement, or pain during ROM
✓ Care reminders:
• Perform ROM exercises at least 2-3 times a day (or per care plan)
• Avoid placing pillows directly under the knees for long periods
• Ensure proper alignment in chairs and beds (use footrests!)
• Support affected limbs to prevent further strain
Bottom line: A resident’s ability to move depends on the care you provide today. Keeping joints flexible is about preserving their independence and quality of life.