A contracture is a joint abnormally bent by shortened soft tissues in and around the joint. The shortened tissues pull the bone out of normal position. A contracture may develop in a joint affected by juvenile rheumatoid arthritis (JRA). Because of the effectiveness of today's treatments, your child probably will not develop contractures. However, if a contracture does develop, treatment may include splints and physical therapy.

Surgery is rarely used to treat JRA. However, it is sometimes used to release contractures of at least moderate severity that have not responded to other treatments. Surgery is sometimes necessary to restore motion, especially for hip and knee contractures that interfere with walking.

One procedure used is soft tissue releases of contractures, which involves cutting the muscles attached to an abnormally bent joint. As the muscles and other shortened tissues are released, the affected joint can return to a more normal position.

Goals of soft tissue releases of contractures include:

• Returning the joint to a more functional position.
• Increasing range of motion.
• Relieving pain.

Casts are usually used for several weeks after contracture releases of the knee, followed by physical therapy and nighttime splinting. This procedure often relieves the contracture and pain associated with it and makes it easier for the child to move the joint.

Physical therapy after a soft tissue release is essential to maintaining benefit from the procedure. For this reason, children must be at least 6 years old to be considered for this surgery.