​What kinds of symptoms do patients experience before receiving treatment?

Contractures are permanently shortened muscles or joints that occur most commonly in the elbow, ankle, knee, hip, and shoulder. As the muscle is unable to stretch, the affected area has considerably limited movement. Other symptoms include pain and inflammation.

​What is the impact on patients’ lives of living with these conditions?

The inability to move the affected area impacts mobility and can reduce the patient’s ability to perform daily tasks independently.

What cultural or regional factors affect the treatment of these conditions?

Trauma is a major cause of contractures, and road traffic accidents—particularly with motorcycles—are pervasive in Cambodia. In addition, the longer that the contracture goes without treatment, the less chance there is of motion recovery; the lack of many surgical centers in Cambodia means that patients do not often present early for treatment.

What does the treatment process look like?

Contracture release surgery aims to remove or cut the thickened scar tissue (fascia) and procedures vary depending on the joint affected. There are three main ways of treating a contracture: open fasciotomy, which cuts the fascia by cutting open the overlying skin; needle fasciotomy, which cuts through the fascia using a needle and without opening the skin; and open fasciectomy, which removes the fascia.

What is the impact of this treatment on the patient’s life?

Surgical treatment of contracture restores movement to the affected area, allowing patients increased function and reduced pain.

What potential side effects or risks come with this treatment?

The surgery carries a small risk of infection and of damage to nearby tendons, blood vessels, and nerves. Postoperative complications include loss of flexion and hematoma.

How accessible is treatment in the area? What is the typical journey like for a patient to receive care?

While some treatment for contractures can be available locally, certain contractures need surgery to restore motion. Affordable surgical care is not very accessible, and so patients travel as much as twelve hours to reach Children's Surgical Centre for free surgery, arriving by bus, motorbike, or taxi.

What are the alternatives to this treatment?

Physical therapy, splinting, and other exercises may be able to increase movement if the contracture is only in the muscles; joint contractures and contractures that do not respond to other treatments may require a surgery to restore function of the affected area.