Gupta Pankaj, Joshua Kenneth Kevin, Jahan Tasmin
Lepr Rev. 2016 Dec;87(4):548-52.
Adaptive shortening of long flexors is the common secondary impairment which can occur in patients with long standing claw hand, particularly in those who do not undergo any supervised physiotherapy programme.¹ The main purpose of this short report is to describe the current physiotherapeutic means which are commonly employed for the management of long flexor tightness. This report further gives an insight into the consequences of the delay in corrective surgery and ultimately describes the dire need for further research on this deformity.² Adaptive shortening of the muscles is a phenomenon which can occur for many reasons, like prolonged immobilisation of the of the body segment, postural imbalance, muscle imbalance, impaired muscle performance due to neuromuscular problems or may be due congenital and acquired deformity.Tightness of the muscles leads to limitation of joint range of motion.³ In leprosy the cause of adaptive shortening of the long flexors is muscle imbalance which occurs due to paralysis of the ulnar nerve at the elbow joint. Adaptive shortening of the muscles is a secondary impairment.⁴ Secondary impairments have multidimensional effects on the management of the deformity, including delay in surgery for the correction of deformity which in turn is responsible for the unemployment, social stigma and problems in social integration.⁵ Secondary impairment in some way or other is responsible for the above stated problems, but adaptive shortening of the long flexor (long flexor tightness) is important because sometimes months of therapy are required to attain full muscle length.
