M12 · Stiff joints or shortened muscles
Actual Movement and self-care
Definition
Joints move poorly or muscles tighten, limiting range of motion.- Long immobility
- arthritis
- nerve damage
- burns
- stroke
- Reduced movement
- pain on stretching
- fixed positions
📋 Scenario
A patient lying in bed for weeks has a bent, stiff knee.
Subjective (S): "My knee won't straighten."
Objective (O): Knee fixed bent after weeks in bed; pain on stretching; range of movement 40 degrees short.
Assessment tools for this scenario: CP-MOVE Movement & Self-Care Score CP-PAIN Pain & Comfort Score
Validated scales to consider: Barthel Index, Katz ADL, NRS 0–10, FLACC, PAINAD
**CarePath diagnosis:** Stiff joints or shortened muscles related to long immobility, as evidenced by reduced movement and pain on stretching.
**Interventions and rationale**
| Intervention | Rationale |
|---|---|
| Do range-of-motion exercises. | Moving each joint through its full range regularly keeps muscles and joint tissues from tightening and shortening further. |
| Position correctly. | Good positioning keeps joints in a position that prevents the knee staying bent and the muscles tightening even more. |
| Use splints as ordered. | Splints hold the joint in a good position and gently stretch tight tissue, but only as ordered so they do no harm. |
| Encourage early movement. | Early movement keeps joints and muscles flexible and prevents further shortening and stiffness that come from lying still. |
| Stretch gently. | Gentle, slow stretching gradually lengthens tight tissue without tearing it or causing extra pain, which would make him resist movement. |
**Expected outcomes**
- Within 1 week: range of movement improves by 10 degrees, no new contractures.
- Splint used as ordered.
**Linking the data to the diagnosis**
A patient who has lain in bed for weeks says, "My knee won't straighten." The knee is fixed bent, it hurts on stretching and the range of movement is 40 degrees short. Stiffness and shortening are already present, so this is an actual diagnosis resulting from long immobility. The plan aims to stop it getting worse and begin to reverse it with exercises, positioning, splints as ordered and gentle stretching. Within 1 week the expected outcomes are improvement of 10 degrees in range of movement, no new contractures and splint use as ordered.
CarePath diagnosis
Stiff joints or shortened muscles related to long immobility, as evidenced by reduced movement and pain on stretching.
Interventions and rationale
Listed in priority order.
| Intervention | Rationale |
|---|---|
| 1. Do range-of-motion exercises. | Moving each joint through its full range regularly keeps muscles and joint tissues from tightening and shortening further. |
| 2. Position correctly. | Good positioning keeps joints in a position that prevents the knee staying bent and the muscles tightening even more. |
| 3. Use splints as ordered. | Splints hold the joint in a good position and gently stretch tight tissue, but only as ordered so they do no harm. |
| 4. Encourage early movement. | Early movement keeps joints and muscles flexible and prevents further shortening and stiffness that come from lying still. |
| 5. Stretch gently. | Gentle, slow stretching gradually lengthens tight tissue without tearing it or causing extra pain, which would make him resist movement. |
Expected outcomes
- Within 1 week: range of movement improves by 10 degrees, no new contractures.
- Splint used as ordered.
Linking the data to the diagnosis
A patient who has lain in bed for weeks says, "My knee won't straighten." The knee is fixed bent, it hurts on stretching and the range of movement is 40 degrees short. Stiffness and shortening are already present, so this is an actual diagnosis resulting from long immobility. The plan aims to stop it getting worse and begin to reverse it with exercises, positioning, splints as ordered and gentle stretching. Within 1 week the expected outcomes are improvement of 10 degrees in range of movement, no new contractures and splint use as ordered.