Abstract:

Scleroderma is a chronic connective tissue disease characterized by skin and visceral involvement. Progressive skin involvement may cause severe joint contractures, muscle weakness, and restrictions in activities of daily living. In this case report, the rehabilitation process of a 33-year-old woman diagnosed with localized scleroderma is presented. She had localized sclerotic changes and severe joint contractures on her left upper extremity including the scapular region. Active range of motion (ROM), muscle, hand pinch, and grasp strengths were measured. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire was used to determine upper extremity functionality. The main elements of this therapy protocol were heated modalities, active stretching and strengthening exercises, and a dynamic orthosis to stretch the elbow contracture. She was supervised by a therapist three times a week. She also conducted a home exercise program and continued to use the orthosis at home. The assessment results obtained at the beginning and one month later were compared to decide on the effectiveness of the therapy. ROMs were improved in general. These gains were as high as 40° at elbow extension and shoulder abduction. Despite slight decreases in pinch strengths, there was 5.6 kg increase in grip strength. A considerable improvement was observed in the DASH score. No change was observed in muscle strength. In this report, it is shown that conventional rehabilitation modalities supported with the use of a dynamic stretching orthosis could be effective in the correction of rigid contractures and could enhance functional status in localized scleroderma patients.

Keywords: