DMD: Contractures of the Upper Extremities

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- Discussion:
    - adduction contractures of shoulder and flexion contractures of elbow are not a problem in themselves,
          as muscle weakness renders patient unable to abduct the arm above the level of the shoulder or
          to extend the elbow against gravity;
    - pronation contractures of the forearm and flexion contractures of wrist and the MCP and PIP joints also occur;
    - tightness is demonstrated when passive dorsiflexion of the wrist is associated with obligate
          flexion of the fingers, due to the tightness of the long flexors of the fingers;
    - treatment of all joints of the upper extremities involves daily, passive, range-of-motion
          exercises to minimize contractures.
    - when passive dorsiflexion of the wrist is limited to neutral, patient should wear orthoses at night;

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