Nephrogenic Systemic Fibrosis

[pt64109]

I am looking for ideas regarding gaining joint range in patients with Nephrogenic Systemic Fibrosis (NSF).

Nephrogenic Systemic Fibrosis develops in patients with renal failure, on kidney dialysis, or after renal transplant who were exposed to gadolinium contrast agent during a MRI scan. It was first described in 1997, but is being reported with increasing frequency. The fibrosis is systemic, involving the skin, multiple jts, muscles, connective tissues. The pt I am treating right now presented 2 yrs post NSF onset, with symmetrical, bilat hip (-30deg ext), knee (-50deg ext) , and ankle (-5deg DF) contractures; no spasticity, and no unexpected muscle weakness (4/5 throughout bilat LEs). Joints are painfree within available range. At rest she is painfree; she hurts only when stretched. The spine and UEs in this individual are minimally involved. She has independent mobility, but walking is profoundly limited due to the contractures.

The literature is lacking in how to recover range in these patients. The current patient is increasing range very slowly, improving <10deg/mn at her knees using Dynasplints and in-clinic stretching 3x/wk.

Does anyone have experience treating these patients with NSF? Do you have any thoughts on treating NSF?

Thank you for your suggestions.

Paul Hansen, PT, PhD
Rehabilitation Institute of Kansas City
Kansas City, Missouri, USA

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