Prevention and treatment for the diagnosis of osteoarthritis
The diagnosis of osteoarthritis is increasingly heard from the lips of doctors and patients. This disease is the most common cause of pain and dysfunction of the knee and hip joints in the elderly. In the absence of proper treatment, the disease can cause disability. To avoid this, when you have the first symptoms, you need to seek qualified medical help.
Osteoarthritis: aetiology and pathogenesis
Chronic degenerative joint disease in medical terminology is called osteoarthritis or arthritis. First of all, articular cartilage, capsule and joint structure are damaged in this disease. All these pathological processes are accompanied by a disturbance of metabolism in the tissues, as a result of which the cartilage loses its elasticity, becomes rough and disrupts the sliding of the articular surfaces.
The main causes of arthritis and arthrosis are:
- post-traumatic joint and cartilage damage,
- is a hereditary predisposition to poor development and disruption of joint function.
Factors contributing to the development of osteoarthritis:
- age over 50,
- permanent physical activity,
- complication of other diseases( rheumatoid arthritis),
- occupational sports,
- female sex.
Clinical picture of the disease
The first symptom of the disease is osteoarthritis of aching joint pain, which is significantly increased when performing physical exertion. This disease is characterized by meteorological dependence, in which the intensity of pain is affected by temperature, humidity and atmospheric pressure. The patient complains of aching in the bones before a sudden change in weather conditions. In the absence of drug treatment and the progression of pathological changes, there is crepitation during movement, swelling, redness and fever in the joint. Partial or total impairment of mobility in damaged joints is observed.
Osteoarthrosis: diagnosis and treatment
For correct and accurate diagnosis, as well as effective treatment, it is necessary to undergo a number of diagnostic procedures that will help the doctor assess the type and severity of the disease and also prescribe a complex of treatment and rehabilitation. In addition to an objective examination and a history of the disease, the attending physician can prescribe such diagnostic procedures:
- X-ray examination of the damaged joint in several projections,
- magnetic resonance imaging and computed tomography,
- biochemical and general blood and urine tests,
- , if necessary, consultation of narrow specialists - endoprosthesis specialist, anesthesiologist.
When the diagnosis of osteoarthritis is made, the attending physician will prescribe the necessary treatment, which should be comprehensive and include:
- complex LFK,
- physiotherapy procedures.
From medicamentous preparations for osteoarthritis, the use of painkillers( olfen, diclofenac, orthophene, ibuprofen), chondroprotectors that gently affect cartilage, improving metabolic processes in it, externally it is possible to rub ointments that have an anti-inflammatory and analgesic effect. If you need to quickly stop the attack of pain the doctor can decide on the intrasynovial administration of hormonal drugs. But it is worth remembering that all drugs have a number of contraindications and side effects. Therefore, to treat arthrosis should a highly qualified doctor, appointing a course of procedures and medications individually for each patient.
Regarding curative physical education, there is a special educational and methodological manual that allows you to independently study a set of exercises that contribute to the restoration of the function of the joint.
Operative and sanatorium-resort treatment of arthrosis
If ineffective conservative treatment of osteoarthritis can offer surgical treatment. Do not be frightened of this outcome, because endoprosthetics is a radical method of treating diseases of the musculoskeletal system, which is often the only chance to preserve the patient's quality of life. Endoprosthetics today is constantly evolving, the technique of minimally invasive surgical intervention allows you to carry out the necessary manipulations without touching the muscles and ligaments, thereby significantly shortening the recovery period. Most often, with arthritis, arthrosis( osteoarthritis), these types of surgery:
- arthroscopy - minimally invasive surgical intervention, with which you can remove cartilage without damaging the surrounding tissues;
- endoprosthetics is a partial or complete replacement of a damaged joint with an implant that can replace a damaged joint.
Diagnosis of osteoarthritis is not deadly and does not involve internal organs in the pathological process. But in the absence of adequate medical treatment can lead to a wheelchair, disability and survival on social benefits.
After the course of treatment of arthrosis, the attending physician will recommend fixing the result, having completed the course of sanatorium-and-spa treatment, which is one of the stages of the rehabilitation period. It is worth noting that to go through sanatorium treatment is necessary only during the remission of arthrosis. Healing mud, baths, massages, exercise therapy will help restore the function of the damaged joint with arthrosis, osteoarthritis and will have a beneficial effect on the patient's neuropsychic state.
As the main precept of medicine says, any disease is easier to prevent than to treat it for a long time. And arthrosis is no exception. Therefore, in order to avoid the appearance of osteoarthritis, it is necessary to avoid dampness, hypothermia, heavy physical exertion. Also, it is necessary to avoid excess weight, which increases the burden on the musculoskeletal system and all internal organs. In order to maintain a normal relationship between height and weight, you need to eat right, eat better, fortified, fortified, in small portions, but often. Do not forget about reasonable physical activity such as walking, combined with rest, swimming. Stimulate and harden the body morning contrast shower and wiping. Secondary prevention of osteoarthritis is the prevention of exacerbations of synovitis. To help in this case, the dosed physical load will come. Recommendations on the method of performing such physical exercises can be found in the medical literature such as "Osteoarthrosis. Handbook on treatment and prevention. "
Diagnosis of osteoarthritis should not be frightened - it's just a diagnosis of the disease, which can be treated with early diagnosis and timely access to a doctor. With the appearance of the first symptoms of arthrosis, you should not self-medicate to not further damage your body.
Symptoms and treatment of the disease osteoarthrosis
Osteoarthritis is a chronic joint disease, in which primary degeneration of the cartilaginous tissue of the joint is observed, which leads to its deformation. At an early stage of the disease, the articular cartilage softens, the surface becomes torn, with small cracks and slits, which under the action of mechanical loads lose integrity, and the subchondral bone covered by them is exposed, cysts( osteophytes) appear on it, the bone thickens. Bony processes osteophytes, popularly known as spurs, sprout into joints, to the attachment points of ligaments.
All these internal degenerative processes lead to severe pain when moving the joint, which without adequate treatment can lead to disability of the patient. Rheumatologists claim that the cause of osteoarthritis can be:
- excessive mechanical load of healthy cartilage;
- reduced the resistance of cartilage to physiological load.
Osteoarthritis is more affected by older people, after 50 years this disease is diagnosed in 27%, after 60 years - in 98%.Osteoarthritis is common in both men and women. But women are more prone to this disease during menopause. In women, interphalangeal joints of the big toes and toes are more often damaged, but for men - hip joints.
The clinical form of osteoarthritis and the causes of
The form of osteoarthritis can be:
- primary( idiopathic) - arises from a genetic predisposition and arises in young people;
- secondary( acquired) - this kind of osteoarthritis is acquired throughout life, due to injuries, bruises, complications of other diseases.
Common clinical forms of osteoarthritis:
- gonarthrosis - osteoarthritis of the knee joint, most common in women, damaging one joint;
- coxarthrosis is a form of osteoarthritis in which the hip joint is damaged, this form becomes the most common cause of disability among men;
- osteochondrosis - affection of cartilaginous intervertebral discs;
- spondylarthrosis is a form of the disease in which degenerative changes occur in the body of adjacent spines;
- polyostoarthrosis is a common form of the disease that damages multiple peripheral and intervertebral joints.
Osteoarthritis: causes of
- chronic joint disease;
- features the mineral composition of water or food in a certain region;
- is not normalized physical activity;
- infringement of a blood supply of a joint;
- is overweight;
- age over 50;
- is a professional sporting activity;
- bad habits( smoking, drug addiction, alcoholism);
- is a disease of the endocrine system.
Disease osteoarthritis does not carry a mortal danger to the patient, but in the absence of timely diagnosis and treatment can lead to disability and loss of ability to work.
Osteoarthritis: diagnosis and clinic
Most often at the initial stage of osteoarthritis, the disease can be asymptomatic, before the pain in the joint after the load, is perceived as fatigue. Often the pain occurs when moving or in a certain static stress. After a rest or a warm compress the pain subsides and for a while stops worrying the patient. If during this period, do not conduct examinations and treatment, then later the pain will arise in the middle of the night, and in the daytime. Sometimes patients complain of pain, which fetters movement and subsides after 15-20 minutes of motor activity.
The synovial membrane of the joint is subjected to constant irritation, as a result of which an extra amount of lubricant is produced in the joint, which is accompanied by a swelling of the joint and an increase in its size. With active movement, you can hear crunching, clicking and rubbing the bones. In women during menopause, when there is a change in the hormonal background, often there is a nodular form of osteoarthritis. The knot form of osteoarthritis arises as a result of inflammation of the nodules of Geberden or Bushard on the І and ІІІ fingers of the hand. The clinic of this form of the disease manifests itself as follows: the articular surface of the joints is covered with dense, painful palpation of bone knots( osteophytes) the size of a pea.
When the knee and hip joints are affected, the clinic is significantly different. So, with osteoarthritis of the knee joint ligaments are stretched, and the joint itself loses its stability, whereas in the hip joint, mobility is impaired. The unifying symptom is severe pain.
Special attention should be paid to the clinic of osteoarthritis of the spine, in which the main symptom is a constant back pain. The first symptoms of this disease manifested minor pain in the lower back after physical exertion, stiffness in the spine usually passes after an overnight rest. However, the fading of pain does not mean the diminution of the degenerative process. Bone at this time grows and begins to squeeze the nerves and blood vessels, causing numbness of limbs, impaired sensitivity, eyesight, blood circulation of the brain, the work of the digestive tract is disrupted.
Diagnosis of osteoarthritis
Diagnosis of osteoarthritis and osteoporosis can only be performed by a highly qualified physician who will conduct an examination of the patient and assign the necessary set of additional research methods:
- general and biochemical analyzes of blood, urine and synovial fluid;
- X-ray of the damaged joint in several projections;
- magnetic resonance imaging and computed tomography;
- if necessary, consultation of narrow specialists: anesthesiologist, endoprosthesis.
Specialists distinguish three clinical and coronary forms of the disease:
І form, characterized by a slight restriction of mobility in the joint, a radiologic picture shows small proliferation of bone tissue along the edges of the joint cavity;
ІІ form - limitation of joint mobility, atrophy of nearby muscles, the picture shows significant growth of bone tissue and narrowing of the joint gap;
ІІІ form - deformation of the joint with significant changes in the radiographic image, complete disappearance of the joint gap, extensive marginal proliferation of bone tissue.
Osteoarthritis: treatment of
When the doctor diagnosed with osteoporosis and the cause of the disease is established, the most important period is the treatment of the disease. It is worth noting that only qualified medical care, treatment in a hospital or under the strict medical control can lead to a full recovery at an early stage of the disease. Osteoarthritis is treated in a comprehensive manner and includes:
- drug therapy;
- physiotherapy procedures;
- complex exercises exercise therapy.
Drug therapy primarily includes preparations of anti-inflammatory, analgesic, actions, chondroprotectors. All these drugs help to remove a strong pain syndrome, eliminate swelling and inflammation, and also have a cartilage-protective effect. If necessary, the doctor can recommend the use of hormonal drugs that can stop the degenerative processes in the joint.
Physiotherapy procedures( electrophoresis, UHF, ozokerite applications, therapeutic baths and mud) relieve swelling, inflammation, joint pain, improve blood circulation in the joint, stimulate metabolic processes.
Complex LFK and massage can improve metabolic processes in the tissues of joints and nearby muscles, partially restore mobility in the joint, reduce spasm and pain when moving.
If the conservative treatment is ineffective, an orthopedic doctor may raise the issue of performing an operation on a damaged joint. Endoprosthetics is a radical method of treatment of osteoarthritis, which in most cases gives a chance to prolong life and preserve its quality. Today, it is possible to perform minimally invasive surgical interventions, in which the circumferential ligaments and muscles are practically not injured, thereby shortening the period of postoperative recovery. Most often, with osteoarthritis, the following types of surgical intervention are recommended:
- arthroscopy is a minimally invasive surgical procedure that allows the cartilage to be removed without damaging nearby tissues;
- endoprosthetics - replacement of a damaged joint with an implant( partial or complete).
Sanatorium treatment and prevention of osteoarthrosis
After the treatment, the patient needs a course of restorative procedures. The attending physician will prescribe a course of rehabilitation procedures, which can be done at specialized sanatoriums.
Osteoarthritis, osteoporosis, like other diseases, is easier to prevent than to treat for a long time and exhaustively. Therefore, throughout life it is necessary to follow several simple rules:
- to keep track of your weight;
- engage in gentle sports( walking, swimming);
- to eat natural vitaminized food;
- is hardened;
- avoid excessive physical exertion.
Remember that when the first symptoms occur, you should not self-medicate, but you should consult a doctor for qualified medical care.
Osteoarthrosis is a disease of the joints of the limbs and joints of the spine, which is based on dystrophic changes in the cartilaginous cover with its gradual destruction.
At later stages, pathological changes are added in the synovium and the joint capsule adjacent to the cartilage of bone tissue, as well as in the periarticular muscles. As a result, there are pains in the joints and a restriction of mobility, deformations develop and the functions of the limbs and spine are disturbed. The most commonly affected knee, elbow, hip and shoulder joints, as well as the joints of the foot, hand and spine.
Currently, intensive and multidisciplinary research is under way on the problems of joint diseases, which is determined by the frequency of suffering and its steady progression, which leads to a gradual loss of the ability of the joints to function normally. For example, 10-12% of the population suffers from a disease like osteoarthritis. With age, the frequency of the disease increases and after 70 years it reaches 97%.Women suffer from this disease 2 times more often than men. Let us consider in more detail the nature of osteoarthritis.
Osteoarthrosis is a chronic and progressive joint disease in which metabolism and the articular cartilage are disturbed, leading to destruction of the articular surface( degeneration and destruction of the cartilage), structural changes in the subchondral bone, the appearance of osteophytes, to the obvious or latentmoderate effusion in the joint( synovitis).
Osteoarthritis initially affects the articular cartilage. Externally, the cartilage loses its normal shine, its surface becomes rough, the elasticity decreases. Gradually it is thinner, sometimes disappears, bareing the bone.
The process of cartilage destruction is more rapid in areas of articular surfaces experiencing an overload. Simultaneously with the destruction, the regeneration process takes place, which leads to the appearance of sprouting( osteophytes) in the less loaded parts of the joint( usually along the edges of the joint surfaces), which change the shape of the joint, deform it.
Therefore, later stages of the disease are often called deforming arthrosis.
However, in spite of the fact that the bony growths increase the area of contact of the articular surfaces, the inferiority of this additional support does not allow to significantly reduce the burden on the affected parts of the joint, and the deformation leads to a deterioration of its biomechanics and limitation of mobility. The synovial membrane coarsens as a result of the development of the fibrous process, periodically becomes inflamed when the joint is traumatized.
Subchondral areas of bone can become denser, sometimes foci of destruction are formed. Bone ankylosis( complete fusion of the articular ends of bones with loss of mobility) does not happen, despite pronounced deformation and a significant limitation of the amplitude of movements in the joint.
In most cases, dystrophic changes in the joint develop slowly and gradually. The immediate causes that initiate the onset of the disease are not known. There are factors that dramatically accelerate the destruction of cartilage not only in the elderly, but also in young people. Incomplete or incorrect development of the joint, the so-called dysplasia and anomalies, lead to an overload of individual parts of the joint and the appearance of osteoarthritis even in adolescence. Injury of the joint also accelerates the process of cartilage destruction and causes posttraumatic osteoarthritis.
Clinical picture in osteoarthritis( as osteoarthritis manifests itself)
Osteoarthrosis affects, as a rule, one or two large joints, rarely more. With the localization of the disease in the spine, joints of cervical and lumbar vertebral motor segments suffer more often. As it is customary to say, salts are deposited in the joints. Initially, the patient appears only pain in the joint after physical exertion, sometimes - a crunch when moving. Gradually, the intensity of pain increases, the crunch becomes rougher, and periodically there is tight mobility in one direction of movement.
In the late stage of the disease the joint is deformed , it sharply limits mobility, the pain becomes intense, the limb support function is significantly reduced. The patient moves only with the help of an additional support - a cane or crutches( with the defeat of the joints of the lower extremities).The function may suffer even more, since with arthrosis in the joint cavity sometimes there are different bodies( pieces of cartilage, bones, enlarged villi of the synovium).Such bodies( "articular mice") can be trapped between the articulating surfaces of the joint, causing severe pain and limiting mobility.
Some sources state that a disease like osteoarthritis does not respond to treatment. Unfortunately, in part this is so. Let's see why the destruction of articular cartilage in osteoarthritis does not imply its restoration.
Regeneration( restoration) in the articular cartilage has the character of "incomplete or perverted regeneration".In case of superficial damage, due to the absence of cambial cells( progenitor cells) in the articular cartilage, the defect is not filled with tissue. In case of damage penetrating through the cartilage into the subchondral bone tissue, biologically active substances and stem mesenchymal cells ( precursor cells of the connective tissue) migrate to the defect area, which activate the processes of cartilage repair. Therefore, only in certain conditions, when the size of the defect, the age of the patient, the specificity of the joint load, and also with the timely stage complex treatment allow the progenitor cells to differentiate into cartilage cells, and the defect is replaced by hyaline cartilage.
In general, the defects of the articular cartilage are filled with a fibrous tissue that does not have those unique characteristics that hyaline cartilage possesses - elasticity, elasticity in combination with harmonious strength.
Stages of the disease
Three stages are distinguished in the development of the disease.
In the first stage of the , patients complain of pain arising in the joint under load and passing at rest.
Palpation of the joint area is usually painless, but it causes discomfort, especially during the exacerbation of the disease. Mobility in the joint is limited only slightly, only the volume of those movements that have the smallest amplitude decreases. Even at this stage the patient spares the affected joint, which results in the development of mild atrophy( a decrease in the volume and smoothness of the contours) of the periarticular muscles and limb muscles. The function of the joint almost does not suffer, which prevents active activity only for persons engaged in manual labor.
In the second stage of the , the pain in the joint acquires a permanent character, at rest decreases, but it does not usually completely pass. Palpation causes painful sensations not only in the projection of the joint space, but also in the periarticular( paraartricular) zones. Mobility in the joint is limited significantly( up to half the amplitude of movements), although it remains in the amount sufficient for self-service and relatively normal life.
In the joint, contractures develop( restrictions in the amplitude of movements), which are mostly of a near-articular nature and can be corrected with conservative treatment, without surgery. There is a pronounced atrophy of muscles that move in the affected joint. The function of the joint is severely affected, which particularly restricts the ability of the people engaged in manual labor, which sometimes results in a change in the profession or disability;there are difficulties in the work activity of intellectuals.
In the third stage of , patients complain of constant, severe pain, the intensity of which increases with movements. Palpation of the joint and the periarticular region is sharply painful. Mobility in the joint is severely limited, remaining in an insignificant amount, sometimes only in the form of weak swinging movements. Developing persistent contractures, which are mainly a consequence of intra-articular changes. With osteoarthritis, there is never ankylosis( complete immobility) of the joint. Atrophy of the periarticular muscles is expressed. The function of the joint is often lost completely, which forces the patients to use the means of unloading( cane, crutches, walkers).
The most common forms of osteoarthrosis
Most often affected by osteoarthritis are the joints bearing the greatest static load( knee, hip, small foot joints) and dynamic load( shoulder joint, hand joints).Clinical manifestations of osteoarthritis are different, depending on the localization of the lesion.
Gonarthrosis - osteoarthritis of the knee joint. The most common osteoarthrosis of the internal part of the knee( medial typhi-femoral articulation) and osteoarthrosis between the articular surface of the patella and the joint surface of the femur( patellofemoral joint).
Biomechanics of the knee joint is well studied. Normally, the load axis passes through the center of the tibiofemoral section( Figure 1.3.1).
Fig.1.3.1 Diagram of the joints( joints) of the knee: 1-femur;2-patella;3-tibia;4-fibula;5-medial tibiofemoral articulation;6-lateral tibiofemoral articulation;7-patellofemoral joint
However, during movements the load on this department is 2-3 times that of the body, and when flexing the knee joint, the load on the patellofemoral part is 7-8 times greater than the body weight. Often this explains the high incidence of osteoarthritis of these parts of the knee joint.
Osteoarthritis most often affects people of young age, more often men, with isolated lesions of one, rarely two knee joints, who have had a knee injury in the past or a joint operation( removal of the meniscus).
Another large group of patients with osteoarthritis is made up of middle-aged and elderly people, mostly women( many of them are overweight) who have osteoarthritis at the same time and other localization.
The most important symptoms of gonarthrosis are joint pain in walking, standing and climbing stairs;crunching in the joints during movements;local tenderness in palpation, mainly along the inner part of the joint space;painful restriction of flexion, and later extension of the joint;marginal bony growths;atrophy of the quadriceps muscle of the thigh.
Periodically, if osteoarthritis of the knee is affected, signs of inflammation are found. This changes the nature of the pain: pain increases, there is "starting" pain, pain at rest, morning stiffness in the joint lasting up to half an hour. In the joint area there is a slight swelling, a local increase in skin temperature. Due to the possible presence in the joint of the "articular mouse", the symptoms of "blockade" of the joint may appear - acute pain in the joint, which deprives the patient of the opportunity to make any movement.
For osteoarthrosis, the varus deformity of the lower extremity( venu varus) is characteristic, reflecting the lesion of the internal part of the joint( Figure 1.3.2, a).
Fig.1.3.2.Deformation of the knee joint: a-varus deformation( genu varus);b-valgus deformation( genu valgus);in-flexion contracture of the knee joint
When a joint is affected in all departments accompanied by a synovitis, a valgus deformation( venu valgus) is observed( Figure 1.3.2, b).Fixed flexion contracture, when the knee can not fully unbend and is constantly under a certain angle, is noted in osteoarthritis complicated by synovitis( Figure 1.3.2, c).
Swelling and effusion in the knee joint are determined by the smoothness of the contours of the knee joint. With the synovitis, ballotation of the patella and fluid fluctuations in the joint are noted.
Gonarthrosis is characterized by soreness and restriction of movements in the knee joint, sometimes the instability of the joint is determined.
The course of gonarthrosis is prolonged, chronic, progressive, with a slow increase in symptoms, often without pronounced exacerbations. Periodically, there may be a spontaneous decrease in the severity of symptoms. Osteoarthrosis of the knee joint proceeds with periods of exacerbation, which are usually accompanied by the appearance of effusion into the joint cavity and can last for a long time( days, months).In some cases, the course of the disease worsens for several weeks or months, which may be due to joint instability. Sometimes sudden, almost instant pain in the knee joint can mean the development of aseptic necrosis of the joint end of the femur, which is a rare but severe complication of osteoarthritis.
Coxarthrosis - osteoarthrosis of the hip joint. The disease usually affects people aged 40-60 years. The main predisposing factors are congenital dysplasia of the hip joint, Perthes' disease. Unilateral joint damage is more common than bilateral. About 60% of patients with coxarthrosis are men, 40% are women.
The hip joint is located most deeply under the soft tissues( subcutaneous fatty tissue, muscle mass), therefore it is very rare to detect swelling in the joint, swelling and tenderness during palpation. Soreness is noted often when palpation in the inguinal ligament. Sometimes the first signs of this disease are difficulty and restriction of movements in the joint, so it is very important to know the normal amplitude of movements in the joint.
Mobility in the hip joint is examined in the prone position. Extension in the joint is performed in the patient's position on the side, normally it is 20 °, and it is very important that the pelvis and spine do not participate in movement. The angle of flexion, equal to the norm of 115 °, is determined by maximally attracting the limb bent in the knee joint to the abdomen in the supine position on the back, with the immobility of the pelvic bones. The amplitude of the abduction and reduction of the leg in the hip joint is 45 ° and 40 °, respectively. One of the earliest signs of hip joint damage is the restriction and soreness of rotational movements, which are examined with the lower limb bent at right angles in the knee and hip joints. Normally, the external and internal rotation is 45 °.
The main symptom of coxarthrosis is pain when walking and resting on the leg in the thigh, buttock, groin, sometimes the pain irradiates( transfers pain impulse) to the knee joint, which greatly complicates the diagnosis. The functional capacity of the patient decreases: it is difficult, bending over, putting on socks, shoes, lifting something from the floor. In the most severe cases, you can hear crepitation when moving in the joint.
Tenderness over the external surface of the joint may be due to inflammation of the bag of large trochanter and sciatic tuberosity, as well as in the places of attachment of muscles and tendons to the large trochanter( enthesopathy).In later stages of coxarthrosis, lameness occurs due to the shortening of the leg due to the movement of the femoral head, and in bilateral lameness, the lameness has a characteristic kind of swaying from side to side: "duck walk".Develops atrophy of the muscles of the thigh and buttocks, there is a coxalgic gait, the so-called Trendelenburg sign: when trying to lean on the affected leg, the pelvis also falls.
The study compares the length of the limbs( from the anterior superior iliac bone to the inner ankle).At their same length, but with a visible shortening of one of the extremities, one can suspect a "skewed" pelvis, which is associated with changes in the spine. At varying lengths, changes in the hip are likely( a violation of the anatomical relationship between the femoral head and the acetabulum).
Coxarthrosis - the most severe form of osteoarthritis, has a chronic, progressive course. With a rapidly progressing course for several years, rapid disability occurs, in most cases, patients need surgical treatment - hip joint endoprosthetics.
Osteoarthritis of the first metatarsophalangeal foot joint is the third most frequent after gonarthrosis and coxarthrosis and often accompanies them. The development of the disease leads to a violation of the static-dynamic function of the foot due to an incorrect redistribution of the body weight load.
Due to the progression of osteoarthrosis, a specific deformity of the foot is formed, the first finger digs outward, it seems to float on the 2nd toe of the foot, which hammers bends. Externally, this manifests itself in the form of "protrusion" along the inner surface of the foot of the 1st metatarsophalangeal joint, which periodically inflames and leads first to discomfort, and then to severe pain and impossibility to wear shoes on the heel or too narrow.
Periarthrosis humeroscapular. The pain that occurs in the shoulder joint is characterized by the fact that it is felt not in the area of the joint itself, but in the upper part of the arm, below the shoulder joint by the width of the palm. Intensive pain extends lower on the shoulder, and also upwards, into the neck area. Pain often begins gradually, without an obvious provoking factor. It is variable in intensity, but usually has a progressive nature, often awakens the patient at night and significantly affects the performance of everyday movements.
Pain in the shoulder region is not always a manifestation of osteoarthrosis or joint capsule damage, often the osteochondrosis of the cervicothoracic spine, which is a frequent companion of the humeroparous periarthrosis, often manifests itself. When palpation in the shoulder region, soreness is detected in the projection of the joint space, sometimes crepitation during movement, felt under the fingers.
The patient is asked to perform two "difficult" active movements during the examination in connection with the violation of the function of the shoulder joint: lay both hands behind the head( assessing the withdrawal, external rotation and flexion in the shoulder joint, as well as the function of the supraspinatus, subacute and small round muscles)hands behind the back( internal rotation, withdrawal and extension in the shoulder joint, as well as the function of the subscapular muscle are evaluated).An "arch of soreness" is evaluated - a straightened arm is withdrawn slowly from the trunk and is also slowly lowered( Figure 1.3.3).
Fig.1.3.3 Diagram of the "arch of pain"
With this composite movement, the first 90 ° is performed by retraction in the shoulder joint, the next 70 ° - due to rotation of the scapula and the remaining 20 ° - also due to movement in the shoulder joint. Therefore, painfulness in one or another part of the arc, described by the hand in this movement, can be distinguished from the damage of the shoulder joint from other causes that cause pain in the shoulder region( for example, from damage to the rotator cuff of the shoulder).
The main distinguishing symptom of shoulder joint damage is the restriction of the external rotation of the shoulder( at a normal 45 °) and the possibility of removing the straightened upper limb to the side. Also assess the instability of the joint.
Osteoarthritis of the hand joints is formed with age or independently of it, if the hand is physically stressed. It manifests itself in the form of pain, restriction of the function of the fingers and specific deformities of the fingers. In 90% of patients, the process is localized in the distal interphalangeal joints. The process in the joints begins gradually, gradually progressing, hitting the articular cartilage. In the future, there are sprouting of newly formed coarse-fibrous tissue. In the distal interphalangeal joint( the joint between the nail and the middle phalanx of the finger) they are called the Geberden nodes, in the proximal interphalangeal joint( the joint between the main and middle phalanges of the finger) - the knots of Bouchard.
Often, these manifestations are symmetrical on both hands, extend to different joints, are accompanied by muscle atrophy, do not give an effusion to the joint and do not cause acute suffering.
Prevention of osteoarthritis
It is known that human health depends not only and not so much on the skill of the doctor, but on the correct way of life. And maybe the main task of a doctor is to teach his patient that.
The disease is characterized by a chronic course and periodic exacerbations. Therefore, measures aimed at preventing exacerbations and slowing the progression of the disease are secondary prevention. It is necessary to pay special attention to the diet and the motor regime. Thus, during an exacerbation of osteoarthritis, the affected joint needs rest, but with a reduction in the pain syndrome, the motor mode should be expanded, and the strength and duration of movements should not be excessive.
With arthrosis of the joint, increased physical activity promotes the further destruction of the cartilage, so therapeutic exercises should be gentle, easy, in a position that facilitates movement. It is recommended to unload the sick joint( use a cane, and sometimes crutches), do not walk for long distances, avoid long standing on the legs, stay in a bent position. Do not try to "break salt" in the joints - this leads only to the traumatization of cartilage and inflammation of the periarticular tissues, and consequently, to the further progression of the disease.
Orthopedic regimen is one of the main means for joint diseases, without its observance, other therapeutic measures may be less effective. With prolonged walking, even in the absence of pain syndrome, unloading of the joint( cane, crutches, soft and comfortable footwear) is necessary. When using a cane, remember that the handle of the cane should be at the level of the large trochanter of the femur. The angle of flexion of the arm in the elbow joint should be about 45 °.The cane is taken in the hand from the side of the healthy joint. Incorrectly selected cane can cause functional overload of the muscles of the upper limb and spine.
Wrongly selected by the bones lead to squeezing the soft tissues of the shoulder( brachial plexus) and the development of "crutch" plexites. With a pronounced inflammatory process in the joint, a bed rest is recommended with a gradual, accurate activation of the limb after the pain subsides.
Osteoarthritis occurs more often and progresses more rapidly in persons who are overweight, which means an increased strain on the joints of the limbs and the spine. Reducing the body weight in obese patients with osteoarthrosis of the joints of the lower extremities is an important component of the success of treatment along with drug therapy. Clinical studies have shown that with a decrease in body weight, even by 3-6 kg, the severity of symptoms decreases by 30%.Patients with osteoarthritis are recommended diet food.
It is necessary to exclude animal fats, digestible carbohydrates( sugar, chocolate, confectionery, white bread), fatty milk and kefir, cream, condensed milk, fatty and bold cheeses, mayonnaise, pork, mutton, duck and goose meat. It is necessary to use vegetable oil containing polyunsaturated fatty acids( corn, olive, sunflower, cotton), lean meats( veal, chicken, turkey, rabbit), fish( including fatty varieties), vegetables( except potatoes, its consumptionshould be limited) and fruits, skim milk and kefir, low-fat cheeses.
It is recommended to eat a balanced diet with caloric restriction due to fat and carbohydrates, but rich in proteins and vitamins. When exacerbating osteoarthritis, it is desirable to limit carbohydrates, salt and alcohol. In complex therapy, dietary supplements containing chondroitin sulfate and glucosamine sulfate can be recommended.
Medical treatment of osteoarthritis
Treatment of osteoarthritis today is an actual and serious problem, even though the list of used medications has recently been significantly enlarged. First of all, this is due to the fact that most drugs used in osteoarthritis have only symptomatic effect. Until the ability of any drug to radically change the course of the disease and completely heal the joint has not been proven.
To the tasks of treatment of osteoarthritis can be attributed the following:
decrease in the severity of symptoms of the disease;
improving the functional activity of the limb and the patient as a whole;
slows the progression of osteoarthritis.
Based on data on the main links of structural and metabolic disorders in the joint tissues, we can identify the main principles of drug treatment of osteoarthritis.
The first principle of is the correction of intraarticular disorders( normalization of cartilage cell supply - chondrocytes, suspension or delay of the processes of cartilage and bone tissue destruction, normalization of articular fluid production, protective, protective, cartilage damage prevention).
The second principle - relief of pain ( fight against inflammation in the joint, normalization of the tone of the periarticular muscles).
The third principle - improvement of intraosseous and regional blood flow.
The fourth principle - stimulation of metabolic( metabolic) processes in the body .
Osteoarthritis: causes and clinical picture: Medical blog of an ambulance doctor
After reading this article, you will learn:
- what is osteoarthrosis
- if you live to age 70, you will have only 1 chance out of 3 notget
- osteoarthritis when eating articular cartilage
- why it is necessary to give way to grandmothers on the
- bus to whom climbing the stairs is easier than descending
- for what reason the weightlifting is a risk group
- because of what the patient does not feel pain in the initial stage of the disease
- what is more useful for health: an ice palace or a swimming pool.
Note .To better understand the terms in the article( osteoarthritis, osteoarthritis, etc.), I recommend to recall the principles of Latin and Greek medical terminology.
WHAT IS OSTEOARTHROST
Osteoarthrosis - is a degenerative joint disease with elements of inflammatory changes in them .Osteoarthritis is, perhaps, the most common joint disease .At the age of 45-64 years, signs of osteoarthritis have 30-35% of the population, and after 65 years - 60-70% .This means that you have every chance of getting sick in the future.
The old name for osteoarthritis was " deforming arthrosis ", as the disease was associated with age-related degenerative changes exclusively in cartilage. Nowadays the approach has changed: osteoarthritis - disease of the whole joint , including its capsule, nearby bones, muscles and ligaments. Nevertheless, the greatest changes occur in the articular cartilage.
Healthy cartilage has 2-3 mm thickness , ensures the sliding of the joint surfaces and evenly distributes the load to the underlying bone. Muscles help the cartilage: for example, when we jump from a height, the work of the leg muscles during the landing softens the impact. Leaping from a height and landing on straightened legs, we subject the articular cartilage to huge overloads. Any trauma breaks the complete mutual correspondence of the shape of the contiguous joint surfaces, and, therefore, creates the basis for osteoarthritis in the future.
WHAT IS THE JOINT MASSAGE OF
? In a healthy cartilaginous tissue, there are many proteoglycans of ( a combination of proteins and carbohydrates), chief among them is chondroitin sulfate .It keeps water molecules on its surface, which is important for the normal functioning of the joint. In osteoarthritis, instead of chondroitin, in excess amount kerotan sulfate appears, unable to retain liquid, which leads to dryness of cartilage, its cracking and, ultimately, loss of damping( springing) properties.
Cartilage does not have vessels, nutrients arrive, and metabolic products are removed predominantly during compression-stretching cycles( imagine sponge ).In the cartilaginous tissue of there are no nerves of , therefore at the initial stages of osteoarthrosis the joint already suffers due to lack of substances for normal metabolism, and the patient does not feel anything and, of course, does not consult a doctor. The appearance of pain signals that the process has gone beyond the cartilage : either the synovial membrane of the joint or the adjacent bone is involved.
CLASSIFICATION AND CAUSES OF OSTEOARTHRASIS
Primary and secondary osteoarthritis is distinguished.
Primary osteoarthrosis of : cartilaginous tissue in 50% of patients have genetic inferiority of .Physical stress on the joint only triggers irreversible damage in it. For example, the grandmother had a twisted thumb on the foot, and the daughter or granddaughter will be formed the same. With each new generation, the disease begins a few years earlier and thus "gets younger".Today, ostearthrosis is often diagnosed in 40-year-old patients.
Secondary osteoarthrosis of : the disease occurs during life under the influence of external causes:
- injury .Not only fractures, but also easier injuries( dislocation, subluxation, "twisted the leg," "not so set foot").
- permanent physical overload of , especially associated with lifting weights( work, playing sports).I do not advise you to often unload carriages or carry sacks of potatoes.
- intoxication ( viral infections, alcohol, smoking, heavy metal salts, uncontrolled drug intake).Toxic substances easily accumulate in the cartilaginous tissue, but with difficulty they are washed out of it, tk.in cartilage there are no vessels.
- endocrine disorders ( diabetes mellitus, thyroid dysfunction, climacteric period).Cartilage is particularly sensitive to the decrease in the body of female sex hormones, estrogen , participating in metabolic processes: as soon as a woman has a climacter, "unexpectedly" and joint pains appear.
- congenital disorders of joint structure .Due to the displacement of the load on one half of the joint( internal or external), it works with overload and is quickly damaged. The same group includes congenital dysplasia of hip joints ( dysplasia - developmental dysplasia).After 40 years, it will manifest dysplastic osteoarthritis.
- excess weight. Try at least a few hours to wear a bucket of water. And in many patients with osteoarthritis, excess kilograms are measured not by one "bucket" and can reach half the body weight.
- vascular disorders ( atherosclerosis).For example, the joint and the head of the hip bone feeds only one artery. If the walls of the artery are affected by atherosclerosis, then the head nutrition suffers and osteoarthritis develops. If the blood supply is severely impaired, aseptic necrosis may develop with head disruption.(Necrosis - death, aseptic - sterile, from the words "a" - denial and "sepsis" - infection).
- varicose veins of the shin ( also vascular disorder).The resulting venous congestion leads to a lack of oxygen and, accordingly, hypoxia of the tissues, which contributes to the disruption of metabolic processes in the knee and ankle joints and leads to the development of osteoarthritis. More details: varicose veins and other vascular diseases( interview with a surgeon).
Pathogenesis of osteoarthritis( development of the disease)
In the case of osteoarthrosis of , the tissue decay process exceeds their synthesis of , which is why cartilage can not recover. In the articular cartilage appears defects, because of which the remaining parts of the cartilage tolerate an even higher load and wear out more quickly. The joint is destroyed, the process becomes uncontrollable. Muscles try to fix the joint in its previous position, because of which the load on its parts and muscles becomes uneven. Because of overload and muscle spasm , pain appears. Later on, irreversible changes occur in the muscles( atrophy of ).At the edges of the damaged cartilage, bone tissue proliferates, osteophytes ( pathological growths) are formed.
Stages of the pathogenesis of osteoarthritis : A - a healthy joint covered with articular cartilage, B - fragmentation and thinning of the articular cartilage, C - partial loss of cartilage and changes in the underlying bone, D - rapid loss of cartilage, cystic bone loss and formation of osteophytes.
In some patients, the process of destruction of cartilage triggered by mechanical stress can be exacerbated by by inflammation in the joint cavity of ( arthritis) with fluid accumulation. Scientists believe that inflammation develops as a reaction of the body to products of cartilage destruction( cartilage detritus).With such autoimmune inflammation of the , the hormones , the glucocorticosteroids , are injected into the joint through the needle, suppressing any inflammation.
CLINICAL PICTURE and DIAGNOSTICS of osteoarthritis
The largest joints of , bearing the greatest functional load( knee, hip, ankle) are affected first of all by .Please note that the common pains in the region of the shoulder joints of are usually caused by the lesion not of the joint itself but by the of the periarticular tissues of the .Pain in the shoulder region often occurs due to problems in the cervical spine( vertebrogenic pain).
The first "call" about osteoarthritis is pain in large joints, especially after excessive work or unusual work of .It passes quickly - after a day or two, but already at this stage, the radiograph of the joint shows the manifestations of osteoarthritis: bone compaction under the articular cartilage( subchondral sclerosis).Later, the pains become stronger, arise with each movement, and sometimes - even at rest. The X-ray of the joint reveals at the edges of the articular surfaces bone growths( osteophytes ).
Pain is a typical manifestation of osteoarthritis, but they are different. In the morning after sleep, joint pains are short-lived, they are called " starting ".The patient rises in the morning, experiencing discomfort, takes 2-3 steps and discomfort disappears. The cause of starting pains is the products of destruction of the cartilage, accumulating over night between the articular surfaces. When moving, they are pushed out, and the pain disappears.
The typical pain of in osteoarthritis is associated with physical activity. The patient was like - the pain intensified, rested - decreased. In contrast to the "starting", they are longer. When hip joints are affected, pain is usually felt in the groin( because of this, patients can contact a urologist or gynecologist).If knee joints are affected, it hurts in the patella, pain can descend down the shin. Because of this, there is a characteristic symptom - a patient descending the stairs is more difficult than climbing.
When the disease progresses, the pains become practically constant and no longer depend on the load. The shape of the affected joints varies, sometimes the limb may even shorten. Long-term pain from day to day( months) can often be removed only by antidepressants or sedatives( soothing) drugs.
Pain in osteoarthritis is multicomponent.
- If the synovium or the adjacent pain bone is damaged, appears when the is loaded;
- with muscle irritation with osteophytes - after movement of ;
- , when gets into the joint cavity of the cartilage fragments, acute sudden piercing pain( symptom of blockage of the joint) arises. Sharp pain is caused by the so-called " articular mouse "( arthremitis) - a detached fragment of articular cartilage, a meniscus or other joint structures freely located in its cavity. Most articulate mouse is found in the knee and elbow joints. The articulate mouse is usually single;shape is different, sizes from 2 mm to several cm in diameter. The diagnosis is confirmed by an x-ray of the joint. Treatment at the surgeon: removal of pathological formations.
- in the case of blood stasis and increased intraosseous pressure in varicose veins - night pain ( "articular migraine").
Thus, for the diagnosis of osteoarthritis, it is enough to study the clinical picture and make an X-ray. The general blood test is not changed for , but it is performed to exclude other diseases.
Prevention of osteoarthritis
For prevention and treatment of osteoarthritis, the must be maintained in a good state .One of the best tools is the pool .When swimming, joints work under optimal conditions - without static load.
At an early stage, swimming stops the pathological process and strengthens the muscles, and at the later stage it allows you to remove muscle spasm, which reduces pain. In addition to swimming at least 2 times a week , patients are assigned special set of exercises , which is recommended to perform lying - to reduce the load on the joints.
Why do joints need to move?
- strengthens the muscular frame
- cartilage feeds mainly during the movement of the joint
- if there is no movement in the joint for a long time, it seems to be "overgrown", appears stiffness .For example, with a fracture of the hand with the imposition of a cast bandage after the removal of gypsum, it takes a long time to develop a hand.
Osteoarthritis is a chronic illness, during which the cartilage of the joints and the bone bordering them are deformed, resulting in pain and difficulty in the mobility of the joints. If the physique of a person is sufficiently dense, the disease can suffer many notable complications. That is why the diet for osteoarthritis should be observed, because only through it you can achieve weight reduction and getting the body all the necessary substances for him, allowing to form a proper layer of their cartilage. But before you decide on a diet, you need to understand the causes of osteoarthritis.
In the normal state, when we move the joints rub very slightly against each other, which allows them not to wear out unless they are heavily loaded or injured. At an early stage, osteoarthritis develops when the functions of our cells are disrupted, and the synthesis of cartilage components is difficult. In consequence of this, cartilage joints become less elastic and thinner. Soon they formed cracks. After the slippery and smooth edges of the joints turn into rough, you can say, in a wounded disease. Naturally, the joint can not continue to work properly. The movement of the joints themselves becomes more and more difficult, a characteristic crunch arises accompanied by pain.
Osteoarthritis. Causes of appearance:
- various injuries of joints( fractures, dislocations, bruises, sprains);
- intra-articular cracks, microtrauma and fractures;
- violation of the correct metabolism in the body;
- overweight( increased pressure on the musculoskeletal system);
- immoderate physical load.
The development of osteoarthritis occurs for a long time, and unnoticed for the patient. Some parts of the cartilage of the affected joints do not receive the right amount of food, which is why the process of their destruction begins.
Proper nutrition with osteoarthritis, as already mentioned, is the most important component in the treatment of this disease. Weight reduction will help to organize various diets and the right way of life.
First, in order to reduce weight, you need to reduce the amount of fat consumed in your diet.
Do not forget about the unseen fats, found in various confectionery products: in cakes, pies, sweet snacks and similar products. Labels allow us to get all the information you need. According to medical recommendations, from your diet you should also exclude meat, which can be replaced with fish or poultry. The first can even be oily, since there are a lot of acids in the fish, including omega-three, which allow to normalize and restore the correct functioning of the whole organism. All dairy products must necessarily only be fat-free.
In the range of foods during osteoarthritis should include especially welcome black bread, cereals and cereals. The presence of various vegetables, fruits and berries is welcomed, because it is they that can sufficiently saturate the entire body with fiber, which prevents the growth of new fatty tissues. Sugar in food should be imposed strict restrictions and do not forget about hidden sugar, which is in a huge number of drinks and products. Increase the overall condition of the affected can mucopolysaccharides contained a special substance located between the cells of connective tissue. Thanks to them, the ligaments again get their elastic properties, resulting in a new healthy cartilage that will cover the entire joint cavity. Mucopolysaccharides, in addition to all this, are the most important participants in the whole process of synthesizing another substance that allows to lubricate and protect against the destruction of the joints. Their( saccharides) are obtained with the help of new biologically active additives, which can be chosen by the attending physician. It is also possible to obtain through some food - holland, jellied fish and rich dishes. For dessert, the use of jelly is very welcome.
As general recommendations, it can be advised, first of all, several times a week, even better daily, to walk for twenty to thirty minutes in one place at a moderate pace. It will not be superfluous to enroll in swimming, sometimes to ride a bicycle and, perhaps, to engage in easy skiing.
In order to relieve your joints, you need to exclude running for a long time, squats and jumps, as well as long walking, in particular on uneven surfaces, ladders, for example. To prevent further development of osteoarthritis, you should also remember that it is not recommended to stay in the same position for a long time, for example, when squatting or standing for a long time. If the joints of the hands are damaged, you should limit or eliminate the lifting of heavy objects and squeezing the laundry. Cold water in general should be avoided.
Do not forget to perform various physical exercises on exercise bikes, which are aimed at strengthening the muscles. Shoes should be chosen comfortable and soft, only with a small heel - about two to three centimeters. To wear elastic fasteners and use additional support methods, selected individually, is correct during osteoarthritis of any of the stages.
Of course, drug treatment during osteoarthritis can not be ruled out. It is prescribed only by the doctor individually. First of all, these are analgesics, hormonal and anti-inflammatory( nonsteroidal) drugs. In some cases, chondroprotectors are prescribed.
Prevention of osteoarthrosis of joints is the most optimal option, which should be carried out at all ages from time to time, because the treatment of osteoarthritis is a rather complex exercise, which is almost impossible to complete. First of all, it is necessary to note some important points, which require correct prevention of osteoarthritis of the joints.
You always need to move more, because movement is life. If your joints are healthy, then you need to maintain them in such a tone by charging, and best if it is oriented to the cardinal profile, when the load is dynamic( swimming, walking, running, etc.), and not static( lifting weights, bars andetc.).Sports exercises of this type will overcome excess weight, and if it does not, then do not let it appear. In addition, movement enhances circulation around the cartilage of the joints.
Joints should not be exposed to cold. This applies to everyone - elderly, and young, and patients with osteoarthritis in the first place. The knee pads will be a good help in the heat retention in the body.
It is necessary to strictly observe the correct regime of the day. It would seem that here a little overeat, there is not a little slept, and yet all this will greatly affect the condition of the body and on the joints as well. To avoid osteoarthritis, you need to lead a healthy, healthy lifestyle: to save enough time, to eat right, to be out in the fresh air, to improve your mood and then all diseases will bypass you.
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