What is joint enthesopathy - the methods of treatmentEnthesopathy - inflammation with degenerative changes , arising at the attachment points of ligaments, tendons to the bones.
Often observed around different joints.
Prolonged inflammation and emerging changes cause the formation of foci of ossification, a decrease in the strength of the tendons and even their rupture.
This affects the ability to work of patients.
Classification of the disease
Depending on the location of enthesis is:
- of the knee joint;
- Achilles tendon;
- of the hip joints;
- of the shoulder joint;
By the mechanism of occurrence is divided into:
- primarily degenerative;
- is primarily inflammatory.
Subspecies of the disease:
- Tendonitis of the long biceps head - inflammation of the biceps arm muscle at the site of its passage in the humerus.
- External epicondylitis - inflammation of the tendons of the muscles, attached to the external epicondyle of the shoulder bone.
- Internal epicondylitis - inflammation of the tendons of muscles, attached to the internal epicondyle of the humerus.
- Radial styloiditis - inflammation of the attachment point of the forearm tendon to the subulate process of the radius.
- Elbow epicondylitis - tendon of the elbow extensor of the hand. Occurs less often radial.
- Trochanetis - inflammation of the tendons in the place of their attachment to the large trochanter of the femur.
- Enthesopathy of the ischial hill - inflammation of the tendons in the place of attachment to the ischial tubercle.
- Enthesopathy of the goose paw of the knee - inflammation in the place of attachment to the tibia of the tendon of the tailor, elegant and semitendinous muscles.
- Achillodynia - inflammation in the place of attachment of the Achilles tendon to the calcaneus.
- Hepatic fasciitis - inflammation of the attachment site of the plantar aponeurosis to the calcaneus.
With knee enthesopathy, three whole muscles suffer.How to detect trochanteritis of the hip joint in time - symptoms and signs of the disease, which indicate the pathology of the joint.
We will tell and tell you how to treat gonarthrosis of the knee joint effectively and least painfully without severe consequences and disability.
Causes of the disorder
The appearance of the pathology is associated with:
- with prolonged exertion;
- microtraumas obtained by performing standard movements;
- rheumatic disorders.
Athletes, professionals, persons of working specialties, dancers often suffer from a deviation.
Symptoms and Symptoms
The disease manifests itself gradually.
- aching pain in the lesion;
- pain in the tension of the muscles of the diseased tendons;
- infringement of mobility of joints;
- swelling of damaged joints is not always observed;
- temperature rise above the involved area;
- pain when feeling the tendons.
Therapeutic proceduresTreatment of enthesopathy is a long process. This deviation is difficult to treat and often occurs again.
Usually, when treating a person, it is necessary to release the diseased limb from the load.
For the neutralization of inflammation take non-steroidal anti-inflammatory drugs .It is mandatory to use physiotherapy and local products - ointments and cream. Corticosteroids are often injected into the lesion.
Helps to fight the violation of the drug ambene. But the treatment should be done only by the prescription of the doctor and under strict supervision.
After the end of treatment, a person needs to save his legs.
The knee joint, hip joint, shoulder joint and some other joints enthesopathy is treated with physiotherapy.
- Shock wave method favors the acceleration of the renewal of disturbed tissues, relieves edema and increases local blood flow.
- Ultrasound .When waves of different frequency are affected, joint pain decreases, ultrasonic vibrations enter diseased tissues and vessels, relaxing them, and local heating helps restore blood flow and tissues near the joint.
- Laser therapy, magnetotherapy .These procedures serve to reduce pain, restore tissue and improve immunity.
- Electrostimulation .Removes inflammation, neutralizes pain by stopping impulses of pain to the nerves.
- Manual therapy reduces the load on the joint tissues, releases clamped blood vessels and nerves and normalizes the mobility of the joint.
Running forms require serious surgery. It is performed with prolonged pains, severe limitation of joint mobility, with absolute loss of motion.
Arthrosis is necessary if fibrous contracture occurs. As a result of the procedure, the patient can again move the joint, the lost functions are normalized. Postoperative treatment lasts 3 months, its basis is a special gymnastics.
Treatment by folk methods consists in the use of herbs for compresses, sprays. Reception of broths allows to restore immunity and reduce inflammation.
- a decoction of chamomile, plantain, mint and burdock root;
- tincture of calendula;
- horseradish table.
Prognosis and complications
Complications include the transition of the disease to a chronic disorder and the appearance that over time can affect the mobility of the joint.
Cure prognosis is positive. After the operation, it is possible to return to normal life.
The prevention of a violation is aimed at avoiding an activity that causes a deviation:
- avoid monotonous actions with an emphasis on the joint;
- weight control;
- maintenance of the muscles of the damaged area.
Video: Tennis elbow or lateral epicondylitis
The most common cause of pain in the elbow is epicondylitis. About the causes, symptoms and treatment of the disease in the video.
Enthesopathy is an inflammation with degenerative changes that develops in areas of attachment of ligaments, joint capsules and / or tendons to bones. It is more often localized near different joints.
Strangely enough, this is a disease for which patients themselves and doctors pay little attention. But if it does not begin to be treated timely, then in the future it can lead to such an unpleasant problem as a calcaneal spur( or other ossifying processes in connective tissue).And this is only one of the main complications arising from negligent attitude towards one's health. This is an inflammatory disease of the "enterosis" - the junction of the tendon with the bone. In this case, the inflammation( pathological process) may not be limited to the tendon, but spread to the surrounding ligaments, fasciae, joint capsule, synovial joint bag, to muscle tissue and even cause metabolic changes in the apophyses of the articular ends of the bones. A certain complex of degenerative-inflammatory processes, localized in periarticular tissues.
The term entere means the place of a strong connection of the tendons, ligaments and articular capsules directly to the bone. Before going into the bone structure, tendon fibers become compact and then cartilaginous. And the process of feeding the entereza occurs through the tendon sheaths.
If an inflammation has occurred in the entere, this does not mean that it will be confined to the connective tissue. In many cases, experts note the involvement of cartilage and bone in pathological changes. If you do not get qualified help in time, it can lead to the development of periostitis and the appearance of erosion.
Enthesopathy causes the onset of
Similar pathological changes are currently widespread and occur in 63% - 85% in the adult population.
Prolonged sluggish inflammation is accompanied by degenerative-dystrophic transformations and can lead to the formation of ossifits, osteophytes( foci of ossification) and partial rupture of tendon fibers.
In patients with such changes, due to chronic pain, work capacity is significantly reduced. According to statistics, in 35% to 85% of patients with arthritis or arthrosis, there is an enteropathy of a periarticular tendon or other connective tissue element.
Often this disease develops with reactive urogenital arthritis, including Reiter's disease.
This is what most often provokes enthesopathy, the main reasons:
1. the presence of rheumatic diseases such as ankylosing spondylitis and psoriatic arthritis;
2. excessive and prolonged physical activity;
3. numerous micro-traumas, obtained during the performance of various stereotyped movements( screwing, washing dishes, etc.);
4. Often, medical practice is encountered with enterosopathy among professional weightlifters, football players, dancers, jumpers, as well as among workers whose activities are related to the painting of walls, plastering, grinding and other construction specialties.
5. An indispensable companion of Bechterew's disease, Reiter's disease, Behcet's syndrome and other autoimmune pathologies. The articular syndrome that accompanies these diseases, in 60% of cases is expressed precisely by enthesopathy.
As a rule, problems with enteroses are characteristic for professional athletes or people whose work causes them to regularly strain a particular joint( for example, builders, miners, etc.).According to some statistical studies, more than 75% of all people seriously involved in sports experience pain of an enteropathic origin.
Enthesopathy clinical manifestations
As a rule, enthesopathy manifests itself gradually. Patients experience:
1. persistent aching pain in the joints and / or tendons;
2. pain that occurs when the muscles of the affected tendons are strained;
3. joint stiffness;
4. puffiness of the involved joints is not always;
5. Local temperature rise above the affected area;
6. Local tenderness when feeling in areas of attachment of tendons.
The most commonly involved tendon of
1. Achilles tendon. Quite often it suffers from volleyball players, athletes;
2. Tendons in the place of attachment to the ischial tuberosus or to the gluteal bone( hamster syndrome and APC-syndrome, respectively).Hips joint enterosopathies are common for sprinters( runners for short distances) and football players;
3. Knee ligament( the so-called "knee jumper", also found in weightlifters);
4. articular cartilage of the knee( the so-called "knee runner");
5. elbow joint( so-called "tennis elbow", power lifting);
6. Shoulder joint.(in the group of risk - gymnasts, discus throwers and spears, archers drivers of vehicles);
7. foot and heel( so-called heel spurs).These parts of the body are vulnerable to dancers, skaters.
Diagnosis with enteropathy
1. Tendonitis of long biceps head
2. External epicondylitis, which is still called "tennis player's lokol".
3. Internal epicondylitis or "elbow of the golfer".
4. Radial styloiditis.
Knee, hip, and shoulder joints
- 4.4 Operative treatment
The human articular apparatus is designed to perform the main function - motor, without which it is difficult to imagine a full life. Bones are connected together by means of ligaments and muscle tendons, which maintains the stability and stability of the joints. Such a structure, similar in construction to a lever mechanism, provides the very possibility of movement and active interaction of a person with the surrounding world.
Many injuries of the musculoskeletal system are accompanied by damage to the soft tissues at the place of attachment to the bones. With constant and long-term loads, as well as as a result of the acute impact of the mechanical factor, it is possible to develop an inflammatory process in connective tissue fibers. So are formed enthesopathies - a common pathology of the periarticular soft tissues, proceeding according to the type of periarthritis. At the same time, tendons, ligaments, as well as synovial bags and fascia are involved in the pathological process. Depending on the anatomical zones in which the affected structures are located, these enterosopathies are distinguished:
- Brachial( long head of the biceps).
- Elbow( epicondylitis).
- Knee( "goose paw").
- Feet( achillodynia, calcaneus fascia).
Enthesopathy is a generalized concept that includes tendinitis( tendovaginitis), bursitis, fasciitis. This is due to the similarity of the causes and mechanism of development, symptoms, diagnostic and therapeutic measures in this pathology. In addition, affecting one structure, the inflammatory process often spreads to other tissues, acquiring a combined character.
Often, enterosopathies are not given due attention - they can remain unrecognized and lead to a significant restriction of motor activity.
Causes and mechanism of development of
Under the influence of various factors, the inflammatory process in the periarticular tissues can develop. With its long existence, it is inevitable that dystrophic changes in connective fibers are attached. As a result, the elasticity and elasticity of ligaments, tendons, fascial leaves decrease. Increased risk of rupture and further deterioration of joint function. Therefore, it is worth paying attention to the common causes of enthesopathies of different localization, which include:
- Blow into the joint area.
- Falling with an emphasis on the limbs.
- Constant increased loads( static and dynamic).
- Congenital anomalies and acquired deformities of the musculoskeletal system.
- Infectious, metabolic diseases( brucellosis, gout, Bechterew's disease, psoriasis, osteoarthritis).
Inflammation of the periarticular tissues is a frequent result of injuries - sprains, bruises, joints or limbs. Such a process can be triggered by myositis or arthritis, when the tendons are affected secondarily in relation to the muscles or joint capsule.
Enthesopathies are common among athletes and active individuals. Such injuries are frequent pathologies in heavy and athletics, football, tennis, golf and other sports. Often, the disease occurs in persons whose professional activities involve monotonous or difficult work( computer scientists, painters, loaders).
Prevention of disease - an important component of the prevention of sports and domestic injuries. It is necessary to know the causes and symptoms of the disease in order to reach a doctor in time.
Clinical manifestations of inflammatory changes in the periarticular tissues have much in common. The specificity of this or that type of enthesopathy is determined by the mechanism of injury and localization of the affected structure. For the inflammatory process in connective tissue formations, there are common symptoms:
- Pain in the area of the affected tendon, which increases with the tension of the corresponding muscle.
- Local puffiness in the form of a roller, the formation of seals.
- Mild reddening of the skin over the inflamed area.
- Increase in local temperature.
- Disturbance of mobility in the joint.
- Tenderness on palpation of the affected area.
As a rule, the inflammatory process develops gradually, so you can not notice the first symptoms of the disease. However, further progression of pathology leads to joint stiffness due to formed contractures.
The course of enterosopathy is prolonged, other manifestations may be associated with development, such as ruptures of the tendon-ligament apparatus, instability. This causes deformation of the joints, can be the cause of a complete blockade of movements. The untreated process leads to loss of ability to work, a decrease in the quality of life of patients.
Timely detection of symptoms will allow early treatment of the disease to prevent adverse effects.
Encephalitis of the elbow joint( epicondylitis) is a common occurrence among weightlifters, gymnasts, golfers, badminton, tennis. In this case, extensors or flexors of the hand may be affected. In the first case, they talk about lateral tendinitis, and in the second case, they talk about medial tendinitis.
Symptoms of the disease are similar to that of other tendons. Depending on the type of epicondylitis, pain is observed when the wrist is bent or unbent, which will be localized along the inner or outer surface of the forearm. The patient experiences difficulties in holding dishes and shaking hands. Over time, the restriction of these movements develops.
The pathology of the shoulder joint is found in swimmers, tennis players, discus throwers and spears. In this pathological process, the tendons of the muscles of the so-called "rotator cuff" of the shoulder are involved: small round, supraspinous, subscapular and subacute. Also, inflammation can cover other tissues - the joint capsule and the subacromial bag. But most often the tendon of the supraspinous muscle is damaged.
Among the symptoms, attention is drawn to the pain in the shoulder that occurs when lifting and withdrawing the hand. Often, it intensifies at night when you turn on the affected side. In the future, pain syndrome worries in other movements, in which the shoulder joint does not directly participate( hand shake, lifting objects from the floor), and with the progression of the disease - and at rest.
Starting as tendonitis of the supraspinous muscle, gradually inflammation affects all the structures of the shoulder joint, leading to significant functional limitations due to the development of contractures.
Knee joint enthesopathy mainly proceeds as a lesion of the "crow's foot": the tendons of the thin, tailoring and semimembranous muscles at the fixation point to the tibia. Patients are concerned about pain outside the knee, which occurs when the first steps( "starting") or climbing the stairs. The similarity of the signs determines the need to differentiate the pathology with osteoarthritis of the knee joint. Such pathology is found among people engaged in certain kinds of sports( running, jumping, football, basketball, skis).
Soft patellar tissues are also damaged. The inflammatory process covers the ligaments of the knee, and then involves the tendon of the quadriceps muscle of the thigh. The pain syndrome is localized above and below the patella, where the tendon and ligament are respectively located. Appearing after physical exertion and strengthening with the extension of the tibia in the knee joint, the pain becomes more intensive as the progression of enthesopathy progresses. In addition, the stiffness in the knee and the weakness of the quadriceps muscle are disturbing. Characteristic restriction of extension of the lower limb.
Hip joint lesion has much similar symptoms of other localization. The tendons of the long leading, ilio-lumbar and deflecting muscles are most often affected. No less common is sciatic enthesopathy, which is typical for people who are long-time engaged in sedentary work.
The patient feels pain on the outer surface of the joint, which occurs when the hip is guided, resting on the leg and walking. Unpleasant sensations spread into the inguinal region, as well as down the inner or outer surface of the femur. Movement in the hip joint is limited, his palpation is painful. It is noted that it is impossible to lie on the affected side or sit on a hard surface.
Serious intesopathy of the hip joint should be taken seriously, as there may be a significant reduction in the motor function of the lower limb later.
A frequent result of flat feet or other deformities of the foot is achillodynia or plantar fasciitis. At the same time, the tendon of the gastrocnemius muscle and the plantar aponeurosis in the places where they attach to the calcaneus are affected.
There are pains in the heel and sole that can spread up the calf. Often they acquire a burning or boring character, become monotonous, interfere with daily activities. Pain syndrome increases with walking, resting on the foot, palpation of the affected area.
To confirm the diagnosis and distinguish pathology from similar diseases, resort to an additional examination. It must comply with generally accepted standards and clinical recommendations. The diagnostic complex includes instrumental methods, the results of which can accurately be said about the presence of enthesopathy. The most commonly used:
Treatment of enteropathy in the physiotherapy department ofEnterospaty is an inflammatory disease of the entere, that is, the place of connection of the tendon with the bone. In this case, the inflammation may not be limited to the tendon, but also apply to ligaments, fascia, joint capsule, synovial joint bag and even to muscle tissue. Most often, enthesopathy occurs in the region of the knee, shoulder, hip, as well as in the foot and Achilles( heel) tendon. Enterospaty refers to the most common diseases of the musculoskeletal system, although its symptoms often remain without due attention. Meanwhile, a careless attitude towards enthesopathy can have serious consequences, including the development of deforming osteoarthritis, periarthrosis, periarthritis and joint contracture. As a rule, the inflammatory process with enterosopathy is preceded by degenerative-dystrophic changes in tissues. Therefore, in order to reliably eliminate pain and other symptoms of this disease, stop its development and avoid complications, it is not enough simple application of anti-inflammatory drugs. This requires a comprehensive course of restorative treatment, the most important component of which is shock wave therapy( UVT).
Results of application of shock wave therapy for enteropathyAs a rule, in the treatment of enterosopathy, a combination of shock wave therapy, laser therapy and acupressure is used( if necessary, acupuncture is also used).Complex application of these procedures allows achieving lasting and lasting results:
- Completely eliminate joint pain( enthesis).
- Restore the volume of movements in the joint, motor activity.
- Prevent further development of the disease and its complications.
- Improve the resistance of the tendon to physical stress.
- Increase working capacity and quality of life.
How and why there is enterosopathyThe inflammatory process with enterosopathy can be primary or secondary, against a background of degenerative-dystrophic changes in tissues. In the first case, its main cause is systemic damage to the body of an autoimmune nature. In the second case, enthesopathy occurs as a result of prolonged increased loads on the enteric region associated with occupational activities and / or sports, as well as chronic traumatization( multiple microtrauma).
Symptoms of enterosopathyThe main symptoms of enthesopathy are pains that increase with physical activity and the performance of active movements. The pain syndrome, in turn, causes limited movement.
Treatment of enterosopathy with shock wave therapyHigh efficiency of shock wave therapy for enterosopathy is due to its directional, point action. Acoustic waves of infrasonic frequencies act exactly on the border of soft and dense tissues, it is in such places as the connection of the tendon-bone. Creating the effect of intense pulsed massage, they activate local blood circulation and blood supply of tissues, which helps their healing and recovery. Thus, shock wave therapy mobilizes recovery processes in the periarticular tissues, directly affecting the cause of the inflammatory process. The expressed anti-inflammatory effect is reached already on some medical sessions which, as a rule, are spent with an interval of 3-4 days. The number of pulses during a session, their frequency and power are selected individually. The combination of UVT procedures with laser therapy makes it possible to achieve a more rapid anti-inflammatory effect. Call and sign up