Since childhood, we get used to running, jumping, boys love to climb and play football, strings and more.And the active lifestyle is entering the human mind that, over the years, when somewhere the muscle has pulled, somewhere the articulation fell ill, the person does not even pay attention: "Well, think how many times Kolenko has hurt."Here in today's article, we'll talk and why the knee can hurt, and if this is always the usual result of the clear movement.
What is arthrosis?
Arthrosis -A group of diseases of the musculoskeletal system of different origin, but with biological, morphological manifestations and similar clinics.The basis of its development is the degenerative lesion of all components of the joint, especially cartilage, sinvial bone, synovial membrane, ligaments, capsules and periarticular muscles, with the formation of marginal osteophytes and a clear or hidden and hidden synovitis.As with this disease, pathological changes capture cartilage and bone tissue.
Arthrosis is often called Osteoarthritisand sometimes Osteoarthritis.
Statistics (Epidemiology)
Among all joint diseases, arthrosis is up to 80% of cases.
The disease develops mainly in sock and old age.At an early age, arthrosis can occur after joint injuries, inflammatory processes as well as with the congenital pathology of the musculoskeletal system.
Signs of arthrosis X are detected in most people over 65 years and almost 95%over 70 years.
Women suffer from arthrosis almost twice more often than men.The incidence rate increases during the postmenopausal post.
A major role in the development of arthrosis is played by hereditary factors.It was established that the frequency of disease development in families of osteoarthritis patients is twice as much higher than in the population as a whole, and the development of arthrosis in people with congenital defects of the musculoskeletal system increases 7-8 times.
Arthrosis - Cid
- MKB-10: M15-M19, M47
- MKB-9: 715
- MKB-9-km: 715.3
Symptoms of arthrosis (clinical image)
The clinical manifestations of the disease and its severity depend on the location of the pathological process, the patient's health and the image of his life.
The first signs of arthrosis
Arthrosis usually begins gradually, imperceptibly for the patient.
The first symptom of the disease is usually a lower short -term joint pain (arthralgia), which supports the highest load.These are first and foremost the joints of the lower extremities of knee, hip and Phalanx of the first thumb of the foot.From the joints of the upper limb, the interphalangeal joints, the brush's thumb carpal joint are more often affected.
Arthrosis usually begins with the injury of a joint, but after a while other joints are involved in the process.
The main symptoms of arthrosis
With arthrosis, patients complain of pain, crisis, restriction of joint movements, swelling and joint deformation.
Separately, it is worth breathing the nature of pain.With arthrosis, mechanical and initial pain is possible.Mechanical pain occurs with the load in the affected joint.This pain is mainly bothered at night at rest, disappears after several hours of rest.The appearance of this type of pain is associated with a gradual increase in bone pressure during physical exertion.The pressure causes bone beams and irritation of the painful bone tissue.
The initial pain appears at the beginning of the walk, then quickly and occurs again during physical exertion.The initial pain may appear with the friction of the joint surfaces of the affected joint.Small necrotic cartilage particles fall to the cartilage surfaces.In the first steps, these particles are pushed to the joint bag cavity and the pain ceases.
With arthrosis, pain may be associated with periartritis and tendon (inflammation of soft periarticular tissues, ligament appliances and joint bag).This pain occurs only during the movements in which the affected tendons participate, as well as in certain joint positions during the movements.
Pathological changes, as a rule, begin with large joints, which are subjected to great physical effort during the day.At the beginning of the disease, pain occurs as a result of inconsistency of the possibilities of the microcirculatory canal with the needs of joint tissues.Therefore, to reduce pain, patients slowly take their first steps and only then accelerate the rhythm of the walk.The pain may appear after half to two hours walking or working in a standing position.This is a signal to change the load, short term rest or type of work.
In the posterior stages of the disease, arthralgia can occur with minimal loads in the joint and remain at rest for a long time.This is due to the fact that, in later stages, rude changes in joint tissues, the destruction of the joint cartilage and secondary synovitis are formed.With the development of rude and massive alterations in the --cent bone tissue, their individual fragments can be separated and, falling into the joint gap, cause acute pain.This phenomenon is called the joint mouse symptom.
During the examination of the joints, the deformation is noteworthy.In addition, with arthrosis, there is a thickening of soft tissues of periasta, hypotrophy of the regional muscles, displacement of the limb axis.The thickening of the interphalangeal joints with bone growth and the seal of the periarticular tissues is called Gerberden's nodes.
The pain when feeling the joint is located in the joint gap, the places of attachment of the joint capsule, but this symptom of the disease is not always.Swelling and joint pain are determined by secondary synovitis.
The violation of joint function in the early stages of arthrosis manifests itself by a limitation of the amplitude of the movements.This is due to the injury of periosyatic tissues and synovitis.
In later stages of the disease, clinical manifestations of contractures develop different in terms of gravity.Most of the time, knee and hip joint functions are impaired.
Symptoms of arthrosis, depending on the location of the pathology
Arthrosis with damage to knee joints - Symptoms
The knee joint injury with arthrosis is called gonarthrosis.Primary gonarthrosis develops in menopause women.The reasons for the secondary are usually knee joint injuries and a violation of static with the curvature of the spine, boring feet.Patients complain of knee joint pain that occurs during movements, especially when climbing the stairs.The pain is located at the front or inside the knee joint.Articulation movements are limited: first flexion and posterior extension.When moving, a crisis usually appears.With the development of reactive synovitis, pain during movements intensifies and cares about rest.The swelling of the joint, pain during palpation, redness (hyperemia) and an increase in skin temperature are determined.Over time, due to bone growths, knee joint deformation occurs.
Arthrosis with damage to hip joints - Symptoms
The hip joint injury is called COKSARTROSIS.This is the most severe form of arthrosis.The causes of the disease can be congenital hip joint dysplasia, injuries, menopause.Patients have joint pain during movements in standing position.The restriction of joint movements is gradually increasing (first internal and external rotation, posterior flexion).There is a claudication associated with limb shortening.With bilateral damage, the duck march is typical.The atrophy of the muscles of the thighs and buttocks develops.There is no swelling of the joints with cartrosis.Palpationally determines the limited pain in the femoral head.
In the early stage of arthrosis, joint functions are preserved.With the additional development of the disease, it is temporarily limited and then the ability to work is completely lost, the patient loses the ability to take care of self -care, needs external help.
The causes of arthrosis
Arthrosis is based on the primary degeneration of the articular cartilage with the destructive changes that accompany it in the bones that form the articulation.This degeneration occurs as a result of an imbalance between mechanical loads on the articular surface of the cartilage and the possibility of compensation for this load.
In the development of degenerative changes in joint cartilage, several factors can participate simultaneously:
- Functional overload, including professionals, households and sports, causing mycotrauma from cartilage;
- joint injuries;
- Infectious and non -specific inflammation of the joint;
- Joint dysplasia, leading to a violation of comparison of joint surfaces;
- Body static violation as a result of spine curvature (kyphosis, scoliosis, pathological lordosis, etc.), flat feet;
- Chronic hemarthrosis:
- Diseases with metabolic disorders (gout, obesity, chondrocalcinosis);
- Osteodistrophy or Pedget disease;
- osteomyelitis;
- Peripheral nervous system pathology with loss of sensitivity;
- Endocrine pathology (acromegaly, diabetes, amenorrhea, hyperthyroidism);
- Hereditary trend.
Risk factors of arthrosis include elderly age, female, obesity.
Development mechanism
Cartilage metabolic disorders are based on quantitative and qualitative changes in the main substance of cartilage.The main substance consists of proteoglycans that provide collagen stability.The development of arthrosis is accompanied by insufficient formation or increased destruction of cartilage components.
With osteoarthritis in the cartilage tissue, the content of hyaluronic acid, chondroitin and keratin decreases.In addition, altered proteoglycans lose the ability to retain water.It is absorbed by a swell collagen, causing a decrease in cartilage resistance.
If chondrocytes are damaged, they begin to produce collagen and non -characteristic proteoglycans of the normal tissue of the cartilage.These altered substances cause the loss of biochemical qualities of cartilage.
Of great importance in the development of arthrosis are immune disorders.The destruction of cartilage proteoglycans is accompanied by the appearance of cellular and humoral immunological reactions.In turn, this causes progressive fibrosis and sclerosis of the synovial membrane, pathological changes in intraarticular synovial fluid and a violation of cartilage.The lower synovial shell supports the progression of degenerative changes in the joint cartilage.
A hereditary factor has a certain value in the development of arthrosis.
Arthrosis Classification
Arthrosis is divided into two groups: primary and secondary.
In distribution (primary arthrosis):
- Local (with damage to three joints)
- Common or widespread polartrosis (defeat of three joints or more).
Depending on the (secondary) destination:
- A. Tasobada joint (cokearthrosis);
- A. Knee joint (gontrosis);
- A. The elbow joint;
- A. The shoulder joint;
- A. column;
- A. Cervical Department (UN -Koarthrosis);
- A. Hands;
- A. Ankle joint (cruzartrosis)
- A. Stop.
By etiology:
- post -traumatic
- metabolic
- Due to endocrine pathology.
Diagnosis of Arthrosis
The variety of clinical manifestations and variants of arthrosis makes it difficult to diagnose the disease.The falsehood of the diagnosis is also associated with the lack of specific symptoms, the hidden onset of the disease.Of great importance is the definition of factors that contribute to the development of arthrosis:
- chronic joint trauma;
- long -term execution of stereotyped movements;
- Physical activity in the joint for a while;
- Violation of salt or fat metabolism;
- Hereditary addictions of the musculoskeletal system.
An X -ray examination is the most important meaning in the diagnosis of arthrosis.A visualization radiography of both knee joints is performed in a direct position, a folded position, plus a side position.The classic signs of arthrosis on the radiography are: narrowing of the joint gap, presence of osteophytes, subchondral bone sclerosis and subchondral cysts.There are the following stages of radiological change in arthrosis:
- 0 - There are no changes.
- I - Radiologically doubtful signs.
- II - Minimal changes (a slight narrowing of the joint gap, subsidiary osteosclerosis, unique osteophytes).
- III - Moderate manifestations (moderate narrowing of the letter, multiple osteophytes).
- 4- Express changes (joint gap is not visible, several rude osteophytes are determined), synovitis is usually present.
In the presence of these symptoms, other tools are not necessary.
In its absence or low gravity, joints, magnetic resonance imaging, scintigraphy are performed.
Clinical tests of blood, urine and intraarticular synovial fluid are not included in the list of mandatory studies for the diagnosis of arthrosis.But these tests are needed to exclude these joint pathologies.
The main clinical and diagnostic signs of arthrosis:
- Mechanical joint pain;
- fatigue;
- A feeling of instability in the joints of the lower extremities;
- damage to the first finger joints of the foot and the hands;
- the gradual onset of the disease;
- slow progressive current;
- joint deformation;
- hypotrophy of the regional muscles;
- recurrent synovitis;
- restriction of joint movements;
- X -Ray changes.
Arthrosis should be differentiated with damage to the articulations with rheumatoid arthritis, infectious, metabolic and reactive arthritis.
Rheumatoid arthritis, unlike arthrosis, begins with the inflammation of the small joints of the hands and feet.It is characterized by intense inflammatory pain, morning stiffness of the joints, the presence of rheumatoid nodules.
Gotric arthritis is found mainly in men.High local activity with acute paroxysmal pain in the first posterior Phalanx joint of the foot thumb is characteristic.With the gout, the presence of tofus is typical, on the radiography that there is "punch".
Psoriatic arthritis is characterized by skin lesions, especially the scalp, fingertips and a bright raspberry color of the skin above the affected joints.
Infectious arthritis is characterized by acute onset, rapid development and course, acute pain, high temperature and efficacy of antibacterial therapy.
Treatment of arthrosis
Treatment for arthrosis should be long, complex.The basic principles of arthrosis treatment:
- Unloading of joints (the correct mobility mode and mechanical loads, dose walking, body weight reduction, extended foot exclusion, using weights, strengthening the muscle ligament apparatus using physiotherapy exercises, massage, electrical stimulation).
- Conservative correction of static disorders (use of orthopedic shoes, corsets, supervisors).
- The impact on general metabolism and blood circulation (the use of biostimulants, vasodilators, balneotherapy and physiotherapy courses twice a year).
- Elimination of reactive synovitis, anti -inflammatory therapy.
Arthrosis patients show a diet with a limitation of salt, sugar, strong tea, coffee, smoked meats, sharp dishes.This improves the sensitivity of vascular and joint receptors, restores the tone of blood vessels, normalizes the exchange in chondrocytes.With arthrosis, it is necessary to drink sufficient liquid (at least 8 glasses of water a day).
Drug treatment of arthrosis includes the use of anti -inflammatory drugs and fast analgesics (anti -non -esteroids -Aines), basic medicines -controlProtective.No-?Non-selective and selective TSO-2 inhibitors are used from NSAIDs.
As local therapy for affected joints, NSAIDs are used in the form of ointment or gel.
In the presence of reactive synovitis, tendonitis or having vaginitis, when the treatment of NSAIDs is ineffective, the appropriate intraarticular or intramuscular administration of corticosteroids.
Basic therapy with chondroprotectors (chondroitin, glucosamine, hyaluronic acid) is used to prevent joint cartilage degeneration.
The treatment of chondroprotectors is indicated in the clinical and radiological stages of the I-III arthrosis.
In addition to direct chondroprotectors, medicines that stimulate the restoration of cartilage tissue (biogenic stimulants) are used.These medications are used during remission in the absence of reactive synovitis.
With arthrosis, drugs that improve microcirculation are also indicated.In the presence of varicose veins of the lower ends, venous blood flow correction is required.
In patients with arthrosis, it is necessary to diagnose and treat osteoporosis in a timely manner.
Physiotherapy of Arthrosis
Physical treatment methods also relate to basic arthrosis therapy.Under its influence, metabolic processes, blood microcirculation and tissue liquid are stimulated, neuroguroral regulation is restored.
The arthrosis treatment complex includes induction, microwave therapy, pulsed chains, medicine electrophoresis and magnetotherapy.To eliminate synovitis, the ultraviolet irradiation of the joint area affected in erythema doses, a high frequency electric field, analgin, diexide or hydrocortisone electrophoresis.
For the prevention of arthrosis progression, it is recommended to reduce body weight, avoid increasing joint loads, walking in a suppressed area, increased moisture and hypothermia.An individual selection of shoes and supervisors is important.
With gonarthrosis, regular exercise, swimming and cycling are shown to strengthen muscles.Heavy and light athletics classes, football is not recommended.
Therapeutic exercises are performed differently, in the sitting position, lying in the pool.Movements should not be intense, traumatic, volume and number of repetitions gradually increase, avoiding overload.
Popular and effective arthrosis treatment methods also include massage and cinemaiterapia.
With significant joint changes with deformation, mobility restriction is recommended, surgical treatment is recommended.Arthroplasty, endoprothetic, osteotomy are performed.
The prognosis of the disease
Primary arthrosis rarely leads to complete disability.In the presence of reactive synovitis, patients are temporarily disabled and are sometimes forced to change the profession.With the secondary duties, the prognosis is less favorable due to the rapid progressive course of the disease with the development of a significant joint function.In such cases, disability may occur over several years of illness.
Arthrosis prevention
Primary arthrosis prevention should begin in childhood.Is as follows:
- Prevention and treatment of scoliosis;
- Flat feet correction using special supervisors;
- Physical Education classes to strengthen muscles and ligaments;
- rational nutrition and prevention of metabolic disorders;
- Heavy sports restriction on childhood and adolescence;
- Alternative work sitting at a table with walk;
- The correct organization of work and the rest of employees of the companies where there are heavy physical activities.
Secondary prevention provides measures that prevent the development of recurring reactive synovitis.This includes walking doses, restriction of physical exertion, support with support and other measures that discharge the joints.With severe symptoms of arthrosis, it is necessary to constantly take basic medications.General strengthening therapy, improvement of blood circulation and metabolism, is recommended the annual treatment of the SPA.
Which doctor will he go to?
- Rheumatologist
- Orthopedist