Primary joint pain:
Arthritis
The most common joint disease. Arthritis develops against the background of advanced trauma, infectious and autoimmune diseases. There are two subgroups of arthritis: acute and chronic. In acute arthritis, pain in the joints is sharp, accompanied by severe swelling, redness and increased temperature of the joint. In chronic cases, the joint constantly aches, but there is no severe swelling or redness. The patient quickly gets used to it and stops paying attention to the pain until the joint completely collapses. With arthritis, the joints often hurt constantly, and over time, problems with flexion and extension appear.
Arthrosis
Wear and destruction of joint cartilage. With arthrosis, cartilage loses its elasticity, becomes thinner, and metabolism in the cartilage tissue is disrupted. Most often it affects the knee joints. Arthrosis is characterized by aching pain, weaker after sleep and intensifying during the day. The intensity of the pain increases with tension in the leg and pressure on the joint. With advanced arthrosis, the pain does not subside even after rest. Other symptoms of arthrosis are clicking and crunching sounds in the joint.
Bursitis
Inflammation of the mucous membranes of the joints most often occurs as a complication of injuries. Bursitis is characterized by painful swelling due to abnormal enlargement of the joint sac. The pain varies depending on the stage of development of the disease, it can be aching, severe, shooting and throbbing, and can radiate beyond the joint. Often worsens at night.
Joints of the free lower limb
Functional anatomy of the lower limb.
The bones of the lower limb are divided into:
• bones forming the girdle of the lower limb (pelvic bones),
• skeleton of the free lower limb,
ü which in the hip area is represented by the femur,
ü in the area of the leg - the tibia and fibula,
ü and in the area of the foot - the tarsal bones, metatarsal bones and finger bones.
LOWER LIMB BELT (PELVIC GIRL)
• Both pelvic bones are connected in front by fibrocartilage (pubic symphysis), and in the back - with the sacral bone by a paired sacroiliac joint and form a strong bone ring - the pelvis (therefore, the girdle of the lower limb is also called the pelvic girdle).
Hip bone.
• Pelvic bone, steam room.
• In children, it consists of three separate bones - the ilium, ischium and pubis.
• In an adult, these three bones fuse to form a single pelvic bone.
• The bodies of these bones, connecting with each other, form a deep hemispherical cavity on the outer surface of the pelvic bone - the acetabulum (this cavity connects to the head of the femur).
• Although the pelvic bone is a single bone, it is usually described as having three parts.
Ilium.
- The ilium is the largest of the bones that form the pelvis. The lower part of the bone is thickened and is called the body.
- The body of the ilium represents the superior part of the acetabulum
- Above which is a wide, flattened part of the bone called the wing of the ilium.
- The upper edge of the wing is called the iliac crest. It is S-shaped and ends in front with a protrusion that can be easily palpated through the skin - the superior anterior iliac spine, and in the back - the superior posterior iliac spine.
Ischium.
q Consists of two parts:
ü body of the ischium and
ü angled branch of the ischium.
q The body of the bone forms the posteroinferior part of the acetabulum.
q On the posteroinferior surface of the curved section of the branch there is a thickening with a rough surface - the ischial tuberosity.
q The lower part of the ramus in the anterior parts fuses with the lower ramus of the pubis.
The pubic bone consists of three parts:
- bodies and
- two branches - the superior ramus of the pubis and the inferior ramus of the pubis.
The body of the pubis forms the anterior part of the acetabulum.
FREE PART OF THE LOWER LIMB.
Hip bones:
• Femur
• Patella
Femur. It is the heaviest, longest and strongest bone in the body.
Its proximal end has a spherical head, which is attached to the pelvic bone in the acetabulum.
The distal end of the femur has lateral and medial epicondyles, which articulate with the tibia.
The greater trochanter is a protrusion at the distal part of the head and neck of the femur and can be felt in the gluteal region.
The patella is the largest sesamoid bone in the skeleton. It lies in the thickness of the tendon of the quadriceps femoris muscle, can be easily felt through the skin and, with the knee bent, easily moves to the sides, as well as up and down.
The posterior surface of the patella articulates with the patella surface of the femur.
Shin bones.
The tibia is long. It consists of a body and two epiphyses - upper and lower. The body of the tibia is triangular in shape. Located medially (inside). At the proximal end of the bone, the medial and lateral condyles connect to the distal end of the femur to form the knee joint.
- tuberosity of the tibia.
- medial.
The fibula is located on the outside of the lower leg and is a thin, rod-like bone.
Bones of the foot.
7 tarsal bones
• The two largest bones of the tarsus primarily bear the weight of the body: the calcaneus and the talus, which lies between the tibia and the calcaneus. The scaphoid, medial cuneiform, intermediate cuneiform, lateral cuneiform, and cuboid bones make up the other five tarsal bones.
5 metatarsals
• The metatarsals form the instep of the foot.
14 phalangeal bones
Joints of the pelvic girdle
• Sacroiliac joint.
• Pubic symphysis.
The pelvic bone, in addition to the sacroiliac joint, is connected to the spinal column through a series of powerful ligaments.
Joints of the free lower limb
The hip joint is formed by the articular surface of the head of the femur, which is covered with hyaline cartilage throughout, with the exception of the fossa, and the acetabulum of the pelvic bone. The acetabulum is covered with cartilage only in the area of the semilunar surface, and the rest of the area is made of fatty tissue and covered with a synovial membrane. The acetabular lip is attached along the free edge of the acetabulum, which slightly increases the depth of the acetabulum.
Unlike the shoulder joint, the parts of the hip joint fit tightly together.
Joint capsule.
Extends from the rim of the acetabulum to the neck of the femur. The joint capsule is very strong and tight during extension, in sharp contrast to the thin and weak capsule of the shoulder joint.
Bundles:
Iliofemoral ligament: A thick and strong triangular strip located anteriorly.
Pubofemoral ligament: triangular, thickened inferior part of the capsule.
Ischiofemoral ligament: A spiral ligament located along the posterior aspect of the capsule.
These three ligaments are designed so that when a person stands up (that is, the hip joint moves from flexion to extension), the femoral head “screws” into the acetabulum and is held tightly in this position.
Femoral head ligament: Also called the round ligament or capitate ligament, this flat intracapsular ligament runs from the femoral head to the inferior lip of the acetabulum. It includes an artery that supplies the head of the femur. This ligament is weakened during most hip movements and therefore does not add stability to the joint.
Movements
Flexion, extension, abduction, adduction, medial and lateral rotation, rotational movements (more limited compared to the shoulder joint).
Knee-joint.
Three bones take part in the formation of the knee joint:
• Distal epiphysis of the femur
• Proximal epiphysis of the tibia
• Patella.
The knee joint is the largest and most complex joint in the body. The articular cavity has three joints: the lateral and medial tibiofemoral joints (between the femur and tibia) and the femoropatellar joint (between the femur and the kneecap).
Joint:
Tibiofemoral joint. The femoral condyles are connected to the tibial condyles by two C-shaped menisci, or lunate cartilages, between the opposing articular surfaces. Menisci are triangular cartilaginous plates. Their outer edge is thickened and fuses with the articular capsule; internal, free, edge is pointed and facing the joint cavity. The upper surface of the menisci is concave, the lower is flattened. The anterior edges of both menisci are connected by the transverse knee ligament.
Femoropatellar joint. The posterior surface of the kneecap connects to the patellar surface of the lower end of the femur.
Extracapsular ligaments.
• Tibial (medial) collateral ligament. A wide, flat strip of tissue extending from the middle epicondyle of the femur down and forward to the middle condyle of the tibial shaft. Some fibers fuse with the medial meniscus.
• Peroneal (lateral) collateral ligament. Round cord-like ligament, completely separated from the thin lateral part of the capsule. It extends from the lateral epicondyle of the femur down and back to the head of the fibula.
• Oblique popliteal ligament. A continuation of the semimembranous tendon that passes superiorly and laterally over the posterior aspect of the joint.
• The anterior sections of the joint capsule are strengthened by ligaments that are directly related to the quadriceps tendon. The tendon of this muscle approaches the popliteus, covers it on all sides and continues downward, reaching the tibia. Most of the bundles coming from the apex and adjacent surfaces of the patella reach the tibial tuberosity. This band is called the patellar ligament. The suspensory ligaments of the patella play an important role during movements in the joint, holding the patella in the desired position.
• Arcuate popliteal ligament. Passes from the head of the fibula upward and medially, entering the posterior part of the capsule, to the lateral condyle of the femur, strengthening the posterior part of the joint
Intracapsular ligaments.
• Anterior cruciate ligament. It runs obliquely upward, laterally and backward from the anterior intercondylar region of the tibia to the medial surface of the lateral femoral condyle. It prevents posterior displacement of the femur onto the tibia and limits hyperextension of the knee joint.
• Posterior cruciate ligament. Passes superiorly, medially, and anteriorly from the posterior intercondylar region of the tibia to the lateral aspect of the medial femoral condyle. Thus it is on the medial side of the weaker cruciate ligament of the knee. It prevents the femur from moving forward onto the tibia.
• The cruciate ligaments are located within the joint capsule but outside the joint cavity. The synovium covers most of their surface.
In addition, there are three more ligaments directly related to the menisci:
• 1. Transverse knee ligament, connects the anterior surface of both menisci.
• 2. Anterior meniscofemoral ligament, originating from the anterior portion of the medial meniscus, running superiorly and laterally to the medial surface of the lateral femoral condyle.
• 3. Posterior meniscofemoral ligament, runs from the posterior edge of the lateral meniscus upward and medially to the inner surface of the medial femoral condyle.
Movements:
Flexion, extension. Some rotation may occur when the knee flexes. In addition, as a result of tension in various ligaments (especially the cruciate ligaments) and tendons, slight medial rotation of the femur may occur above the stationary tibia, with the knee joint fully extended. (When the thigh and tibia are not fixed, as in a kick, the tibia rotates laterally at the end of extension and medially at the beginning of flexion.)
NOTE: The hamstrings "unlock" the extended knee joint before flexion, allowing the flexion process to occur.
Connection of the leg bones.
The proximal epiphyses of the tibia bones form the tibiofibular joint. The articular surfaces of the joint are represented by the flat surfaces of the head of the fibula and the lateral condyle of the tibia.
The joint capsule is attached along the edge of the articular surfaces, stretched taut and reinforced by the anterior and posterior ligaments of the head of the fibula. The proximal articulation of the tibia is a low-moving joint.
The interosseous space between the bones of the lower leg is filled with the interosseous membrane of the lower leg, which is a syndesmosis.
The fibers of the membrane run from top to bottom and laterally from the interosseous edge of the tibia to the fibula. In the lower section the membrane is stronger.
Distal tibiofibular syndesmosis. Articulation Between the rough triangular opposing surfaces at the distal end of the tibia and fibula.
There may be limited passive movement of the ankle joint.
Ankle joint
Articulation Between the distal tibia, the medial malleolus of the tibia, the lateral malleolus of the fibula and the talus. The lower ends of the tibia and fibula create a “socket” for the talus.
The joint is strengthened by a large number of ligaments.
Movements:
Dorsal and plantar flexion.
Joints of the foot.
• The foot is formed by a large number of bones, articulated by joints that are complex in structure and function.
• The foot is an important supporting and springing apparatus of the human body, which is ensured by its arched structure. There are longitudinal and transverse arches of the foot. The longitudinal arches are formed according to the five metatarsal bones. All longitudinal arches, starting on the heel bone, fan out in the longitudinal direction. Consequently, each arch includes the metatarsal bone and part of the tarsal bones, lying on the axis of the arch and located between the calcaneus and metatarsal bones. The transverse arch passes through the cuboid and sphenoid bones, as well as the bases of the metatarsals. Depending on the severity of the arches, it is customary to distinguish between a normal foot, a strongly arched foot and a flat foot. Factors such as bone shape, ligaments, and muscle function play important roles in stabilizing the arches of the foot.
• Ligaments are a passive apparatus for strengthening the arches. The longitudinal arches are fixed by the long plantar ligament, plantar calcaneonavicular ligament and plantar aponeurosis. The transverse deep transverse metatarsal ligament and interosseous metatarsal ligaments support the transverse arch of the foot.
• The muscles of the foot and partly the lower leg serve as an active apparatus for maintaining the shape of all arches of the foot.
Secondary joint pain:
Tendinitis
inflammation of the ligaments and tendons of the legs. The joints of the legs are fixed by a large number of ligaments and tendons, so with tendinitis, both the ligaments and the joints themselves hurt. Typically, pain appears when moving and pressing on the tendon, accompanied by redness and increased temperature of the skin. With tendinitis, the strength of the tendons decreases, which causes the mobility of the legs to be impaired, and painful tendon ruptures and joint dislocations can occur.
Diseases of the lumbosacral spine
The sciatic nerve, which is responsible for the sensitivity of the legs, is attached to the sacral spine, so diseases of the sacrum and lower back cause pain in the legs. The appearance and mobility of the joints remain normal, but pain occurs simultaneously in all joints, more intense in the hip and weaker in the joints of the feet. Pain in diseases of the spine is constant, does not subside during rest and intensifies with prolonged sitting. In this case, there are sensations of numbness and “goosebumps” on the skin, coldness of the limb, a feeling of weakness and heaviness in the legs.
Classification of joint diseases according to the nature of the pathological process
1. Inflammatory and infectious.
In this case, an infectious, allergic or autoimmune process develops in the body, which causes inflammation of the joint. Edema and swelling appear. In just a few hours, symptoms progress to their maximum, and then recede and enter the chronic phase.
To determine the degree of inflammation, an x-ray examination is performed. Thus, in the second degree of arthritis, destruction of cartilage and bone tissue is visible in the photographs, as in grade 2 osteoarthritis, and in the third degree there is significant deformation of the joint.
This group includes:
- rheumatoid arthritis;
- infectious-allergic arthritis;
- gout;
- Bekhterev's disease;
- psoriatic arthritis, etc.
Arthritis can be caused by tonsillitis, scarlet fever, gonorrhea and any other infection.
2. Degenerative joint diseases.
Most often they are caused by wear and tear of cartilage tissue, but also occur against the background of osteoporosis - reduced bone density. Arthrosis of the hip, knee, and elbow manifests itself gradually - starting with a slight pain after a hard day. Over time, the pain increases even after rest, and mobility is limited. The joint may ache due to the weather and swell. Deforming arthrosis of the knee and hip joint is the most common cause of disability in joint diseases.
X-rays and MRIs can determine the extent of joint damage. At the initial stage, a slight reduction in the height of the gap is noticeable due to the thinning of the cartilage tissue. At the second stage, the cavity is reduced by a third of normal, and bone growths appear. The third is characterized by irreversible deformations up to bone fusion. In this case, only joint replacement will help, however, there are certain contraindications to it.
Yoga is an excellent preventative against arthrosis and osteochondrosis.
3. Congenital joint pathologies.
Most often, congenital hip dislocation is diagnosed in combination with hip dysplasia. If the disease is not treated, it will progress and cause problems with the child’s gait and posture. Congenital dislocation can be corrected conservatively.
Marfan syndrome is somewhat less common, which is manifested by increased joint mobility, poor posture and a keeled chest. People with this diagnosis are more likely than others to end up in the hospital with a fracture or dislocation, but this condition can be kept under control.
Even babies are susceptible to joint diseases
4. Diseases of periarticular tissues.
Although these pathologies do not affect the joint, they can seriously worsen its function without adequate therapy. These include tendonitis, bursitis, ligamentitis, fibrositis - inflammation of tendons, joint capsules, ligaments and fascia. As a rule, they develop after excessive physical exertion and “coldness” of the limbs.
With such diseases, discomfort is felt only during active movements, while during massage or palpation the person does not complain of anything. With lesions of the periarticular tissues, there is always a point of maximum pain, while with arthritis, for example, the pain is diffuse.
Diseases of the periarticular tissues are no less dangerous than pathologies of the joints
Treatment of pain in the joints of the legs
If you have pain in your leg joints, do not self-medicate under any circumstances. Due to improper treatment, complications can arise, which are much more difficult to cure than the primary disease. Make an appointment with a neurologist or orthopedic traumatologist. The doctor will listen to complaints, perform palpation, and prescribe additional examinations: ultrasound, MRI, arthroscopy and laboratory tests.
Once the diagnosis is made, the doctor will create a treatment plan. Treatment of joints includes taking various medications: anti-inflammatory, antibiotics, chondroprotectors or hormonal. Almost all patients are prescribed physical therapy and physiotherapy. In advanced cases, prosthetic surgery is performed.