Rheumatic inflammation of soft periarticular tissues

Inflammations of the soft tissues of the leg can occur in various forms and be localized in a variety of places. The clinical picture, however, has general manifestations. The course of treatment must be prescribed by a doctor, one of the stages is shock wave therapy.

With a small depth of the process, painful swelling develops with redness and increased skin temperature. If the inflammation goes deeper, the patient experiences attacks of fever, and signs of intoxication appear. This indicates the beginning of the purulent-necrotic stage.

If you suspect inflammation of the soft tissues of the leg, you should immediately consult a doctor, since a rapidly developing inflammatory process may ultimately lead to the need for amputation.

Types of leg inflammation

It is very easy to get inflammation even in everyday life. Broken knees, abrasions, scratches are typical causes of the development of various inflammations of the leg. Penetration of microbes into the soft tissues of the legs can also occur:

• with skin scratching - for example, with an allergy to insect bites;
• for fungal diseases accompanied by cracks in the skin;
• for diabetic ulcers;
• with varicose veins;
• when injecting in unsanitary conditions - for example, in cases of drug addiction;
• for injuries and wounds - for example, in athletes or military personnel;
• when microflora is introduced from primary inflammatory foci with blood or lymph.

The causative agents of purulent inflammation of soft tissues are pyogenic bacteria, mainly staphylococcal bacteria. At the initial stage, blood microcirculation is disrupted, which is associated with damage to the tissue structure. If you do not immediately begin to treat inflammation of the soft tissues of the leg, swelling begins, which already causes pain when the muscle tissue is bursting with accumulated fluid, and they signal this through the neuromuscular junction. In the vast majority of situations, the patient takes pain medication and forgets about the problem. Meanwhile, the inflammation enters the purulent stage, when the neuromuscular connection is lost, there is no more pain, but pus accumulates. There are two known variants of purulent inflammation:

• Abscess. In common parlance - an abscess. It develops in the muscles and subcutaneous tissue, has clearly defined boundaries within the purulent capsule, which is formed as a protective reaction of the body to infection.
• Phlegmon. Acute diffuse inflammation of the subcutaneous tissue, has no clear boundaries, easily spreads to the entire limb.

Anaerobic infections also pose a great danger to the feet. The most common inflammations of the soft tissues of the leg associated with this type of infection are:

• Erysipelas. Manifests itself in the form of blisters on the skin, redness, and hemorrhages. The causative agent is streptococcus; inflammation can develop upon contact with a person affected by a streptococcal infection, for example, a sore throat. In rare cases, this type of inflammation goes away on its own, but you shouldn’t count on it. Advanced cases of erysipelas will have to be treated for several months.
• Gangrene is tissue death. The causative agent is bacteria of the Clostridia family, “living” in soil and dust. Gangrene can only be treated by amputation, so in case of injuries it is very important to disinfect the wounds and immediately consult a doctor.

Rheumatic inflammation of soft periarticular tissues

As a pathology, rheumatic inflammation occurs against the background of chronic diseases, or less often independently. It includes lesions of soft periarticular tissues and degenerative changes in muscles, ligaments, tendons, synovium, and fascia not caused by a tumor or infection.

The disease is very common, but most often occurs in men and women of mature age, whose profession involves constant physical activity.

Symptoms of rheumatic lesions

Damage to the periarticular tissues is manifested by the occurrence of increasing pain and difficulty moving the limbs. Other symptoms include:

• local change in temperature regime, since many pathological processes affect the adequate distribution of temperature over the surface of the body;
• the appearance of puffiness and swelling in areas of inflammation;
• limited movement;
• problems with lifting, flexion, extension of limbs, amplitude;
• increased pain when touching inflamed areas.

The most common diseases of this series

Among rheumatic pathologies of periarticular tissues, the most common are:

• tendonitis – characterized by painful sensations when raising the arm;
• bursitis – pain spreads from the joint, along the entire hip or shoulder;
• capsulitis – severe pain occurs in the shoulder area and limits mobility;
• tenosynovitis - inflammation of the tendons, pain in the entire wrist or just the thumb;
• lateral epicondylitis or otherwise “tennis elbow” - pain appears in the elbow joint when tense;
• Fibromyalgia – accompanied by intense muscle pain.

The latter pathology is chronic in nature and differs from others in a wider range of symptoms and clinical manifestations: fatigue, muscle spasms, irritable bowel and bladder syndromes, and depressive disorders.

Treatment by a rheumatologist

Regardless of the type of rheumatic inflammation, it is necessary to undergo examination and treatment under the supervision of a specialist.

Taking into account the characteristics of the identified pathology of the periarticular tissues, the rheumatologist will make a prescription and give recommendations for a speedy recovery.

To reduce pain, anti-inflammatory agents are prescribed. Primarily non-steroidal drugs and ointments. In some cases, your doctor may prescribe corticosteroids.

Physiotherapy includes therapeutic baths, exposure to the source of inflammation with ultrasound and microwaves, to which phono- and sonophoresis can be added. An integrated approach to treatment is impossible without regularly performing exercises from a complex of special gymnastics.

Given the characteristics of fibromyalgia, antidepressants and muscle relaxants are usually added to the list of recommended medications.

If after several weeks there is no noticeable relief, loss of ability to work occurs, the doctor prescribes a periarticular block. These are novocaine injections or glucocorticosteroid injections. In addition, X-ray therapy sessions are performed.

Treatment with home remedies

Traditional methods can be used as an additional remedy in the fight against pain and relieving the inflammatory process. You should not completely abandon traditional treatment. Home remedies are auxiliary measures that are used after consultation with your doctor.

Advanced rheumatic inflammation of extra-articular soft tissues leads to a chronic course of the disease, complications and further disability.

To relieve intense painful sensations, traditional medicine recommends using salt compresses. A tablespoon of salt is diluted in half a liter of boiling water, then gauze is soaked in the solution and applied to the affected area. The exposure time is eight hours, after which the old compress is replaced with a fresh one. The course of treatment is 14 days.

Gentle self-massage of the affected area with lavender or pine oil is helpful. It will help relax the muscles in the area of ​​inflammation.

Many people consider mustard lotions and baths with herbal extracts to be effective.

Among the effective remedies are also compresses made from beaten cabbage leaves or fresh potatoes. Vegetables are placed on the inflamed area and tied with a warm cloth. The compress is changed every four hours for one week.

Causes of rheumatic inflammation

Most often, soft tissues are affected in the presence of chronic joint diseases or heavy physical activity. At the same time, they are observed in office workers who are forced to remain without movement for a long period.

Pathology can be caused by:

• diabetes mellitus;
• obesity;
• it is caused by flat feet
  , when, due to improper positioning of the foot, pain occurs on the outer part of the thigh, around the ankle or heel;
• menopause;
• myocardial infarction;
• congenital differences in the development of the ligamentous apparatus and tendons;
• professional sports or heavy physical labor;
• osteoarthritis.

The latter disease is one of the main culprits in rheumatic inflammation of soft tissues. With osteoarthritis, the development of pathological processes over time involves not only the joint, but also all periarticular structures.

In isolated cases, the cause may be previous infections, but then the clinical manifestations are more varied and are not limited to symptoms of damage to periarticular tissues.

Injuries or bruises or lack of protective bandages during significant physical activity lead to inflammation.
Author: K.M.N., Academician of the Russian Academy of Medical Sciences M.A. Bobyr

Treatment methods for leg inflammation

Inflammatory processes are treated in several stages. If the disease has progressed to a purulent stage, surgical removal of the pus and treatment of the wound are necessary. Further, and in milder stages, anti-inflammatory drug therapy is prescribed - a course of antibiotics in the form of tablets or injections, depending on the origin and severity of the infection. It is very important to choose the right drugs; for this, bacterial culture is done. The patient is prescribed to drink plenty of fluids to quickly remove toxins from the body.

At the recovery stage, physiotherapy is prescribed, aimed at regenerating the circulatory system and lymph flow. This can be successfully dealt with by a course of shock wave therapy, which promotes rapid restoration of soft tissues. You can take it at our Medcenter-Plus clinic.

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Phlegmon

Acute diffuse inflammation of fatty tissue and cellular spaces. A feature of phlegmon is diffuse, rather than limited inflammation. It can be either an independent disease or a complication of other purulent processes. The clinical picture is characterized by rapid spread, diffuse compaction and redness, severe pain, high fever and pronounced intoxication. Quite often there is a form of phlegmon with a rapid spread of the purulent process to the subcutaneous and intermuscular tissue.

Furuncle

Acute purulent-necrotic inflammation of one hair follicle and the adjacent sebaceous gland. Most often, inflammation is caused by Staphylococcus aureus. Initially, a small nodule appears and redness around it, with a hair located in the center. After 1-2 days, a blister with purulent contents appears in its place. During the transition to the stage of formation and rejection of the purulent core, the area of ​​hyperemia and edema itself increases. A so-called pyramid is formed with a purulent-necrotic core in the center. Gradually, the skin in the area of ​​the shaft melts, and the contents begin to be rejected. After complete cleansing of purulent-necrotic masses, a tissue deficiency forms in this place, which is subsequently replaced by connective tissue. As a result, a retracted scar is formed.

Carbuncle

Acute purulent-necrotic inflammation of several hair follicles and sebaceous glands with the formation of a single infiltrate. It is distinguished from a boil by massive necrosis of the skin, involving the subcutaneous fat. At the beginning of inflammation, a zone of infiltration (inflammation) with hyperemia is formed. Characterized by severe intoxication and febrile temperature of 39-40°C. At the next stage, a zone of necrosis is formed, after which purulent contents are released through the holes in the area of ​​the hair follicles.

Incidence of soft tissue sarcomas

In 2002, 3055 cases of soft tissue sarcomas in adults were identified in Russia. At the same time, the incidence rate for both sexes was 2.1. In children, soft tissue sarcomas account for 4-8% of all malignant tumors. Every year, 5-9 cases of such cases are registered per 1 million children.

In the United States in 2004, an estimated 8,680 cases of soft tissue sarcomas could be identified (4,760 cases in males and 3,920 in females). These data apply to children and adult patients.

Risk factors for soft tissue sarcomas

Currently, some factors have been identified that increase the risk of developing soft tissue sarcomas.

Ionizing radiation is responsible for the occurrence of 5% of soft tissue sarcomas as a result of previous radiation for other tumors (eg, breast cancer or lymphoma). The average period between exposure to radiation and detection of soft tissue sarcoma is 10 years.

Diseases in the family. It has been found that some hereditary diseases increase the risk of developing soft tissue sarcomas. These include:

• Neurofibromatosis , which is characterized by the presence of multiple neurofibromas (benign tumors) under the skin. In 5% of patients with neurofibromatosis, neurofibroma degenerates into a malignant tumor.
• Gardner's syndrome leads to the formation of benign polyps and cancer in the intestines. In addition, this syndrome causes the formation of desmoid tumors (low-grade fibrosarcomas) in the abdomen and benign bone tumors.
• Li-Fraumeni syndrome increases the risk of developing breast cancer, brain tumors, leukemia, and adrenal cancer. In addition, patients with this syndrome have an increased risk of soft tissue and bone sarcomas.
• Retinoblastoma (a malignant tumor of the eye) can be hereditary. Children with this form of retinoblastoma have an increased risk of developing bone and soft tissue sarcomas.

The only way to prevent the development of soft tissue sarcomas is to (if possible) eliminate known risk factors.

Hidradenitis

Purulent inflammation of the sweat glands. Most often, the causative agent is Staphylococcus aureus, which enters the child’s body through sweat glands or abrasions. The most common location is the axillary region, less commonly the groin. Initially, a painful, dense swelling of small size appears, then hyperemia occurs, the skin becomes purplish-red and uneven. During the transition to the stage of abscess formation (spread of the purulent process to the subcutaneous tissue), a fluctuation appears in the center of the lesion (softening of tissue upon palpation). Acute hidradenitis often has a recurrent course.

Felon

Acute purulent inflammation of the tissues of the fingers and toes.
The severity of intoxication depends on the type of panaritium. Types of felon:

1. Skin: inflammation is localized only in the papillary layer of the skin and epidermis and has the most favorable course. In the cutaneous form, it is presented in the form of a bubble, pain and swelling are mild, there are practically no signs of intoxication.
2. Nail (subungual): the focus of purulent infection is located under the nail plate. Often the child complains of throbbing pain in the finger.
3. Paronychia: This is an inflammation of the periungual fold that becomes swollen and red. Over time, pus accumulates under the skin.
4. Subcutaneous panaritium: localized in the subcutaneous fat of the finger. The subcutaneous form is characterized by increasing, twitching pain, moderate swelling and hyperemia.
5. Tendon: affects the tendon sheath and finger tendon. The peculiarity of the tendon panaritium is that when you try to straighten the finger, a sharp pain appears, which subsides when bending.
6. Articular: the source of inflammation is located in the joint space and affects the ligamentous and cartilaginous apparatus of the finger.
7. Bone: inflammation is localized in the bone tissue of the finger. In the bone form, the finger is thickened at the level of inflammation, throbbing pain, and pronounced signs of intoxication. Over time, a fistula with purulent discharge may form.
8. Pandactylitis: the most severe variant of the course. Characterized by inflammation of all tissues of the finger. Local symptoms are noted: pain, hyperemia, swelling.

Lymphadenitis and lymphangitis

Acute inflammation of the lymph node and lymphatic vessels. Most often, the cause lies in secondary infection. The initial sources may be infections of the ENT organs, carbuncle, furuncle, etc. Infection occurs mainly by the lymphatic route, less often by hematogenous route. Most often, acute lymphadenitis occurs in children of the first years of life due to the anatomical immaturity of the lymph nodes. The first clinical signs are an enlarged lymph node in size and pain. As the infection progresses, the swelling increases, the skin turns red, and a sharply painful lymph node conglomerate is palpated. Abscess formation occurs over time.

Diagnostics

With superficial inflammation, diagnosis is not difficult.
The diagnosis is made based on the clinical picture. In cases where the source of infection is located deep, in the presence of local symptoms of inflammation, it is necessary to use additional research methods. Ultrasound of soft tissues: makes it possible to accurately determine the presence of free fluid and cavity, which is an indication for surgical treatment. The CBC will show an increased content of leukocytes (due to neutrophil cells) and an acceleration of ESR. If it is difficult to diagnose, a CT scan is prescribed, which makes it possible to determine the location of the abscess and evaluate its structure and volume.

Necrotic cellulitis of newborns

Acute purulent-necrotic inflammation of the subcutaneous fatty tissue, characterized by a severe course due to the rapid formation of extensive areas of necrosis of the subcutaneous fatty tissue, followed by its detachment and necrosis of the skin.
Occurs only during the neonatal period. The reason for the occurrence of this pathology lies in violation of the principles of child care and non-compliance with hygiene.

Typical localization is the area of ​​the shoulder blades, sacrum, and lower back.

At the beginning of inflammation, a red spot appears with a focus of necrosis in the center, compaction and swelling of the soft tissues. Subsequently, fluctuation is noted in the center of the lesion (tissue softening upon palpation). Within a day, the spread of the disease can cover a fairly large area of ​​skin. In more severe cases, tissue peeling and necrosis occurs with the formation of serious defects. Therefore, a child with such a diagnosis requires emergency hospitalization and comprehensive treatment.

Soft tissue infections

Soft tissue infection is an acute inflammatory process of various localizations caused by pyogenic microflora.
For the development of infectious inflammation, 3 main conditions are necessary: ​​the causative agent of the infection, the entrance gate and the macroorganism (human body). The most common pathogens in children include: staphylococcus, streptococcus, E. coli. The difficulty of treating soft tissue infections is associated with years of developed resistance of microorganisms to antibacterial therapy - due to the widespread use of antibiotics in recent decades.

The entrance gates, as a rule, are damaged skin and mucous membranes. Microorganisms enter the child’s body through various abrasions, bites, scratches, abrasions, and even through the excretory ducts of the sweat and sebaceous glands.

Considering the characteristics of children's skin - a relatively high content of intercellular fluid, abundant blood supply, easy vulnerability, poor development of the basement membrane - soft tissue infections are quite common in children.