Ankylosis of the joint: pathogenesis, classification and general symptoms

Ankylosis

- This is an absolute loss of joint mobility. In most cases, it develops against the background of previous injuries or progressive diseases; congenital cases can occur extremely rarely. Pathology can occur in various parts of the musculoskeletal system (MSA) of the human body, including the temporomandibular system.

The main symptom of ankylosis is loss of functionality of the musculoskeletal system.

With fibrous fusion, pain is observed, which intensifies significantly when testing loads and attempting to perform movements.

Diagnosis and the final diagnosis are carried out based on the results of a visual examination, as well as data obtained as a result of primarily x-ray examination.

Treatment of ankylosis is predominantly radical. It is possible to fix the limb in the most advantageous position for the patient. Restoration of mobility is achieved through plastic surgery or prosthetics in combination with medication and physiotherapeutic treatment.

General information

Ankylosis is a serious consequence of various types of injuries or diseases of the joints. Pathology can develop at any age, however, it is most progressive in middle or old age.

According to medical practice, ankylosis of the lower extremities is much more common than the upper extremities. Up to 50% of all diagnosed cases are due to pathologies in the knee.

Considering the features of the clinical manifestation, the closest attention should be paid to lesions of larger joints, as well as diseases of the musculoskeletal system, accompanied by ankylosing spondylitis.

Reasons for development

The main cause of epicondolitis is the loads that fall on the elbow area. This can include intense physical activity, power lifting, sudden movements, or not very intense, but regular and monotonous actions. They are usually associated with human activities - professional or amateur, sports. For example, they can be provoked by sports in which the hands are actively involved, and professions associated with carrying various heavy objects. It is the regular performance of monotonous movements, which are based on flexion and extension of the elbow joint with simultaneous load on the hands and forearms, that becomes a factor contributing to the development of the disease.

Another common cause is trauma and microtrauma. In particular, the cause of inflammation in the posterior area of ​​the elbow is most often a fall on the elbow.

The risk group includes people with congenital connective tissue dysplasia. Often, people with thoracic and cervical osteochondrosis also develop epicondylitis.

Epicondylitis is more common in men. The risk of developing the disease is present in the more active hand, that is, right-handers are more likely to develop right-sided epicondolitis, and left-handers are more likely to develop left-sided epicondolitis.

Causes of ankylosis

The development of pathology has certain prerequisites and is most often caused by tissue fusion or activation of inflammatory processes, as well as the characteristics of recovery processes after injury.

According to numerous studies and best practices of domestic and foreign doctors, it is customary to identify the following causes of ankylosis:

• previous infectious arthritis - negative pathogenesis can cause fusion of bone ends;
• rheumatic diseases - pathologies involving joint tissues and causing inflammatory processes, as well as the scar formations that follow them, provoke loss of mobility;
• various groups of osteoarthritis - degenerative type lesions provoke structural changes, which causes the formation of bone growths that limit or provoke loss of the ability to perform movements;
• previous injuries - serious fractures and various types of dislocations that occur in the background significantly increase the risk of developing pathology, especially in the presence of infection;
• restriction of movements - immobilization or, in other words, a prolonged lack of the required level of mobility of the musculoskeletal region leads to a shortening of muscle movements, forming certain changes. Soft tissue structures grow together, which leads to various types of pathologies.

Ankylosis in children

Since bone tissue is in the active growth phase at a young age, bone ankylosis predominates in children. They often become the result of purulent inflammatory processes, birth and other types of traumatic injuries (fractures, dislocations). In the absence of correct and timely treatment, complications develop that affect not only the damaged joint, but also other structures - shortening and curvature of the limbs, malocclusion, etc. (as active growth and maturation of tissues continues).

A common childhood pathology is ankylosis of the temporomandibular joint.

Pathogenesis of the disease

It is the cartilage that creates comfort and optimal conditions for free movement, ensuring the sliding of the surfaces that form the joint, the mobility of which is achieved exclusively due to the natural properties of the synovial membrane and, of course, the tissues adjacent to it.

The development of the pathology in question involves a violation of one or several links responsible for the mobility of the musculoskeletal system.

The most common sign of ankylosis is considered to be complete or partial loss of cartilage with the provoked fusion of joint surfaces and the proliferation of fibrous formations. In rare cases, cartilage fusion is observed.

Types of disease

The disease is classified depending on the location of the inflammatory processes and their severity. The following types of illness are distinguished.

• External or lateral epicondylitis - the inflammatory process mainly spreads along the outer part of the elbow. This type of disease is also called “tennis elbow” because typical for professional tennis players. When performing grasping movements, carrying or lifting objects, there is a disturbance in the movement of the hands, which is accompanied by painful pressing sensations over the bones that enter the joint area.
• Internal or medial epicondylitis - localization of the inflammatory process occurs along the inside of the elbow joint. A person experiences discomfort in this area.
• Inflammation of the posterior area of ​​the elbow - characteristic is the development of bursitis and damage to the mucous membrane of the bursa.

Classification of ankylosis

In modern medicine, it is customary to distinguish several types of ankylosis:

• fibrous ankylosis – development is typical in conditions of prolonged lack of movement, as well as the course of non-purulent chronic processes. With this type, the key sign of ankylosis is the connection of bones with fibrous tissue. The results of the X-ray examination suggest a slight deformity, but at the same time, they note the preservation of the joint space. Functional capabilities are largely lost, leaving only the ability to perform minor movements of small amplitude;
• bone ankylosis – formed after purulent arthritis or intra-articular fracture. The bones fuse into a single mass, which makes it impossible to determine the joint space on X-ray films;
• cartilaginous ankylosis - detected mainly at a young age. The formation is caused mainly by arthrogryposis. The key features are loss of mobility, as well as disruption of the configuration of the ends of the articular bones, which is clearly visible on the x-ray.

Useful information about contractures

CONTRACTURES

The term contracture (contractura - narrowing; contraho - tighten, lat.) understands the limitation of the amplitude of passive movements in the joint with the involuntary nature of this limitation.
Naturally, every limitation of passive mobility in a joint is accompanied by a limitation of active movements in it. The complete absence of both passive and active movements in the joint due to bony fusion of the articular ends of the bones is called ankylosis. In addition to restriction of movement in the joint, any contracture is characterized by another symptom: early onset muscle atrophy. On the concave side of the affected joint there are compacted tissues and connective tissue scars. There are often signs of tunnel damage to the nerve trunks located in the joint area. Let us recall that contractures can be congenital (a component of many malformations of the musculoskeletal system - clubfoot, torticollis, arthrogrypposis, congenital clubhand, etc.) and acquired. Acquired contractures are a limitation of movement that occurs as a result of local traumatic, inflammatory, reactive and dystrophic pathological changes in the joint or in the tissues surrounding the joint - skin, subcutaneous tissue, fascia, ligaments, tendons, blood vessels and nerves.

Contracture in any joint of a limb can cause severe functional impairment. Thus, with contractures in the joints of the lower limb, patients cannot move freely, spinal deformity and flat feet develop on the healthy leg. Severe contractures in the joints of the hand make it completely non-functional, limiting the possibilities of self-care and work activity. In this regard, the prevention and treatment of contractures are among the tasks that a rehabilitologist solves.

Types of contractures

According to the position in which the limb is located as a result of movement restriction, flexion (limitation of flexion), extension (limitation of extension), adductor or abductor (limitation of adduction or abduction) and rotational (limitation of rotation) contractures are distinguished. As a rule, combined contractures are most common in the clinic. Contracture in the shoulder and hip joints is most often observed in the position of flexion and adduction. Flexion-extension contractures are usually found in the elbow joint and finger joints. With lesions of the wrist joint, both flexion and extension, as well as pronation-supination movements, are impaired. Contracture in the knee joint is often accompanied by a number of additional deformities: posterior subluxation of the tibia, curvature and outward deviation of the tibia. In the ankle joint, contracture may occur in plantar flexion, dorsiflexion, adduction, and abduction. It should be noted that the ankle joint, due to its significant mobility, is installed in a vicious position faster and easier than other joints of the lower limb. Contracture in the hip and knee joints results in a functional shortening of the limb, and contracture in the ankle joint (for example, with the equine foot) results in a functional lengthening of the limb.

An indication only of the type of contracture (flexion, adduction, etc.) does not yet give an idea of ​​​​the clinical significance of the existing limitation of movements for the patient. It is important in what range this limitation occurred: in a functionally advantageous or in a functionally disadvantageous one. For example, flexion-extension contracture in the elbow joint (hereinafter, a 180-degree system for assessing the range of motion is used, the anatomical position of the joint is taken as 0) within the range of extension 5°, flexion 60° (range of motion 55°), is disadvantageous with from the point of view of upper limb function. A greater limitation of movements, but in a different range (extension 60°, flexion 100°, range of motion 40°) is functionally more beneficial for the patient.

If, for example, there is a flexion contracture in the knee joint in a functionally advantageous position, and the range of motion in the joint is 15-20°, then using such a limb is much more convenient than if the range of motion was twice as large, but the flexion contracture in the knee joint was at right angles. The patient would not be able to use such a limb. Consequently, a small amplitude of preserved movements with a functionally advantageous position of the limb is more valuable for the patient than a larger range of movements within boundaries that are less favorable for function.

In accordance with the predominant localization of primary changes, contractures are divided into dermatogenic, desmogenic, tendogenic, myogenic and arthrogenic.

Dermatogenic contractures are a consequence of damage to the skin over the joint area and the formation of fairly extensive scars. Desmogenic contractures usually develop as a result of damage not only to the skin, but also to the underlying fascia, aponeurosis and ligaments with the formation of scars that prevent normal movements. Tendogenic and myogenic contractures are a consequence of the development of a scar process around the tendons and in muscle tissue. These contractures develop with paralysis and paresis (impaired coordinated work of agonist and antagonist muscles with a predominance of the function of intact muscles, persistent spastic muscle contraction), or as a result of prolonged fixation of the joint in a vicious position. The cause of the development of arthrogenic contractures is pathological changes in the articular surfaces or the ligamentous-capsular apparatus in acute or chronic diseases of the joint (long-term limitation of joint function leads to the fact that the joint capsule shrinks and thickens, articular cartilage loses its elasticity and strength, foci of necrosis appear in it, subsequently scars appear, welding it to the capsule). There is also a process of wrinkling of fascia and proliferation of intermuscular connective tissue, which partially replaces muscle tissue. Scars fuse tendons and other soft tissues with bones. So-called “third points of fixation” arise, which are a persistent obstacle to movement in the joints.

Since the pathological process rarely affects one particular tissue, mixed forms are often observed in the clinic: dermatodesmogenic, tendomyogenic, arthromyogenic.

Based on etiology, neurogenic, reflex, immobilization, ischemic, post-traumatic, post-burn, and professional contractures are conventionally distinguished (the convention of this division is due to the fact that several factors often play a role in the origin of contracture - for example, trauma, immobilization, and ischemia). In his practice, a neurorehabilitation specialist most often deals with the first three types of contractures.

Neurogenic contractures are usually called contractures that occur with diseases or damage to the nervous system as a result of changes in nervous regulation: disruptions of reflex processes, disruption of connections between the cortex and the subcortical and underlying parts of the nervous system. An example is contractures in patients with damage to the extrapyramidal system (spasmodic torticollis, torsion dystonia), in patients with spastic hemiplegia developed as a result of pathological processes in the cerebral hemispheres (cerebral stroke, traumatic brain injury, tumor), in patients with various diseases and injuries spinal cord. In spastic hemiplegia in patients who have suffered a cerebral stroke, early and late contractures are distinguished. Early hemiplegic contracture develops during the acute period of cerebral stroke with massive brain damage (bleeding into the ventricles, etc.), and is characterized by attacks of particularly strong tonic spasm. These attacks can develop under the influence of various irritations and are accompanied by changes in pulse, breathing and pupil size. In favorable cases, protective reflexes begin to further regress, which is associated with the disappearance of symptoms of early contracture. Late hemiplegic contracture manifests itself from 3 weeks to several months after a stroke. Its manifestations are usually reduced to flexion of the forearm, pronation and flexion of the hand, flexion of the fingers and extension of the thigh and lower leg - Wernicke-Mann position. In addition to the most common position in which the limbs are fixed during late hemiplegic contracture, there are a number of individual variations. These are contractures with a predominance of excessive pronation or supination of the hand or with rotation of the foot inward or outward, as well as with flexion on the side of paralysis of not only the arm, but also the leg. These flexion postures with late hemiplegic contracture are associated with simultaneously existing pain.

With various lesions of the spinal cord, contractures can manifest themselves in the form of an extension position of the legs (tonic extension of the hips, legs) - the so-called extensor contracture) or in the form of a flexion position of the legs (tonic flexion of the hips and legs - flexor contracture). Extensor contracture is more typical for predominant damage to the pyramidal tracts of the spinal cord, accompanied by increased tendon reflexes and the appearance of clonus of the patella and feet. Flexion contracture often indicates damage to both the pyramidal and extrapyramidal tracts and is characterized by the presence of pronounced protective reflexes.

Neurogenic contractures can also be a manifestation of disinhibition of motor neurons of the spinal cord and brain stem due to a toxic-infectious process: for example, convulsive muscle contractions during tetanus, which can be expressed not only in individual paroxysms, but also have the character of persistent contractures of the muscles of the face, trunk and limbs; tonic convulsions in case of strychnine poisoning. Persistent contractures can also be observed during hysteria. Moreover, the distribution of contracted muscles always reproduces some kind of voluntary movement or expressive action, and the whole syndrome is clearly associated with some kind of mental experience; the immediate relief of contracture after psychotherapy confirms its hysterical origin.

Neurogenic contractures are most often myogenic and are associated with disruption of normal muscle balance and, as a result, with prolonged forced positioning of the joints.

Reflex contractures occupy a special place. They occur with lesions of peripheral nerves as a result of chronic irritation of various parts of the reflex arc due to wounds, ulcers, and damage to peripheral nerve trunks. Reflex contractures are characteristic of wartime, but are rare in peacetime. Reflex contracture is characterized by peculiar signs of rigidity and paralysis, but there are no objective signs of contracture (limitation of passive movements) and paralysis (changes in muscle tone and reflexes, muscle atrophy). According to I. I. Rusetsky [1954], these patients do not have “real” contracture, there is no “real” paralysis, or as it is said about the features of reflex contracture, “paralysis is not paralysis, contracture is not contracture.” With reflex contracture, the hand takes an almost motionless, frozen position, the fingers are usually straightened, elongated, the hand takes the position of the “obstetrician’s hand.” There may be other positions of the fingers: they are often bent in the main phalanx, occupying a cross position in relation to the other fingers. The brush takes the shape of a scissors or “tobacco-grabbing” position. Contracture of the hand is often accompanied by slight flexion in the wrist and sometimes in the elbow joints. The arm can be brought towards the body. The lower limb in patients with reflex contracture is usually shortened: the leg is bent at the knee joint, and the foot takes the shape of a horse's foot. In other patients, the foot may be concave with bent toes like a vulture or with straightened toes, and be in a position of increased supination and adduction. This position of the limb remains the same when the patient lies on his stomach. With some effort, the doctor manages to straighten the affected leg, but then it bends again and returns to its previous position.

The nature of reflex contractures is associated with direct irritation of peripheral nerve fibers, with ischemia of nerve trunks, with disorders of autonomic innervation, as well as with psychopathological characteristics of the patient’s personality.

Immobilization contractures develop with prolonged immobilization, and when the joint is immobilized not in a physiological, but in a vicious position, the contracture develops much more often and faster.

Ischemic contractures occur as a result of impaired blood circulation in muscles, nerves and other tissues, followed by scarring. These contractures develop after injuries to large arterial trunks, when they are compressed by a plaster cast, a hemostatic tourniquet, bone fragments, or with severe tissue swelling. Ischemic damage to the nerve trunks and perivascular nerve plexuses plays an important role in the origin of these contractures. An example of a typical ischemic contracture is Volkmann's contracture.

Typically, contracture is only one of many symptoms of an underlying disease or condition. The time at which contracture occurs varies widely and depends on the etiology. Thus, after injury or inflammation, deformation as a result of a slowly developing scar process can progress over several months, while Volkmann's ischemic contracture develops over several hours.

Examination of a patient with contracture

The appointment of restorative measures should be preceded by a thorough examination of the patient. After a detailed clarification of the history of the disease, a comparative examination of the limbs is performed (trophic changes in tissue, the degree of muscle atrophy, mobility not only in the affected but also in neighboring joints) and a manual examination (assessment of the amplitude of movements, muscle strength, muscle tone). Attention is also paid to the presence of sensory disorders in the peripheral nerves. The results of the examination and manual examination are compared with the data of instrumental research methods (radiography, electromyography).

X-ray examination of the joint during contractures is crucial in the presence of arthrogenic changes (assessment of changes in the articular ends). For other types of contractures, this study helps in differential diagnosis. It must be remembered that the long-term existence of dermatodesmogenic or myogenic contractures leads to secondary changes in the joint such as osteoarthritis, which are also visible in the picture.

Interference and stimulation electromyography, electrodiagnostics are used to assess the degree of disruption of muscle innervation.

Based on the examination results, an idea is formed about the specific mechanisms of the pathogenesis of this contracture or ankylosis, the role of biomechanical, pain and psychological factors in its development is assessed, which is necessary to develop an optimal plan for rehabilitation treatment

Prevention of contractures

Preventing the occurrence of contracture is much easier than curing it. The main methods of prevention include:

• ensuring the correct position of the limb in case of muscle paralysis or in case of immobilization of the limb with a plaster cast;
• timely administration of measures aimed at eliminating pain, swelling, and tissue ischemia;
• early provision of movement in the joints of the affected limb.

The primary preventive measure includes positioning the limb using splints and orthoses in the correct position - i.e. in a position corresponding to the average physiological one and at the same time helping to prevent edema and ischemia of the limb. This position prevents tension on the capsule and ligaments of the joint and promotes maximum muscle relaxation.

By immobilizing the segment in a physiological position, a significant reduction in hypertension of muscle groups and a decrease in intra-articular pressure, reducing pain, if any, is achieved. Relief of pain syndrome is very important from the point of view of prevention, since pain contributes to the occurrence of protective pain contractures. To eliminate pain, analgesics and physiotherapy (electrophoresis of analgesics, ultrasound) are prescribed.

Correct immobilization includes not only giving an average physiological position, but also ensuring an elevated position of the limb, since edema contributes to the development of contractures.

Methods for preventing contractures include the early prescription of passive and active therapeutic exercises. Muscle contraction and joint movements enhance tissue nutrition and metabolism, accelerate the resorption of pathological products, thereby preventing the occurrence of contractures. In this case, however, rough violent passive movements that cause pain and reflex muscle spasm should be avoided.

Treatment of contractures

Treatment of contractures requires a lot of time and labor, strict individualization of treatment and, despite this, does not always give satisfactory results.

Rehabilitation of patients with contractures begins, as a rule, with conservative measures. Their nature largely depends on the underlying disease, location and type of contractures. However, there are general principles of treatment, which include:

• very gradual stretching of contracted tissues, carried out after preliminary relaxation of the muscles;
• strengthening muscles stretched due to contracture (muscles antagonistic to contracted muscles);
• ensuring painless effects.

It is important to achieve a conscious attitude of the patient towards the applied therapeutic measures.

The basis of complex treatment of contractures is treatment by position and kinesitherapy (active and passive therapeutic exercises).

Treatment by position is carried out with the aim of stretching the contracted tissues. For this purpose, orthoses and splints are used. It is important that the corrective force be small in magnitude. The use of low force eliminates the risk of pain due to tissue trauma. Pain, as is known, causes reflex muscle tension, which not only serves as a serious obstacle to eliminating contracture, but often helps to strengthen it.

At the same time, the corrective force should act as continuously as possible. The forces that fix the joint in a vicious position are very small, but their action is constant and long-lasting. The force that removes the joint from a vicious position should be the same. It is necessary to use a continuous force that lies below the “pain threshold of irritation”, increased gradually, in a “drip” manner, and therefore, to a certain extent, almost imperceptible to the patient.

Kinesitherapy is carried out in the form of passive and active therapeutic exercises. Using passive physical exercises, they try to stretch the contracted muscles and periarticular tissues. In this case, special attention is paid to activities to relax the muscles.

The goal of active exercise is to increase the muscle strength of the stretched muscles, i.e. muscles whose function counteracts contracture. So, with flexion contractures, it is necessary to strengthen the extensor muscles. This is essential not only in the treatment of contracture, but also in preventing its recurrence.

If conservative therapy for contractures is ineffective, surgical treatment is used, which consists of various plastic surgeries on soft tissues and bones: types of skin grafting, myotenolysis, tenotomy, capsulotomy, arthrolysis, etc.

The prognosis in the treatment of contractures depends on its nature and type, the time that has passed since its occurrence, the age and condition of the patient, the date of initiation of treatment and its usefulness. Early treatment usually achieves significant positive results.

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Symptoms of ankylosis

The symptomatic picture is formed individually and depends on the form and stage of the existing disease. It is worth noting that a general clinical picture is still identified, which is observed to some extent in most patients.

In connection with the above, it is worth paying special attention to such general symptoms of ankylosis as:

• pain caused by tension in the muscle frame, as well as their persistence due to a localized pathological process;
• stiffness, manifested mainly in the first hours after waking up from a night's rest (in the initial stages it goes away within half an hour, as it progresses, a longer period is required);
• mild swelling or noticeable swelling;
• local change in skin color (redness), accompanied by an increase in temperature;
• noticeable deformation (exclusively in the later stages), expressed in an increase in the size of the joint and the acquisition of uneven outlines.

It is also necessary to note the existence of a group of specific symptoms of ankylosis, which include:

• severe pain and swaying of the joint joint affected by the disease (with the development of the fibrous form);
• loss of the ability to move, accompanied by pain and severe discomfort (in the bone form).

Symptoms of Elbow Arthritis

The symptoms and course of elbow arthritis depend on its clinical form. But the first manifestations and obvious symptoms also have common characteristics.

First signs

When arthritis of the elbow joint begins, the symptoms may be severe or mild. The skin over the site of inflammation swells, turns red, and it is difficult to move the hand due to severe pain. Fever and chills may appear.

In subacute and chronic cases, the disease can begin unnoticed. The pain syndrome is erased, the swelling in the elbow area is insignificant. Limitation of mobility also increases unnoticed and manifests itself in the form of morning stiffness, which quickly passes after the person begins to move.

When the first symptoms of elbow arthritis appear, you should immediately seek medical help!

Obvious symptoms

In an acute course, characteristic signs appear immediately and cannot be ignored. In the absence of adequate treatment, the inflammatory process becomes less acute over time and the course becomes chronic and protracted and much more difficult to treat.

Obvious signs of chronic arthritis of the elbow joint: increasing pain and periodic swelling in the elbow area, limitation of movements in the arm. If at first movement in the elbow was limited due to pain, then after some time the limitation of movement will become permanent and will not depend on exacerbations of arthritis.

It is better to consult a doctor as soon as possible, but if you do not immediately notice signs of arthritis, do not despair, you can help in any case.

When you need to see a doctor urgently

Sometimes arthritis of the elbow joint occurs with complications, as evidenced by the presence of the following symptoms:

• high fever more than 5 days after the onset of the disease;
• a sharp rise in temperature with existing arthritis;
• significant increase in pain and swelling.

If these symptoms appear, you should call a doctor at home!

To better understand how elbow arthritis develops, you need to know how the elbow joint works.

Current diagnostic methods for ankylosis

If you notice the presence of a number of signs or symptoms of ankylosis, you should immediately seek the help of a treating specialist.

Before diagnosing and starting treatment for the disease, you should understand which doctor to contact. Of course, it is recommended to visit a therapist who will collect anamnesis and recognize the existing disease. After an initial superficial diagnosis, a patient with ankylosis is referred to a traumatologist, orthopedist or surgeon.

As for diagnosis by highly specialized specialists, the first stage is a visual examination. Determining swelling or redness of the surrounding tissues, as well as changes in the shape of the joint and the degree of reduction in the range of available movements provide an opportunity to assess the patient’s condition and tell a lot about the existing disease, for example, the features of its course, the degree of progression and, of course, the prospects for recovery.

In order to accurately make a diagnosis and determine the type of illness, the patient is referred to instrumental diagnostic methods, which include radiography, MRI and CT.

Diagnosis of joint ankylosis

Diagnosis of joint ankylosis begins with a consultation with a surgeon or traumatologist. The patient's medical history is assessed, the range of motion in the affected joint is determined, and the further necessary plan for examination and treatment of identified ankylosis of the joint is formed.

MRI of the knee joint in the sagittal plane (ligaments, meniscus, articular cartilage) with ankylosis.

Of the hardware methods for diagnosing joint ankylosis, a doctor can prescribe and carry out:

• CT joint (computed tomography)
• Joint MRI (magnetic resonance imaging)
• radiography of the joint (arthrography)

Treatment of ankylosis

Like any other disease of the musculoskeletal system, treatment of ankylosis involves a combination of available methods. It is worth noting that due to a number of features of the pathogenesis of the disease, drug therapy is used primarily to eliminate the etiological factor, as well as relieve pain. Despite the variety of therapeutic methods, surgical intervention remains the only advantageous and most effective solution.

Conservative treatment of ankylosis

Conservative therapy is used in the treatment of fibrous type ankylosis. In order to eliminate pain, physiotherapeutic procedures are used such as:

• mud baths;
• electrophoresis using painkillers;
• therapeutic exercises and massage;
• Spa treatment.

Surgical intervention for the treatment of ankylosis

In a situation where conservative therapy is not able to give the desired results or attempts to use it are obviously pointless, the time comes to make more radical decisions, namely, preparation for surgical intervention.

In order to eliminate bone tissue fusion, one of the following operations can be used:

• redressing – forced stretching of tissues with subsequent restoration of their anatomical position;
• osteotomy - a deliberate fracture of the joints in order to restore the natural connection of the articular ends;
• arthroplasty – isolating excess bone formations formed during the progression of pathology, using a spacer made of artificial material that ensures free movement of articular elements;
• endoprosthetics.

There is a list of contraindications to surgical intervention, including the active development of the inflammatory process in the periarticular tissues.

Drug treatment of ankylosis

Drug treatment is mandatory when performing operations of varying complexity.

In order to relieve inflammation before or after surgery, non-steroidal anti-inflammatory drugs (NSAIDs) are used. If inflammation is observed before surgery, then surgical manipulations will become possible only after 6-8 months after the inflammation has resolved.

For fibrous types of the disease, treatment uses analgesics to relieve pain.

It is also worth noting that after the surgical intervention, in order to achieve the most effective result, medications from the group of chondroprotectors are prescribed, which help accelerate regeneration. Artracam is considered to be one of the most effective drugs of this type.

IMPORTANT! determination of the list of medications, as well as the dosage and duration of their use should be determined exclusively by the attending physician.

Ankylosis is the fusion of the bones of a joint. Do not let the joint become ankylotic!

Our doctors

Meet our specialists
Work experience 30 years Status Orthopedic traumatologist Qualification Doctor of the highest category

Donskoy E.O. Chief physician of the medical center "MEDICUS". Receives patients with diseases of the joints and spine.

Work experience 35 years Status Orthopedic traumatologist Qualification Candidate of Medical Sciences

Averyushkin A.V. Engaged in conservative and surgical treatment of injuries and orthopedic pathologies, Candidate of Medical Sciences, author of scientific works.

Work experience 45 years Status Orthopedic traumatologist Qualification Doctor

Khudoleev M.V. Traumatologist-orthopedist, surgeon, sports medicine doctor.

Work experience 15 years Status Orthopedic traumatologist Qualification Doctor of the highest category

Malofeev V.A. He is fluent in all the necessary methods of diagnosing and treating orthopedic pathologies and successfully restores patients.

Work experience 5 years Status Masseur Qualification Massage

Zolotukhin V.V. Massage therapist at LDC MEDICUS. Viktor Vasilyevich’s magical hands put hundreds of patients on their feet and relieved pain.

Work experience over 30 years Status Nurse Qualification Nurse

Pugacheva O.N. Graduated from Leningrad Medical School. Works as a nurse.

Work experience 10 years Status Physiotherapy nurse Qualification Highest category

Murzakova A.Z. In 1981 she graduated from the Ufa Medical School. In 2012 - “Center for Advanced Training of Specialists No. 1”. Specialty: physiotherapy.

Work experience over 20 years Status Chiropractor Qualification Highest category

Azimov O.A. Specializes in the treatment of diseases of the joints and spine, rehabilitation after injuries and fractures. Works as a chiropractor at the Medical Center MEDICUS.

Work experience 4 years Status Nurse Qualification Junior nurse

Semenyuk E.B. Graduated from St. Petersburg Medical College No. 2. Works as a nurse at the Medical Center MEDICUS.

Work experience 30 years Status Nurse Qualification Highest qualification

Gadzhieva L.A. Graduated from Leningrad Medical School. Works as a senior nurse at the Medical Center MEDICUS.

What is the cause?

These can be joint fractures, arthritis, arthrosis, open wounds. Especially if such pathologies are accompanied by a long process of suppuration. Chronic infections can also cause this pathology. And infectious arthritis is considered perhaps the most common cause of ankylosis.

Staying in a cast for a long time can also cause ankylosis of the joints.

What are the signs to determine that ankylosis is developing?

The early stage of the pathology is characterized by poor joint mobility; at an advanced stage, its immobility occurs. With bone ankylosis there is no pain. With fibrotic pain syndrome can be observed if the joint retains the ability to rock.

Results of our patients BEFORE and AFTER treatment

Evgenia Semenovna, 67 years old.

Arthrosis of the knee, stage 3, was sent for joint replacement surgery. With the help of plasma, I coped with arthrosis in 3 sessions. Refused the cane. Avoided surgery. There is no pain, the cartilage and joint capsule have been restored. The duration of treatment is a week.

Pavel Ivanovich, 73 years old

Periarthrosis of the shoulder joint stage 2. I was treated by chiropractors, with leeches and needles - it didn’t help. The plasma caused the regeneration of lost tissue. Full mobility returned, chronic pain of 15 years went away. The treatment period is 10 days.

Natalya Igorevna, 59 years old

Osteochondrosis complicated by hernia formation. Excruciating back pain was relieved in one session. Neurological manifestations - goose bumps in the legs, numbness in the lower leg - disappeared after the second procedure. Course - 2 weeks.

Taisiya Romanovna, 82 years old

Arthrosis of the hip joint stage 3. The operation was refused due to his age and heavy weight. Plasmacytopheresis restored the joint capsule, restoration of articular cartilage and joint lubricating fluid production occurred. Course - 7 days.

Roman Stepanovich, 73 years old

Headaches, cervical osteochodrosis and vertebral hernias. As a result of treatment, headaches disappeared and pain in the cervical spine decreased. The pictures show restoration of the paravertebral tissues, reduction of the hernia.

How to reliably identify ankylosis?

In most cases, radiography is sufficient. However, there is a danger of mistaking ankylosis for contracture. If necessary, and for a more detailed examination, magnetic resonance and computed tomography are used. This is a more accurate diagnosis.

Diagnostic methods

Magnetic resonance imaging

The most effective and accessible research method, presenting information in 3D volume. MRI images are a clear illustration of what is currently happening with the patient’s spine, joints or other structures.

X-ray examination

A method for quickly assessing the condition of internal structures by obtaining an image using x-rays passed through an object. Fast, inexpensive, informative.

ULTRASOUND DIAGNOSTICS

Study of the body using ultrasonic waves. The ability to evaluate organs in motion. Passing through structures of different densities, ultrasound is reflected from them - this gives a picture of the state at the time of the study.

Biochemical analysis

This is a blood test. Show me your tests and the doctor will tell you who you are. This is the fastest and most accurate way to find out everything about the biochemical processes occurring in the patient’s body. Inexpensive, fast, effective.

Electrocardiogram (ECG)

Electrocardiography is the study of the electrical activity of the heart. For measurements, special electrodes are applied, the cardiograph records changes in the work of the heart and displays them in the form of a cardiogram.

How to treat ankylosis?

The main direction is to restore mobility, which means removing swelling and inflammation and eliminating pain, if any. Methods for helping with ankylosis are different; physiotherapeutic techniques, such as electrophoresis, UHF and others, are considered effective. In any case, the doctor has the final say. The MEDICUS clinic offers a full range of assistance for joint diseases, and if your joint needs help, sign up for the online registration using the registration form from the website or by calling 986-66-36.

Treatment methods

Joint reconstruction
1 procedure per course FREE!

Introduction of organic serum with hyaluronic acid into the joint capsule. As a result, cartilage reconstruction occurs Read more…

Neuroprotective therapy

Discount -10%! Only 3 days!

Neuroprotectors are new generation drugs that can restore the conduction of impulses in nerve tissues. Read more…

Plasmacytopheresis

1 procedure for the course is FREE!

Treatment and healing of cartilage with growth factors. Restoration of joint tissue with purified platelet blood. Read more…

Transdermal therapy

Discount -25%! Only 3 days!

The introduction of titanium glycerosolvate into a diseased joint is a unique method of drug delivery without surgery or painful injections. Read more…

Ultraphonophoresis

Discount -25%! Only 3 days!

This is an innovative way to administer medications using ultrasound, which has the unique ability to loosen tissue. Read more…

EHF therapy

Discount -25%! Only 3 days!

This is a promising method of physiotherapy with a great future. In life, waves of this range do not reach the ground, being dispersed in the atmosphere. The device generates these waves itself. Read more…

Infusion therapy

Combinations of drugs for drip administration through a vein. High digestibility and rapid achievement of therapeutic action make infusion therapy Read more…

Blockade

1 procedure for the course is FREE!

A joint or spinal block is a way to quickly help a joint or back. In case of acute pain, the blockade helps to quickly relieve pain and help locally Read more…

Introduction of chondroprotectors

"HONDRO" in Latin means "cartilage" and that says it all. Injection of cartilage cells into damaged segments of the spine Read more...

Autohemotherapy

Treatment using the patient's autologous blood cells. Blood is administered intramuscularly, which provokes the body to intensify the fight against chronic infection, suppuration and trophic ulcers, the immune system is strengthened and effectively resists new infections. Read more…

Laser treatment

Infrared healing with a wavelength of 0.8-0.9 microns affects the internal source of the problem. This relieves inflammation, swelling and pain in the joint. Degenerative processes in the joint fade away as metabolic processes inside the joint accelerate many times. Read more…

Peloid therapy

Nutrition and growth of cartilage cells using peloid dressings. The base comes from Lake Sivash, where mud with a high concentration of Dunaliela Salina microalgae, which is rich in beta-carotene, is extracted.

Why is ankylosis dangerous?

Complications of the pathology include respiratory failure, changes in the position of internal organs and disruption of their functions, skeletal deformation and, in some cases, complete disability.

Prognosis and probable complications of ankylosis

Ankylosis has a rather unfavorable prognosis. In most cases, the disease can only be overcome through surgical treatment.

Regardless of the success of the method used, the pathology is prone to reappearance (subject to partial prosthetics and simpler operations).

Full restoration of the motor function of the joint is extremely difficult to achieve, even with complete replacement of the affected tissues, because the surrounding muscle frame atrophies as the disease progresses.

Basic methods of surgical correction of TMJ ankylosis

If the patient has underdevelopment of the jaw, then at the first stage the surgeon lengthens the body of the lower jaw to normalize the position of the tongue and unblock the upper respiratory tract, eliminating hypoxia. This procedure is performed either by osteotomy, reconstruction of the lower jaw, or by the distraction method using an external or intraoral apparatus. At the second stage of treatment, a false joint is formed as close as possible to the real joint or plastic surgery of the temporomandibular joint is performed with a preserved, artificial or natural joint.

After surgical correction, the jaw is pulled forward and down, the fragments are separated by 2-3 cm, the bone is covered with metal or plastic caps, and soft tissue is formed.

Methods for preventing ankylosis

You can prevent the possibility of loss of functionality of joint joints at any age if you follow a number of medical recommendations, which include:

• timely contact a traumatologist if injury is suspected;
• proper treatment of acquired injuries of various parts of the musculoskeletal system, subject to the condition of preventing their prolonged immobility;
• systematic performance of gymnastic exercises and dosing of physical activity.

Remember that prevention is the best cure for any disease, even the most difficult to treat.
Have you been diagnosed with ankylosis? Do not despair, because a serious attitude to the recommendations of the attending physician, combined with modern medical technologies, can significantly improve the quality of life for various musculoskeletal diseases.

Prevention

Most often, tennis players, painters, carpenters, and massage therapists are exposed to the disease. If you belong to a risk group, you should definitely know what prevention should be for epicondylitis. Preventive measures include:

• primary actions are aimed at preventing the disease;
• secondary – the goal is to prevent exacerbation of an existing disease.

Both types of activities are based on the same recommendations.

• You should try to avoid or at least limit monotonous, stereotypical movements that will increase the load on the joint.
• To protect your elbow, you should wear an elastic bandage or elbow pad. This way you can ensure proper fixation of the tendons and distribute pressure evenly on the muscles. In addition, a light massage will be performed as you move.
• Before you play sports, you need to warm up your muscles. It is important to pay attention to warming up the joints, which will help improve blood circulation.
• It is necessary to perform exercises, maintaining adequate intensity and frequency, and give the body time for breaks.
• Sports equipment must be selected correctly, the load must be feasible.
• Shock absorbers and suitable protective pads and dressings should be used.

If, due to your chosen profession, you are at risk for epicondylitis of the elbow joint, then:

• try to be in a comfortable position while working;
• avoid monotonous movements;
• change your activities from time to time;
• be sure to take regular massage courses;
• watch out for spinal diseases;
• take mineral complexes;
• the diet should contain the required amount of vitamin D, as well as calcium (include cottage cheese and fatty fish in the menu);
• If you experience discomfort or pain in a joint, do not self-medicate with folk remedies, consult a doctor.

As for the prognosis, we can say: it is favorable if the patient consults a doctor on time. With proper treatment, relief occurs after 3-4 days. If the patient follows the doctor's instructions, long-term remission can be achieved.

External epicondylitis of the humerus

It is expressed in sharp pain in the area of ​​the outer epicondyle of the humerus - this is a bone protruding from the outside in the area of ​​the elbow joint. If you put your hands on your belt and try to walk through a doorway, these are the bones with which you will hit the frame. The brachioradialis muscle (m.brahioradialis), which is responsible for dorsiflexion of the hand, is attached to this bone. In a non-professional environment, this movement is called extension. Inflammation occurs at the place of attachment to the humerus - the external epicondyle. It occurs due to overstrain of muscle fibers, which can occur due to repetitive movements of the same type: working with a hoe, practicing with a tennis racket or spinning rod.

If such loads occur spontaneously after a long break, this is often the cause of the onset of inflammation. The fact is that during the rest period we often lean on a table top or handrails or hold a smartphone in our hands, so this muscle is in a shortened state. When we begin to work with a contracted muscle, the load on the attachment site increases, which leads to inflammation, accompanied by partial breakage of muscle fibers, which causes even greater inflammation. Since this area is poorly supplied with blood and is often subjected to stress, the inflammation drags on and becomes chronic. In the patient, external epicondylitis causes great discomfort: the pain makes it difficult to pick up a teapot or cup, and sharply intensifies with any muscle tension in the hand and straightening the arm at the elbow joint.

Causes of the disease

The exact causes of the disease “crooked fingers” have not yet been identified. Several decades ago, it was assumed that contracture appears due to improper protein and salt metabolism in the body. But these opinions were soon refuted. Possible causes of the pathology are:

• suffered a serious organ disease that caused a disruption in the functioning of connective tissues;
• disorders in the development of bone and joint structures (congenital);
• heredity;
• diabetes;
• inflammation and/or destruction in joints;
• hard physical labor;
• pinched nerve, etc.