Arthrosis of the 3rd degree - disability or not

A patient who has been diagnosed with arthrosis of the 3rd degree is entitled to disability, since we are talking about a chronic disease, with the development of which a person loses the ability to fully care for himself in everyday life.

Disability due to arthrosis is prescribed, guided by the relevant order of the Ministry of Labor, which defines the classification and criteria for medical and social examination.

How a knee problem can lead to disability

Almost every person has experienced pain in the knee, ankle and hip joints for one reason or another. Discomfort and severe pain can occur after too active (wrong) training in the gym. Those whose professional activities involve regular static loads often complain of pain in the knee area.

But not everyone experiences such pain regularly and is a symptom of a serious pathology, arthritis, when the joint becomes engulfed in inflammation and the destruction of its tissue begins, or arthrosis, when the pathological process is concentrated in the cartilage tissue and leads to a noticeable change in the shape of the joint. Therefore, the disease is called deforming osteoarthritis. In a number of patients, the genetic factor becomes dominant in the development of arthrosis.

It is important to understand that arthritis and arthrosis are different diseases, and accordingly, they have features in symptoms, course and development of complications.

With arthrosis, the process of nutrients entering the cartilage tissue is disrupted, which leads to a decrease in its functionality. Pain in a joint in which the pathological process has already started does not manifest itself at rest, as happens with arthritis.

The symptom appears only during movement (the leg at the knee is sharply bent and straightened) and during strong physical exertion. As the process progresses, the knees begin to hurt even with low loads. At the 3rd stage of arthrosis, the pain syndrome is already disturbing even at rest.

If previously deforming osteoarthritis was more typical for elderly patients, today a similar problem is increasingly encountered in middle age, and children

Causes

Post-traumatic arthrosis belongs to the group of secondary arthrosis, that is, injuries are a factor contributing to its development. For example, when a joint is injured, tissue rupture occurs, against the background of which inflammatory processes occur. Risk factors for the development of arthrosis also include sprains, fractures, meniscus tears, and dislocations. Any injury, alas, does not go away without a trace. Even minor damage affects blood vessels and nerves. The tissues of the joint are less well supplied with blood, and it is impossible to transmit signals from the brain to the muscles through damaged nerves. This provokes the development of a degenerative process in the joint.

Thus, post-traumatic arthrosis is not considered the prerogative of only older people. Arthrosis after a fracture or sprain also occurs in young people. Most often, the ankle and knee joints are affected by this disease, and less commonly, the shoulder and elbow joints.

Characteristic signs

The main external symptoms of the pathology are:

Persistent pain in the joint (knee - gonarthrosis, hip - coxarthrosis);
Difficulty bending the joint, some stiffness;
Strong, “dry” crunch in the joint;
External deformation of the joint in the absence of swelling.

This is how the pathological process, hidden for the time being from view, manifests itself:

Cracks form in the cartilage itself, the cartilage layer becomes thinner and thinner;
The synovial fluid filling the joint cavity becomes less than normal;
The bone tissue under the cartilage becomes soft and prone to destruction.

The insidiousness of arthrosis lies in the fact that in the first stages the pain bothers you from time to time and is mistakenly associated with natural fatigue after long walking or standing, or staying in an uncomfortable position for a long time. Meanwhile, the disease progresses.

If the moment is missed, there is no longer talk of a complete recovery due to irreversible degenerative changes in the cartilage. Even correct complex treatment (conservative and surgical) can only minimize the manifestations of the disease and, as far as possible for a particular patient, prevent its progression.

In the worst case scenario, a complex and expensive operation will be required. Therefore, advanced arthrosis of the knee joint gives the right to disability. Depending on the further course of the disease and the results of subsequent examinations, disability will need to be periodically confirmed.

Degrees of gonarthrosis

Based on clinical manifestations, the following degrees of pathology are distinguished:

First stage. The appearance of mild pain after physical activity on the joints, which goes away on its own without medications. Short-term swelling in the joints may occur, but the shape of the joint does not change.
Second stage. The pain in the knees becomes more frequent and intensifies, and a crunching sensation occurs when moving. In the morning, the patient may complain of some difficulty in movement, which disappears after physical warm-up. The shape of the knees begins to change, their size increases.
Third stage. Pain is observed almost constantly, walking becomes difficult, and lameness appears. Deformation and increase in the volume of the joint are clearly pronounced.
Fourth stage. Clinical signs correspond to stage 3 of the disease, and it is possible to determine that the disease is progressing only by x-rays. It is noticeable on them that the joint space is completely absent.

Classification of deforming osteoarthritis according to Kosinskaya

The clinical and radiological classification according to Kosinska has been used since 1961 and is as follows:

Functional diagnostics, assessment of SDF

When a patient performs functional tests, the specialist measures the range of motion of the joint, and 4 degrees are distinguished:

less than 50% of the norm,
25-40%,
15%,
the joint is completely immobilized, the limb is shortened, fixed in a functionally awkward position.

To assess the SDF, the specialist relies on X-ray data and functional tests, and also pays attention to the following:

duration and severity of pain,
the pace of movement of the patient, the duration of the distance without a rest break, the ability to move without assistance and without devices,
change in leg size.

The following degrees of expression are distinguished:

Minor. The range of motion is reduced by less than 10%, compensation is normal, pain is observed only after exercise and goes away after rest.
Moderate. The contracture is moderate. Lameness appears. After rest, the symptoms go away. The limb becomes smaller by 4 cm or more, muscle strength decreases sharply, and the thigh circumference on the affected leg decreases by 2 cm.
Moderate, in a late stage. The contracture is clearly expressed, compensation is insufficient, pain is constantly present, the pathology progresses, the limb decreases in length by 5 cm, and the circumference of the lower leg decreases by 2 cm.
Expressed. The contracture is severe, the decompensated stage, lameness, the circumference of the lower leg decreases by 3 cm, the thigh by 7 cm, the limb becomes shorter by 7 cm. Muscle strength is practically absent,
Significantly expressed. The patient's movements are limited and he can move with difficulty, and only with the help of strangers or devices.

Evaluation criteria for assignment of disability

The question at what degree of arthrosis causes disability is partly incorrect. During a medical and social examination, the decision is made depending on the key factor - the presence of clearly defined structural disorders of the joint tissue, due to which the patient loses the ability to naturally move independently and lead normal life activities.

In case of deforming osteoarthritis, a second or third degree disability may be assigned depending on the results of an x-ray or other type of instrumental examination, confirmed by relevant medical documents.

The patient will have to undergo a new examination each time to confirm, extend and change the disability group

It is assumed that the patient's condition may worsen or improve depending on the patient's individual response to the disease and the prescribed course of treatment.

The disability group can be revised (lowered) if the patient has successfully undergone surgery on the joint and at the end of the rehabilitation period his condition has improved.

Life with coxarthrosis of the 2nd degree with disability

Disability is not just a group, benefits and benefits. This is a life associated with limited opportunities for work, communication and self-care. Arthrosis of the hip joint of the 2nd degree is accompanied by chronic excruciating pain, the inability to stand for a long time and walk normally. Buildings for public use (shops, organizations) and entrances to residential buildings are rarely equipped with special devices (handrails, gentle stepless lift, automatically opening doors). All this makes it even more difficult for disabled people to move outside the apartment.

The gentle rise significantly helps wheelchair users to move around

However, it is quite possible to overcome many of the difficulties: to make walking easier, be sure to use a cane or crutches - comfortable and light ones, which can be purchased at an orthopedic store. When walking and moving outside the home, do not hesitate to ask to be accompanied by relatives and close friends. People with disabilities have the opportunity to hire social workers (with preferential pay); there are private companies that provide paid services for accompanying and servicing people with disabilities - sometimes you can contact them.

Remember also about hip reconstruction surgeries. Although these interventions are expensive, they can restore functionality to the joint and remove most movement restrictions.

Features of the analysis of the condition of patients with arthrosis

All criteria for assessing disability are taken into account in Order No. 1024n adopted by the Ministry of Labor (previously Order No. 664n was in force), which has been in force since the beginning of February 2021. The document states that when a disability is assigned, the patient must have a persistent functional disorder associated with a violation of static-dynamic functions, that is, movement of the head, torso or limbs (including joints, bones, muscles).

The degree of violations is assessed on a scale of ten to one hundred percent. Patients with arthrosis have the right to be assigned disability status because, due to the characteristics of the disease, they fall under one of the categories of life activity described in the document, namely, impaired ability to move independently.

The category is expressed in one of three degrees:

They speak of the third degree if they cannot move independently at all without outside help and technical means;
About the second - if partial help is required;
About the first - when the ability to move independently is not lost, but for a longer period of time and aids are used.

A patient with deforming osteoarthritis will be assigned a third disability group if the examination results show that the persistent impairments caused by the disease are of the second degree (indicator 40-60%). In the second disability group, the rate reaches 70-80% and persistent impairments have a second degree. The first disability group can be assigned if a patient with confirmed deforming osteoarthritis is immobilized, cannot walk, stand, sit independently and constantly needs household assistance.

Medical and social examination for arthrosis

Completion of the examination is a necessary step in the group assignment process. Experts in the commission confirm the fact of disability, draw up a report, and issue the disabled person a certificate of the status he has received (the document indicates both the group itself and the period for which it is established).

At the first stage, medical indicators are taken into account, symptoms are studied, and the applicant’s outpatient treatment is studied. Data taken into account:

— blood and urine tests;

— fluorography and electrocardiograms;

- X-rays (more often they use Kosinskaya X-rays, reflecting the condition of the diseased joint);

— diagnoses made by a therapist, orthopedist, neurologist and surgeon.

When examining the X-ray results, specialists detect one of three degrees of motor limitation:

1 - movements are practically unrestricted, the narrowing of the joint space is small, and osteophytes are just appearing;

2 - difficulties in the movements of the joint are present, the joint acts only in one direction and any of its movements entails a crunch audible from a distance, while the joint gap has become two to three times larger, bone spurs have enlarged, epiphyseal cysts and moderate atrophy have developed muscles;

3 - there is no synovial fluid, the deformation and hardening of the joint have become pronounced, it is possible to perform only 5-7 rocking movements, the spurs have spread throughout the joint, there is overgrowth of the joint space and ankylosis (complete fusion of the joint, which in fact allows the problem to be assigned grade 4).

In addition to health, a person's social adjustment is examined, with an emphasis on the degree of disability. In particular, experts are interested in whether the patient can take care of himself, earn money, provide the basic necessities, etc.

For example, 1st degree can be established in relation to various aspects of life:

- limitation to self-care of this degree, indicates a person’s need for more time to perform familiar tasks, all movements are not possible in full, so they have to be divided and the use of an orthopedic device (cane, etc.);

— the ability to move first degree also means that the process will take a lot of time; movements are partial and impossible without aids (crutches, canes);

— orientation skill with the specified degree indicates the ability to determine oneself only in a familiar space or through technical means;

- the ability to communicate at a low level, assistants are needed in the form of equipment or people, the assimilation of information is incomplete;

— self-control in terms of behavior of the same degree gives an idea of difficulties in this area and partial self-correction;

- the ability to learn is marked with the mentioned degree, if the amount of work performed decreases, the previous qualifications drop, although the work as a whole is doable.

By studying the submitted documents, ITU members determine the effectiveness of arthrosis therapy, assess the current status and determine further prognosis. As a result, doctors analyze all available data and determine the degree of the disease and its impact on a person’s life, that is, they give one of three possible groups.

Which patients are prescribed a medical examination?

Medical and sanitary examination, which is a combination of a number of medical studies to assign disability, is carried out by patients with arthrosis who:

In addition to severe arthrosis, they have one or more other chronic diseases that further worsen their overall well-being;
Due to the progression of the disease, they experience serious problems with independent movement;
More than three years have already passed since the diagnosis and due to the active course of the disease, exacerbations occur more than three times every 12 months;
After surgery to eliminate the underlying pathology, they began to feel worse if complications arose and the patient was unable to move independently.

When conducting an examination, the results of the latest medical examination (the current condition of the problem joint) and the ability to move and care for oneself are taken into account. Work opportunities and level of socialization are taken into account.

For example, in patients with grade 3 gonarthrosis, the leg can, in principle, be immobilized and cannot bend - there is practically no cartilage left in the joint, and the bones can gradually grow together (we are talking about ankylosis). The patient is constantly in pain and it is almost impossible to move without the support of technical means and outside help.

A certain disability group is likely to be assigned to patients who have confirmed:

Coxarthrosis of the 3rd degree (pathology involved one or both hip joints);
Ankylosis of joints (knees, hip, ankle);
The disease caused a reduction in limb length by 7 cm or more.

If there is a slight decrease in the functionality of the joints, a patient with arthrosis may be denied a degree of disability.

Conditions for referral to MSE for arthrosis

Of course, it is not possible in all cases to obtain the appropriate status if you have the disease in question. The doctor determines the need to undergo an examination if an applicant for the group:

— has been suffering from arthrosis of the joints for three years since the onset of the disease, and the condition is prone to progression (at least three exacerbations occur per year);

— after surgery recommended for osteoarthritis, when there are disorders that negatively affect life;

— encountered significant violations of static-dynamic function.

If we consider the degrees of motor functionality, doctors will highlight three main ones:

- slight discomfort that occurs during certain movements (for example, flexion-extension of the knee, etc.);

- severe pain, a noticeable crunch, present even during normal activity, as well as a decline in the motor ability of the joint against the background of an increase in the muscle joints overlying the joint;

- changes in the structure of the joint, which can be designated as critical and, in addition, limited mobility with muscle swelling.

The process of registering a disability group

After consultation with the attending physician and clarification of the full list, a package of documents is provided to the medical institution for filing an application for assignment of a disability group. It is necessary to attach the results of the following medical studies:

X-ray in two projections;
Blood test (general), urine;
Fluorography and ECG;
Conclusions of a therapist, neurologist, and trauma surgeon.

The results of the comprehensive survey are reviewed by members of a special commission. The decision to assign a certain disability group is made when pathological changes are recognized as such that do not allow the patient to move and conduct life activities without assistance. The disability group is reviewed annually.

After a successful operation to replace the affected joint with an artificial one, the disability group is reviewed. After surgery, which is quite complex and requires the participation of at least two experienced surgeons, the functionality of the leg is restored and the patient is no longer limited in movement. But the attending physician (or a council of specialists) decides to carry it out only when all other treatment options have been exhausted.

What to do if you are not given a disability?

There are often cases when grade 2 coxarthrosis does not result in disability. Based on my experience, confirming disability is a difficult task. Of all the patients I referred to MSEC (I’m talking in general, and not about coxarthrosis separately), only about 60% receive disability. The commission refuses the rest, despite the fact that I and the patients themselves considered the grounds for disability sufficient.

So in the case of coxarthrosis - a majority vote of MSEC members can decide that the limitations in the functionality of the hip joint are not significant, and the patient can remain able to work with minor restrictions (hard physical labor is not recommended). However, if you do not agree with the decision of the MSEC, you can challenge it in higher authorities (regional, main bureau of the MSEC) or through the court.

Special factors

The decision to assign a second or third (less often, first) disability group may be affected by a number of additional factors related not only to the characteristics of the disease in a particular patient, but also to his lifestyle, weight and age. If the latter is unchanged, then all the others are quite amenable to adjustment, which means that the patient has every chance of significantly improving his condition and reducing the degree of disability:

Weight loss. An acceptable number on the scale is extremely desirable both from an aesthetic point of view and from a health perspective. For patients with arthrosis, it is important to get rid of extra pounds in order to reduce the load on the knees and other joints to normal. The treatment prognosis in this case will be more favorable and the risk of possible limb fractures or dislocations will be significantly reduced.
Strict adherence to the treatment regimen. It is necessary for any disease, but especially in the case of arthrosis. The patient must take medications prescribed by the doctor on an ongoing basis according to the prescribed regimen. This is the only way to provide support to weakened cartilage and stop the destruction process.
Passing a full medical examination and monitoring chronic diseases. Patients with arthrosis who also have problems with blood pressure, liver dysfunction, a diagnosis of diabetes mellitus, and hormonal disorders need to be especially careful. Regular examination and adjustment of treatment for these pathologies is important because they can also affect the results of treatment for osteoarthritis.

The age of a patient with arthrosis is taken into account because the later the pathology begins to develop, the more favorable the treatment prognosis.

Firstly, older patients are more often examined for a specific disease and are less likely to ignore the first symptoms, which make it possible to identify pathology at an early stage. Secondly, unlike young patients, their arthrosis does not have time to go through several stages and cause complications.