Microtrauma of joints occurs due to constant monotonous loads. Pain occurs due to inflammation of the periarticular bursa - periarthritis.
When you have shoulder and neck pain, you always want to take a pill to feel better. In no case should you do this in case of acute periarthritis: by reducing pain, you will perform the same range of movements, and this is a direct path to the chronic form of periarthritis.
Constant use of painkillers has a detrimental effect on the liver and other organs. Therefore, Doctor Ost calls for completely abandoning analgesics with their temporary effect and harmful side effects. We use modern methods of treating periarthritis, which allow us to quickly, literally in one visit, cope with pain and restore injured joint tissue.
Main reasons
The main causes of inflammation of the soft tissues located around the knee include:
- general or local hypothermia;
- intense loads on the joint;
- acute and chronic infectious diseases;
- injuries of bone, cartilage or soft tissue, as well as ligamentous apparatus;
- degenerative-dystrophic processes in the knee area;
- lack of adequate physical activity and physical inactivity;
- congenital defects of the ligamentous apparatus;
- chronic diseases of the bone and cartilage tissues of the knee joint: arthrosis, arthritis, osteochondrosis, osteoporosis, etc.
The risk of periarthritis increases:
- poor blood circulation in the lower extremities;
- atherosclerosis;
- excess body weight;
- type 1 and type 2 diabetes;
- hormonal imbalance;
- spasms in small and large vessels;
- increased blood viscosity;
- pathologies of the endocrine system.
The likelihood of periarthritis increases in professional athletes and young people whose work activities involve intense physical activity. Also at risk are patients who have undergone surgery on the lower extremities. During the rehabilitation period, they may develop inflammation of the soft tissues or ligaments surrounding the knee joint.
What is periarthritis of the knee joint?
Periarthritis of the knee joint is an inflammation of the tissues that surround it.
The disease is accompanied by degenerative changes. They involve muscle fibers, ligaments, tendons, and synovial bursae. They suffer from dystrophy, which results in reactive inflammation. According to statistics, about 10% of people experience periarthritis of the knee joint. Women aged 55 years and older are most often affected. Although sometimes this diagnosis is given even to children. Their joint tissues become inflamed during periods of active growth.
Signs
Symptoms of periarthritis are nonspecific and similar to signs of arthrosis, osteoarthritis and other pathologies, therefore, when diagnosing pathology, you should pay attention to the patient’s age and gender. Inflammatory processes in soft tissues more often occur in women after 40 years of age. In men, periarthritis is diagnosed much less frequently.
The characteristic signs of the disease, which make it possible not to confuse it with arthritis and osteoarthritis, include acute pain. In most patients, it is localized in the area of the connection of the medial condyle of the tibia with the semimembranosus, semitendinosus and sartorius muscles.
The pain in the inner part of the knee at rest is dull and aching. It worsens with any load on the knee area: doing exercises, climbing stairs, walking at a fast pace. Later, the pain syndrome intensifies even when turning from back to side and throwing back the leg, as well as when palpating the inflamed area.
In a neglected state, the following is added to the constant pain:
- swelling;
- swelling;
- redness of the skin;
- low-grade fever.
In acute inflammation, the patient experiences symptoms of general intoxication of the body: weakness, loss of appetite, dizziness, nausea, headaches. In an advanced state, soft tissue necrosis occurs. Dead ligaments and tendons become scarred. Calcium salts are deposited in the periarticular tissues, which limit the mobility of the knee. Later, mineral deposits cause its atrophy, complete immobility and disability.
Clinical picture of the disease
Under the influence of pathological factors, tendon tissues become inflamed, and foci of necrosis form in them. Subsequently, the connective fibers become denser, grow (cell sclerosis and fibrosis), and calcify.
The clinical picture of knee periarthritis is determined by the stage of its development. If at the initial stage the pain is barely noticeable and only bothers you during moments of overload, then as the pathology progresses, it becomes acute. Sometimes a person completely loses the ability to move normally.
In the vast majority of cases, the tendons of the semitendinosus and semimembranosus muscles at their attachment points become inflamed. The pain occurs when walking, when trying to bend the leg, and when standing for long periods of time. Palpation of the affected area allows you to identify characteristic painful points. Sometimes there is noticeable redness and swelling of the skin.
Treatment of acute periarthritis
Acute periarthritis is treated with medication: non-steroidal anti-inflammatory drugs for internal and external use, analgesics. Medicines can be supplemented with physiotherapeutic procedures.
Tablets and ointments for periarthritis
The main NSAIDs for periarthritis for internal use include:
- Movalis;
- Nimulid;
- Dicloberl;
- Ibuprom;
- Nurofen;
- Ketonal.
Non-steroidal anti-inflammatory ointments are also recommended:
- Diklak;
- Voltaren emulgel;
- Lyoton;
- Nimid.
Pain syndrome is relieved by analgesics:
- Analgin;
- Paracetamol;
- Solpadeine;
- Tylenol;
- Novalgin.
Painkillers are supplemented with complexes with B vitamins. For severe inflammation, glucocorticosteroid tablets or injections are prescribed: Diprospan, Kenagol, Hydrocortisone, Prednisolone.
Physiotherapy
Patients with acute periarthritis are recommended:
- high-intensity magnetic therapy;
- infrared laser therapy;
- electrophoresis with lithium, potassium iodide or novocaine.
In case of severe inflammation, it is also worth wearing a bandage, which will limit the mobility of the knee joint and reduce the load on the muscles, tendons and ligaments.
Types of periarthritis and depth of tissue coverage
There are three types of periarthritis, each of which symbolizes a certain stage of development of the process and tissue coverage:
- Simple periarthritis;
- Acute periarthritis;
- Chronic ankylosis.
"Painful shoulder" or simple periarthritis
The early stage of the process, in which the patient suffers from aching pain that intensifies at night. Limitations of mobility are barely noticeable and consist of increased pain when raising the arm or moving it behind the back.
The process is based on inflammation of the tendons and serous membranes of the shoulder muscles. Anti-inflammatory drugs and eliminating stress can get rid of unpleasant symptoms within a few weeks.
Acute periarthritis
The acute course is characterized by severe pain and limited mobility of the shoulder joint. It is already associated with deeper disorders in the tissues: single ruptures of tendon fibers, deposits of calcium salts in them and loss of their elasticity.
Treatment of glenohumeral periarthritis at this stage requires an integrated approach. The use of painkillers becomes ineffective - the pain becomes resistant and continuous, worsening at night. It often causes insomnia, which aggravates the patient's condition.
First of all, efforts are made to relieve the inflammatory reaction of tissues, along with which pain also decreases. After the patient’s condition has normalized, a set of physiotherapeutic procedures is prescribed to help remove calcifications and restore damaged tissues.
"Blocked Shoulder"
Chronic periarthritis is a complicated course of the disease in which not only tendons, but also the joint capsule are involved in the process. An important diagnostic symptom of this type of disease is impaired joint mobility: the patient is not able to even move his arm away from the body, let alone lift it up.
A professionally selected set of treatment methods helps eliminate pain and restore joint mobility. But discipline and perseverance are required from the patient.
Subacute therapy
In the subacute period, periarthritis is treated with ultraphonophoresis, cryotherapy, shock wave therapy, as well as paraffin or ozokerite applications.
Ultraphonophoresis
Ultraphonophoresis is a procedure using ultrasonic waves. They stimulate metabolic and regenerative processes, trigger renewal and restoration of soft tissues. For periarthritis, ultrasound is combined with hydrocortisone, a hormonal drug with anti-inflammatory properties.
Session duration is 5–6 minutes. Course duration is up to 10 procedures.
Cryotherapy
Cryotherapy is a procedure using liquid nitrogen. The substance suppresses inflammation, relieves pain and strengthens local immunity.
Session duration is up to 10–15 minutes. Number of procedures – up to 10.
Shock wave treatment
Shock wave therapy is a physiotherapeutic method using acoustic impulses. The procedure is aimed at relieving inflammation and pain, restoring soft tissue and mobility of the knee joint. UVT also destroys deposits of calcium salts, increases the strength of muscles, ligaments and tendons, and restores their elasticity, therefore it is suitable for the treatment of chronic periarthritis.
Session duration is from 5 to 20–25 minutes. The course of treatment is at least 4 procedures with a break of 7–14 days.
Warm applications
Ozocerite and paraffin compresses are aimed at improving blood microcirculation and activating metabolic processes. Applications are combined with other physiotherapy procedures or medications.
Symptoms of periarthritis of the knee joint
The symptoms of periarthritis are largely determined by its causes. If inflammation develops after an injury, it will make itself felt in 3-10 days.
The easiest form of the disease occurs. It is characterized by minor pain that will intensify with exercise. Often this pathological process resolves spontaneously within 20-30 days.
Acute periarthritis of the knee joint causes more intense symptoms. Among them:
Pain. It is sudden, growing, concentrated in the knee. The pain intensifies during movement, for example, when climbing stairs, when carrying loads. She does not stop bothering a person even at night. Most often, its appearance is preceded by injury or prolonged overload.
Radiation of pain to the ankle and thigh area.
The appearance of swelling in the affected area.
Local hyperthermic reaction, general deterioration of health and fatigue, decreased performance and insomnia. These symptoms are characteristic of severe inflammation.
Acute periarthritis of the knee joint lasts several weeks. If there is no treatment, the pathology becomes chronic. However, the symptoms will be slightly different. Pain bothers a person less often, it is moderate.
At night, joint aches may appear. Shooting occurs periodically, for example, when performing rotational movements with the knee.
If chronic knee periarthritis is not treated, it transforms into ankylosing form. Doctors call it “frozen knee syndrome.” The periarticular tissues become denser, movements with a large amplitude become impossible. Every step feels like a sharp pain.
If a person is diagnosed with periarthritis of the knee joint, treatment should be started immediately. The patient is prescribed painkillers from the NSAID group, for example Ortofen or Diclofenac.
The knee structures should be protected as much as possible from stress. Sometimes the patient is advised to wear orthoses. These devices help minimize the risk of injury to affected tissues.
In case of intense inflammation, they resort to the use of hormonal drugs that are injected directly into the muscle (Prednisolone, Hydrocortisone). Local therapy comes down to the use of ointments that have an analgesic and anti-inflammatory effect.
If knee periarthritis causes severe symptoms and medication treatment is ineffective, then surgical intervention is resorted to. The doctor will remove any adhesions and rid the tissue of calcifications. This will allow the limbs to return to normal mobility.
Diagnostics
If you have pain in the knee joint, you should consult a surgeon or orthopedist. The doctor collects the patient’s medical history, asks about the frequency and intensity of symptoms, palpates the problem area and prescribes additional examinations:
- thermography;
- general blood analysis;
- radiography;
- Ultrasound of the inflamed area;
- CT scan of the knee joint;
- MRI.
Comprehensive diagnostics makes it possible to distinguish periarthritis from arthritis, osteoarthritis and other diseases of the musculoskeletal system. In the chronic form, additional examinations help assess the degree of damage to soft tissues and select the optimal treatment aimed at restoring the knee joint and its motor function.
Research results
The drugs Artradol and Artracam are well tolerated, both in monotherapy and in combination therapy.
The occurrence of undesirable side reactions was observed during monotherapy with Artradol in 10%, and with Artracam in 9.99%. During a course of combination therapy, an increase in undesirable side reactions was revealed to 3.32%. No serious adverse events were identified. The association of adverse events with drug intake was possible or probable. To correct undesirable side effects, dietary measures were carried out; if gastralgia developed, NSAIDs were discontinued and antispasmodics were prescribed (once in all groups). When nausea occurred, the duration of which did not exceed 10 hours, metoclopramide was prescribed. The appearance of flatulence and facial redness did not require medication. Synovitis was controlled by prescribing NSAIDs in adequate doses. There was no need to discontinue therapy in the observation groups.
The need for NSAIDs in the observation groups decreased: after two weeks in 24 (80%) patients in group 2, in 23 (76.7%) in group 3, in 27 (90%) in group 4. After 1 month, the need for regular NSAID use continued to decrease. 27 (90%) in group 2 refused to take non-steroidal drugs, 28 (93.3%) in group 3, and 29 (96.7%) in group 4.
While monitoring patients with comorbid pathology, we did not identify any negative drug interaction reactions, which did not require changing the recommendations of specialists in the relevant field.
Discussion
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