Subchondral sclerosis of the articular surfaces of the hip joints

Subchondral sclerosis of the articular surfaces of the hip joints is a complex of diseases with inflammation and the appearance of degenerative-dystrophic areas.
With pathology, it is difficult for the patient to walk, stand up, sit down, and make other movements. The therapy is carried out by an orthopedist after examination. Subchondral sclerosis of the cervical endplates

Subchondral sclerosis of the articular surfaces of the knee joint

What is subchondral sclerosis

Subchondral endplate sclerosis

The site provides reference information. Adequate diagnosis and treatment of the disease is possible under the supervision of a conscientious doctor. Any medications have contraindications. Consultation with a specialist is required, as well as detailed study of the instructions! Here you can make an appointment with a doctor.

Subchondral sclerosis of the articular surfaces of the hip joints

When the disease occurs, dysfunction and destruction of cartilage tissue occur.
The size of the end plates decreases. In the initial stages, the patient does not feel symptoms; slight fatigue and tension in the joints may appear. The disease progresses gradually. After 60 years, not only the hip areas are damaged, but also the tissues of other joints, for example, the spine.

Gradually, osteoblasts are replaced by connective fibers, which grow profusely. Stiffness of movements develops. The quality of life decreases, the patient cannot exist without outside help.

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When the first signs appear, contact an orthopedist. He carries out the following examinations to make a diagnosis:

• taking anamnesis;
• general examination;
• laboratory blood tests;
• MRI, CT.

The photographs show the destruction of bone formations and cartilage of the acetabulum. The joint space narrows, subchondral osteosclerosis, osteophytes, and arthrosis occur. Local blood flow is disrupted. Nutrients enter the affected area in reduced quantities, and cell regeneration slows down.

Therapy begins only after complete collection of information. They use pathogenetic methods aimed at restoring cartilage.

Additionally, they use symptomatic treatment with drugs to eliminate inflammation and pain. In severe cases, surgery is prescribed to restore the joints.

Symptoms of a hip cyst

Small cysts can exist for a long time without symptoms. But when active growth begins, the following usually occurs:

• dull, arching pain that tends to intensify with physical activity, prolonged standing or sitting;
• stiffness of movement, inability to fully abduct or adduct the hip;
• decreased support function of the affected lower limb;
• decrease in thigh muscle volume.

Due to the fairly large amount of soft tissue surrounding the joint, local swelling and swelling are rarely observed, although it is typical for cysts of other localizations.

But if such symptoms are atypical for children and force them to immediately consult a doctor, then in adults, especially older people, such disorders are often perceived as inevitable age-related changes. This delays the diagnosis of the disease. Also, the symptoms of the cyst are practically indistinguishable from the manifestations of arthrosis of the hip joint, which today is the most common disease of the hip joint.

The formation of a cystic cavity increases the likelihood of pathological fractures, as this is accompanied by the release of specific enzymes. They provoke the resorption of bone tissue and, accordingly, a decrease in its strength. In this case, a fracture is often the first symptom of a disorder. It is especially dangerous for elderly patients and often requires surgical intervention. Otherwise, the likelihood of consolidation of bone fragments is sharply reduced.

In some cases, the hip bone cyst regresses on its own. This is more common in children 2 years after the formation of a cavity. But this does not eliminate the risk of fracture, since the bone remains weakened.

Symptoms of the disease

Signs of pathology depend on the stage of damage to cartilage and bones.

At the initial stage, the following deviations arise:

• pain in the hip area, lower extremities, intensifying towards the end of the day;
• lameness, unsteady gait;
• Difficulty appears when standing up and squatting.

As the process progresses, additional clinical symptoms arise and the condition worsens:

• inability to sit down, stand up, or walk;
• any movement brings acute pain;
• radiating pain from the groin down the limbs;
• atrophy of muscle tissue in the affected area, causing the pelvis to drop in a standing position;
• periodic increase in body temperature due to exacerbation of the inflammatory process.

Pathological formation cannot be completely treated. Its progression can be slowed down with medications and surgery. The methods are aimed at reducing symptoms and reducing the number of relapses.

Complications

If sclerosis of the acetabulum roof is not treated, the bone tissue grows greatly. When it extends beyond the joint, the tissue affects inflammatory processes in the subcutaneous tissue. In advanced cases, a necrotic or purulent process occurs that can be transmitted to internal organs.

For diagnosis, special techniques are used to visualize the structure of the joints:

• MRI;
• X-ray;
• CT scan.

To conduct a differential study, laboratory techniques are used.

How acupuncture can help in treatment

Acupuncture is a method of oriental therapy. It is performed by a doctor who inserts thin needles into the patient's body. The action is aimed at eliminating pain and inflammation. The degenerative process slows down and the patient feels better.

According to Eastern medicine, there are points in the human body that, when acted upon, can eliminate any disease, including the musculoskeletal system. Despite the introduction of needles intramuscularly, the person does not feel discomfort, his body relaxes.

The technique has not been proven through clinical studies, and not every doctor prescribes it to a patient. But if the drugs are not effective, they try different procedures before undergoing surgery.

What is subchondral sclerosis

Subchondral sclerosis is one of the most striking diagnostic symptoms. It indicates the development of inflammatory or degenerative pathology in the musculoskeletal system. Under the influence of negative factors, the subchondral lining irreversibly changes.

The subchondral layer performs various functions. There are no blood or lymphatic vessels in bones and cartilage. They receive biologically active and nutrients from synovial fluid and subchondral tissues.

The latter are equipped with an extensive network of blood vessels. They simultaneously act as a shock absorber, protecting bone and cartilage from injury due to increased loads on the joints or spinal column.

If these structures are damaged, blood circulation is seriously disrupted. Bone and cartilage begin to undergo microtrauma due to nutritional deficiency. Sclerosis develops, which is characterized by a slow but persistent course.

It occurs under the influence of such negative external and internal factors:

1. Excessive physical activity leading to microtrauma.
2. Osteochondrosis, deforming arthrosis, gouty, rheumatic, infectious, reactive arthritis.
3. Low physical activity, leading to circulatory disorders throughout the body.
4. Injuries - fractures, dislocations, subluxations, ruptures of ligaments, muscles, tendons, prolonged compression.
5. Staying in one body position for a long time during the day - standing or sitting.
6. Deficiency in the diet of micro- and macroelements that are required for the restoration of bone and cartilage elements: calcium, phosphorus, magnesium, molybdenum, manganese.
7. Obesity of any severity.
8. Endocrine diseases, including diabetes, thyroiditis, hypothyroidism.

Damage to the subchondral zone always accompanies natural aging of the body. The rate of catabolic processes prevails over the rate of reduction reactions.

Micro-injured elements simply do not have time to regenerate. They are destroyed even more intensely, which leads to damage to the vertebrae and discs, heads of tubular bones, fibrous and hyaline cartilage.

Causes and signs of disease development

This pathology is an important diagnostic sign. Consequently, the development of subchondral sclerosis of the hip joint is provoked by the same negative impact factors as other dysfunctions of the musculoskeletal system.

Causes of subchondral sclerosis:

1. Obesity, excessively gained kilograms.
2. Susceptibility to microtrauma caused by the characteristics of work activity.
3. Sedentary lifestyle.
4. Staying in an uncomfortable position for a long time.
5. Malfunctions of the endocrine system.
6. Disturbance in metabolic processes.
7. Genetic predisposition to pathological changes.
8. Changes associated with age (elderly people).
9. Co-occurring rheumatological diseases.
10. Diseases of the bloodstream.
11. Suffered complex injuries with disruption of the integrity of connective tissue and cartilage.
12. Congenital pathological disorders in skeletal development.
13. Acquired diseases of the musculoskeletal system.
14. Non-compliance with diet, unbalanced diet. Addiction to unhealthy food. It is worth noting that fast food, street food, and processed foods are the cause of serious disruptions in the functioning of the body; disordered eating contributes to the development of osteochondrosis and arthrosis of the joints. The influence of harmful substances in this case is obvious.
15. Underdevelopment of the muscle corset.

The location of sclerosis in the hip joint introduces significant complications during arthrosis.

The following symptoms and signs of subchondral sclerosis also appear:

• Constant pain in the thigh during physical activity (chronic). If the process is not stopped and timely therapy is not resorted to, the pain will be bothersome even at rest.
• Pain in the lumbar region with exacerbations at night. Also during walking.
• Pathological changes in intestinal function are possible.
• Diseases of the genitourinary system develop.
• There is a restriction in the movement of the joint, stiffness (mainly after waking up).
• Lameness develops.
• Tachycardia and pain behind the chest appear.
• Accompanied by respiratory dysfunction.
• The functional ability of the legs is lost.
• The x-ray does not show the joint space of the hip joint. The thickness of the subchondral bone increases.
• The femoral neck becomes fragile and more susceptible to destruction and aseptic necrotic lesions of the head.
• Inability to cope without a cane or wheelchair (disability).

Types of diseases and their characteristics

In medicine, there are several common classifications of pathology. On X-ray images, the damaged areas appear as small, limited circles or large dark areas. Therefore, the disease is spotty and uniform. The first is divided into small- and large-focal, with numerous or rare foci.

There is also a classification depending on its location. Most often in clinical practice, a limited type is diagnosed, complicated by a reactive inflammatory process.

Because of it, cartilage is quickly destroyed, and the pathology quickly spreads to neighboring areas. When it is provoked by constant increased loads on the bone, it is not accompanied by inflammation.

Somewhat less common are common pathologies that affect several structures of the musculoskeletal system. There are rare cases of systemic sclerosis. It develops against the background of severe, long-term diseases.

But classification by localization is especially in demand in medical practice:

1. Cervical spine. It develops unnoticed by humans, and the first symptoms appear only after severe destruction of the layer. It is characterized by pain when turning and bending the neck, crunching, and crackling sounds. Particularly dangerous is the infringement of the vertebral artery, which supplies the brain, by overgrown bone tissue. Due to a lack of oxygen and nutrients, dizziness occurs and coordination of movements is impaired.
2. Thoracic spine. Here the disease is diagnosed least often, because the discs and vertebrae reliably protect the ribs. In addition to pain, a person suffers from many symptoms that are not characteristic of spinal diseases. It's all about compression of sensitive nerve roots by bone growths. Periodically there are heart pains, a dry non-productive cough, and a feeling of lack of air when inhaling.
3. Lumbar spine. He always experiences significant stress when standing, sitting, or walking. Destruction of the structures leads to serious damage to the discs and severe deformities of the vertebrae. Clinically, this is expressed by acute pain, stiffness, clicking when bending and turning the body. With sciatica or lumbago, patients are often hospitalized for adequate treatment in a hospital setting.
4. Joints. Negative changes are observed in arthritis, arthrosis, gout, psoriatic arthritis. A person cannot fully bend and straighten his limbs, including due to severe pain. To relieve the load on his leg, he tries not to step on it. The load on the other limb increases, which causes destruction of its structures. In the morning, swelling and redness of the skin are observed, and in the evening a person has difficulty falling asleep due to muscle tension, the feeling of “crawling goosebumps”, nagging, aching pain.

Subchondral pathology of any type, shape and location is characterized by a deterioration of not only the physical, but also the psycho-emotional state. The patient becomes apathetic, weak, gets tired quickly and sleeps poorly. As a result of limited mobility, his mood often changes, he becomes irritated, worries and worries for no reason.

Treatment and prevention

Before you start treating knee and hip sclerosis, you need to make a diagnosis. It is worth paying attention to excess weight. It is the main factor causing problems.

For the treatment of arthrosis and subchondral sclerosis, an integrated approach is used, including the following measures:

1. Correction of diet.
2. Treatment with medications.
3. Surgery.
4. Therapeutic exercises for subchondral sclerosis.

Exercise will help stop degenerative changes. It is important to ensure the motor activity of the joint through special exercises. A complex of special gymnastics is effective for pathologies in the cervical, thoracic and spinal regions. Yoga, swimming and gymnastics in water are especially beneficial.

Physical activity helps improve vertebral mobility. This allows you to strengthen the muscles and form a strong corset. Loads should increase gradually. The diet does not involve any special restrictions, but salt intake should be limited. The body must receive the nutrients it needs. Proper nutrition speeds up recovery processes. The diet should include lean meats, seafood and fruits.

After determining the exact diagnosis, the doctor prescribes the necessary medications. Antihistamines, painkillers and anti-inflammatory drugs are used as therapy. If infection is present, antibiotics are prescribed. Non-steroidal drugs such as Diclofenac and Indomethacin are used.

If the disease progresses, endoprosthesis replacement surgery may be prescribed. Various surgical techniques are used - from arthroscopy to various prosthetic options. Physiotherapy methods are also used. Such procedures help to activate metabolic processes, improve overall well-being and improve blood flow.

Current procedures include phonophoresis, electrophoresis and UHF. Preventive measures will help prevent the formation of the disease. To do this, you need to play sports and avoid overheating and hypothermia. Injury to the musculoskeletal system should be avoided. If you consult a specialist in time, the formation of the disease can be stopped. This will allow you to lead a healthy lifestyle.

Medicines for treatment

An integrated approach to the treatment of the disease is practiced. At the same time, drugs are used to restore damaged structures and eliminate symptoms. Patients are also prescribed medications for preventive purposes. They inhibit the spread of pathology to healthy areas.

When determining treatment tactics, the doctor takes into account the degree of destruction of the subchondral plate:

1. First stage. Chondroprotectors are used in various dosage forms, balanced vitamin complexes.
2. Second stage. In addition to chondroprotectors, local and systemic analgesics, medications with B vitamins, and muscle relaxants are used.
3. Third stage. Glucocorticosteroids for intra-articular administration, muscle relaxants, vitamins in the form of injections, and less commonly, narcotic analgesics are prescribed. Sedatives, tranquilizers, antidepressants, and antipsychotics are also in demand.

The effect of drugs is enhanced by physiotherapeutic procedures. The patient is recommended sessions of magnetic therapy, ultraviolet training, and electrophoresis. High-grade sclerosis against the background of arthrosis often does not respond to conservative treatment. The patient is prepared for surgery - arthrodesis or endoprosthetics.

Chondroprotectors

These drugs are almost always used in treatment. Only they can start recovery processes and stop the progression of pathologies.

Under the influence of chondroprotectors, special cells begin to be produced - structural units of cartilage and bones. The subchondral zones themselves are restored, damaged blood vessels are regenerated.

In therapy, doctors prefer the following medications:

• Glucosamine-Maximum;
• Chondroitin sulfate;
• Chondrogard;
• Mucosatu;
• Chondroxide;
• Structum;
• Artre;
• Piascledina;
• Alflutop;
• Rumalon.

For mild sclerosis, external chondroprotectors are used: ointments, gels, creams, balms. In other cases, tablets or solutions for parenteral administration are used. The components accumulate in the subchondral region.

After a couple of weeks, they not only begin to restore cells, but also have an analgesic and anti-inflammatory effect. The duration of the therapeutic course is from several weeks to two years.

Complementary therapy

If damage to the layer is accompanied by pain, then analgesics cannot be avoided. Patients are usually prescribed non-steroidal anti-inflammatory drugs. They not only eliminate pain, but also cope well with crunching and clicking noises that occur when moving.

NSAIDs stimulate the resorption of edema and reduce body temperature. Meloxicam, Xefocam, Voltaren, Ketorolac in the form of solutions, Nimesulide, Ketorolac, Diclofenac, Celecoxib, Etoricoxib in tablets are used.

Therapeutic regimens also include the following medications:

1. Glucocorticosteroids - Methylprednisolone, Triamcinolone, Diprospan, Flosterone, Dexamethasone. Analogues of adrenal hormones relieve inflammation, swelling, and immediately eliminate the most severe pain. But their too frequent use leads to damage to muscles, bones, tendons, and ligaments.
2. Means for improving blood circulation - Xanthinol nicotinate, Eufillin, Pentoxifylline and its foreign analogue Trental. They reduce blood viscosity, improve its fluidity, dilate arterioles and capillaries located in the subchondral tissue.
3. Preparations with B vitamins - Milgamma, Kombilipen, Neuromultivit. The drugs improve blood flow, the functioning of the nervous system, relieve inflammation, and stop nerve degeneration. And Combilipen for injection contains lidocaine, which quickly relieves pain.
4. Muscle relaxants - Tolperisone, Baclosan, Tizanidine. Block spinal reflexes, suppress increased excitability. They relax spasmodic muscles, eliminating compression of the nerve roots.
5. Sedatives - tinctures of valerian, motherwort, Persen, Tenoten. Eliminate anxiety, restlessness, sleep disorders, emotional instability.

To replenish the body's reserves of vitamins, micro- and macroelements, their balanced complexes are used. Treatment with Centrum, Vitrum, Supradin, Pikovit, Multitabs is prescribed. It is enough to take tablets per day to satisfy the body’s daily need for bioactive substances.

Examinations that are carried out for the disease

The primary diagnosis of pathologies manifested by sclerosis is made on the basis of the clinical picture and anamnesis. To confirm it, a number of instrumental studies are carried out.

Here are the most informative:

1. X-ray in 2 or 3 projections. Helps to detect the localization of altered tissues and determine the severity of the inflammatory or degenerative process.
2. Magnetic resonance imaging. Used when radiographic examination is uninformative or when certain details are clarified.
3. CT scan. It is carried out to assess the state of the circulatory network of the subchondral layer and determine the degree of innervation disorder.

Laboratory diagnostics are required only to determine the cause of the disease. Biological fluids (usually intra-articular exudate) are collected for microscopy and cytological examination. A general blood test is also indicated to assess general health.

Diagnostics

The main method for diagnosing hip joint cysts is x-ray examination. Therefore, such benign neoplasms are often discovered by chance, for example, when performing an x-ray to diagnose a fracture or to assess the condition of the articular surfaces of bones with arthrosis.

In the photographs, the cyst looks like a single-chamber or multi-chamber neoplasm in the thickness of the bone tissue. In this case, signs of swelling and thinning of the cortical bone are detected. Axial deformation may also be observed. The resulting images allow you to evaluate the size of the cystic cavity, its appearance and other disorders. In adults, arthrosis or arthritis of varying degrees is usually found.

Each type of cyst has its own distinctive radiological signs. Therefore, based on the results of this simple diagnostic method, it is possible to accurately determine the nature of the formation and select the optimal treatment tactics.

Sometimes patients are also prescribed additional research methods to obtain more information about the condition of the hip joint and surrounding structures, in particular CT and MRI.

Which doctor should I contact?

At the initial stage, there is no pain or stiffness. The person does not seek medical help, attributing rare discomfort to ordinary fatigue. But it is at this stage that conservative treatment with chondroprotectors is most effective. If your neck or lower back ache from time to time, or your elbow or knee creaks, then you should make an appointment with a doctor.

The patient cannot independently determine the presence of sclerosis or find out what disease has begun to develop. Even the doctor makes a diagnosis based on test data. Therefore, it is advisable to make an appointment with a therapist. A general practitioner has all the diagnostic skills.

He will order an X-ray examination, and after studying the results, he will refer the patient to a doctor of a narrow specialization:

• rheumatologist for gout, gouty, rheumatoid, infectious, reactive arthritis;
• to a traumatologist for injuries to the musculoskeletal system;
• orthopedist for deforming osteoarthritis;
• vertebrologist or neurologist for osteochondrosis, intervertebral hernia.

These doctors will carry out a number of additional diagnostic measures and then begin treatment. Other specialists will also be involved in the therapy. For example, with osteochondrosis caused by diabetes mellitus, the participation of an endocrinologist is required in treatment.

Dangerous consequences and complications

If a person is found to have damage to the subchondral layer, then an inflammatory or destructive-degenerative disease has already begun to develop in his body. In the absence of medical intervention, it will spread to healthy areas of the spine and nearby joints.

Further cell destruction can lead to the following complications:

• spontaneous hemarthrosis - sudden hemorrhage inside the joint cavity;
• ankylosis - complete or partial lack of mobility in a joint or part of the spine;
• osteonecrosis of peri-cartilaginous tissues;
• subluxations of joints or vertebrae.

The muscles, ligaments, and tendons gradually weaken. The production of synovial fluid, which acts as a shock absorber, decreases. And due to the weakening of local immunity, infectious processes will increasingly develop: bacterial synovitis, bursitis, tendinitis, tendovaginitis. At the last stage of arthrosis, a person has difficulty caring for himself in everyday life, loses professional skills, and becomes deeply disabled.