A Complete Review of Joint Mouse – Arthremfit: Symptoms and Treatment

From this article you will learn everything about joint pain (including in the knee joint): what kind of pathology it is, why it occurs, how it manifests itself. Its treatment and prevention.

Author of the article: Victoria Stoyanova, category 2 doctor, head of the laboratory at the diagnostic and treatment center (2015–2016).

Article publication date: 07/16/2019

Article updated date: 01/11/2020

A joint mouse is a pathological formation that moves freely within the joint. It could be a fragment of cartilage or bone tissue, a meniscus, or a clot of connective tissue.

X-ray of a knee with a joint mouse. Click on photo to enlarge

The official name of the pathology is arthremfit. In response to a provoking factor (trauma, arthrosis deformans, arthritis, Koenig's disease, hemarthrosis, osteochondritis), a part is separated from the articular tissue, which moves freely in the articular cavity and causes pain.

This disease usually affects the knee joint. In very rare cases - elbow, even less often - shoulder, hip.

This article will consider the articular mouse of the knee joint, since in other joints this pathology occurs very rarely - for example, there is almost no chance of pathology developing in the wrist joint.

The disease often occurs in the knee joint due to its complex structure and heavy loads when walking, jumping, and running.

Most susceptible to the development of pathology:

• men and women over 40 years of age;
• athletes;
• persons of heavy physical labor;
• overweight people.

Arthremfit is a serious pathology, the only effective method of treating the disease is surgery, which requires rehabilitation over several months.

With early removal of a joint mouse of traumatic origin, the treatment result is favorable: the functional ability of the joint is completely restored.

If the pathology is latent and there is no pain (when the fragment of cartilage tissue is very small or hidden in the volvulus of the synovial membrane (a pocket of the membrane surrounding the joint), a person can delay treatment. This leads to the progression of the pathology, the following are possible:

• complete loss of limb function;
• blockade;
• ossification of connective tissue.

Click on photo to enlarge

An arthrologist is responsible for the diagnosis and treatment of pathology.

Causes of arthremfit (joint mouse)

Most often, pathology occurs as a result of injury. Due to the impact, a small piece of bone tissue, cartilage or a small part of the meniscus may break off. Also, trauma can lead to the formation of fibrin clots (fibrin is a protein that is the basis of a blood clot), which subsequently becomes denser.

Another possible cause is Koenig's disease (osteochondritis dissecans - separation of part of the cartilage from the adjacent bone and its displacement into the joint cavity). It provokes necrosis and rejection of particles of bone, cartilage or joint capsule. This disease is typical for people constantly engaged in heavy physical labor (loaders, builders, miners).

Joint mouse can also occur against the background of arthrosis. With this disease, osteophytes (bone protrusions to which muscle tendons are attached) grow on the joint, particles of which can break off.

Click on photo to enlarge

The size of the articular mouse ranges from 1–2 mm to 1–1.5 cm. It can be either single or multiple. Sometimes up to 5 freely moving fragments are identified in the cavity of the knee joint.

What could the debris be? He can be:

1. Round.
2. In the form of rice.
3. In the form of a polyhedron.
4. Formless.

Examples of articular mouse

When is shock wave therapy prescribed for the knee?

The procedure helps to quickly cope with pain in the knee joint caused by a variety of processes. Combines well with other treatment methods: kinesiotaping, massage, drug therapy, phonophoresis of glucocorticoid drugs. In most cases, shock wave therapy allows one to avoid or delay surgery.

Shock wave therapy for the knee. Indications:

• pain when walking and at rest,
• sensation of a foreign body in the knee,
• discomfort when moving,
• lack of effect with conservative treatment.

Table 2. SWT on the knee joint: what it does

Characteristic symptoms

The pathology is asymptomatic for a long time. An intra-articular formation makes itself felt only when it is pinched between the surfaces of the joints. Then a so-called joint block occurs.

It manifests itself:

• acute pain;
• limited or complete inability to move.

Constant irritation of the joint cavity by the “mouse” threatens the development of inflammatory processes in the joint capsule.

Additional symptoms:

• pain;
• edema;
• accumulation of effusion (accumulation of fluid released from blood vessels) consisting of excess synovial fluid.

What usually bothers you?

It is obvious that a freely moving particle sooner or later gets between the articular surfaces. Until this moment, the joint may not bother you. Patients note that most often pinching of the articular mouse occurs when climbing stairs. The condition when a free element “wedges” into the articular lumen is called joint blockade. The pain is very sharp, the joint is “blocked”, movement becomes impossible or severely limited. It is difficult to predict when the first joint blockade may occur. Quite a long period of time may pass. Depending on the etiology (cause), resorption of small joint formations is possible. If pinching of a joint mouse is periodically repeated, inflammation of the joint capsule occurs and it releases synovial fluid (effusion). The formation of effusion in this case is characterized by a persistent course and often recurs after puncture. If treatment is not resorted to, the chronic inflammatory process leads to the development of arthrosis.

Identifying the presence of a joint mouse is not always easy. A simple x-ray may be sufficient. But more often we have to resort to ultrasound and MRI. Sometimes, especially if the formation is large, the patient himself can feel the articular mouse.

First aid for joint blockade

1. Immobilize the knee using a tight elastic bandage. Stretch the bandage and wrap once 10 cm above the knee. Repeat the rotation so that the next layer overlaps the previous one by 2/3. Finish bandaging 10 cm below the knee. Make sure that the bandage lies flat, without folds, secures tightly, but does not pinch the knee (the pain should not intensify; if this happens, loosen the tension).
2. Transport the patient to a doctor or call an ambulance.

Diagnostics

The diagnosis of elbow arthritis is made based on a survey and examination of the patient and is confirmed by laboratory and instrumental examination data. Without an accurate diagnosis, it is impossible to prescribe adequate treatment, so if you suspect elbow arthritis, you should immediately contact the clinic. It is impossible to conduct a full examination at home.

Examination plan:

• Laboratory tests
  of blood and urine, as well as examination of synovial fluid taken during arthroscopy; signs of inflammation, autoimmune process, infections are revealed.
• Instrumental studies
  :
  radiography of the joint
  - reveals bone changes;
• Ultrasound
  – reveals the presence of an increased volume of synovial fluid;
• computed or magnetic resonance imaging (CT or MRI)
  - give a clear picture of the pathological process in the elbow;
• arthroscopy
  - examination of the inner surface of the synovial membrane using endoscopic equipment and taking synovial fluid for laboratory testing.

Treatment and rehabilitation

The prognosis for recovery is conditionally favorable. With the help of surgery, you can completely get rid of the disease.

Rehabilitation will last from 1 to 3 months. After this, the patient can return to normal daily life.

The only way to completely get rid of the pathology is surgery.

If the fragment moving freely in the joint cavity is large, then open access surgery is necessary.

If the “mouse” is small, then removal is possible using the arthroscopic method - by introducing a camera through punctures into the joint cavity to visualize the surgical field and surgical instruments.

During the operation, doctors can perform joint plastic surgery (plasty is reconstruction, restoration of articular surfaces using one’s own tissues or artificial materials) to prevent recurrence of spalls.

If the operation was performed with open access, a plaster cast is applied to the knee. If the treatment was carried out arthroscopically, it is recommended to wear a rigid orthosis (a knee pad with a soft inner layer and a hard outer layer (metal, plastic)).

Rigid orthosis

Next, postoperative treatment will be necessary:

• physiotherapeutic procedures;
• physiotherapy;
• medicines.

The duration of the rehabilitation period after surgical treatment is from 1 month (with the arthroscopic method) to 3 months (with surgery with open access to the joint).

Rehabilitation: physiotherapeutic procedures

They allow you to recover faster after surgery by improving blood circulation and relieving pain. The following procedures have been successfully used:

1. Electromyostimulation – muscle stimulation with electric current; improves blood supply to tissues.
2. Electrophoresis is the administration of drugs through the skin using an electric current.
3. Phonophoresis is the administration of drugs through the skin using ultrasound.
4. UHF therapy – exposure to high frequency magnetic waves; relieves inflammation, increases blood flow in tissues.
5. Paraffin applications are a thermal effect on the joint using heated paraffin.
6. Magnetotherapy – exposure to magnetic waves; stimulates local immunity, improves blood flow in the tissues around the joint.

Carrying out magnetic therapy

Rehabilitation: therapeutic exercises

Exercise therapy allows you to restore the normal range of motion of the joint and prevent postoperative complications.

During the rehabilitation period, it is recommended to perform the following exercises:

1. Starting position – lying on your back with your knees bent. Feet are on the floor. Press your heels firmly into the floor and feel the muscles in the back of your thighs tighten. Hold this position for 5 seconds, relax. Repeat the exercise 10 times.
2. The starting position is similar. Bend your healthy leg. Straighten the patient and place her on the floor. Raise your straight leg to a height of 30 cm, pulling your toe towards you. Hold it for 5 seconds and lower it. Repeat the movement 10 times.
3. Starting position: standing against a wall, you can lean on it with your hand. Elevate the affected leg 45 degrees. Wait 5 seconds, lower slowly. Do the exercise 10 times.
4. Half squats, resting your hands on the back of a chair.

Illustration of exercises above:

Exercises for rehabilitation after surgery to remove a joint mouse. Click on photo to enlarge

The doctor selects the remaining, more difficult exercises individually.

Rehabilitation: medications

To relieve pain and inflammation, you need to take NSAIDs - Ibuprofen, Meloxicam. External use of anti-inflammatory drugs is also possible.

Click on photo to enlarge

If a joint mouse has provoked an inflammatory process with the accumulation of effusion, you must first perform a puncture to remove it and take a course of anti-inflammatory drugs, and only then remove the fragment.

Rehabilitation: folk remedies

Traditional methods are suitable as a complement to other methods of rehabilitation after surgical treatment. Homemade remedies help relieve pain and restore the joint.

Traditional medicine recipes:

• Compresses with red and blue clay. Mix them in a ratio of 1 to 1. Add water, bringing the mixture to the consistency of sour cream. Apply the product to gauze or a piece of cloth. Apply to the sore joint for 2 hours. Rinse off with warm water.
• Jerusalem artichoke baths. For 1.5 kg of crushed plant, 8 liters of boiling water. Wait until the product cools down. Place your leg in it until the liquid covers the knee joint. Keep for 30 minutes.

Treating a sore joint with blue clay

Compresses and baths are contraindicated in the acute stage of the process (immediately after injury, with severe pain during exacerbation). You can use folk remedies after acute inflammation subsides and surgical removal of the fragment. Before starting therapy, it is a good idea to consult a doctor.

Injuries and their consequences

Intra-articular fracture.

The main condition for successful healing of a fracture is reliable fixation. It is impossible to return a bone fragment located inside a large joint to the right place by touch. In the same way, it is impossible to securely fix it with plaster. Therefore, there is no way to do without surgery.

Tears and ruptures of ligaments.

With a complete rupture, the situation is obvious: the ends of the torn ligament will not miraculously stick together on their own; they need to be stitched together. Leaving everything “as is” is also not an option - even if the pain goes away over time (which is not always the case), ligaments are needed to stabilize the joint, and an unstable joint is susceptible to constant injury and “wears out” faster (doctors call this degenerative changes in cartilage). But for minor tears, treatment can be conservative, but there is a high probability that the joint will have to be immobilized for a month, or even a month and a half. In this situation, it is good to discuss the pros and cons of each method with your doctor.

Fractures and ruptures of intra-articular cartilage

(including meniscal tears). The situation is similar to an intra-articular fracture: nothing will recover spontaneously. It is necessary to either fix or completely remove the damaged area to avoid chronic pain.

Nuances of the manifestation of pathology in children

A juvenile form of the disease, which is characterized by asymptomatic manifestations or bilateral lesions.

Through the use of innovative diagnostic methods and periodic examination of the state of the body of children, this pathology can be detected at the initial stage - during the period when the use of conservative procedures gives the maximum positive result.

With timely implementation of treatment measures, the patient can count on full restoration of health. Patients in the teenage age group deserve special attention, since the effect on insufficiently formed structures is considered more noticeable. Surgery for Koenig's disease of the knee joint is required only in advanced situations.

Types and stages of Koenig's disease (osteochondritis dissecans)

The classification of the disease is based on the age factor, the results of X-ray examinations and arthroscopic examination of the joint.

Today, two types of osteochondritis dissecans are known: adult and juvenile. In the first case, there is injury to the joint, in the second, a violation of the development of the expanded section of the tubular bone.

Next, you will get acquainted with the classification based on the anatomical characteristics of the affected area. The following stages of the disease are distinguished:

• First stage. The radiograph shows the lesion. MRI and CT images show a sclerotic line, but there is no damage to the articular cartilage;
• Second and third stages. A crack and a split-off part forms on the cartilage tissue;
• Fourth stage. Symptoms of the degenerative process in the cartilage make themselves felt, and the osteochondral fragment changes its position.

Content

• 1 Shoulder-elbow impingement syndrome 1.1 Main features
• 1.2 Prevention
• 1.3 Clinical picture
• 1.4 Treatment
• 1.5 Complications
• 1.6 Forecast
• 1.7 Return to sport

Read also[edit | edit code]

• Anatomy of the elbow joint
• Elbow and forearm
• Elbow joint in children (anatomy)
• Sports elbow injuries - treatment
• Elbow ligament damage
• Lateral epicondylitis - treatment
• Medial epicondylitis - treatment
• Compressive neuropathy of the radial nerve
• Cubital tunnel syndrome
• Hyperextension in the elbow joint
• Taping the elbow joint
• Diseases and injuries of the elbow joint during sports
• Tendopathies of the elbow joint in athletes
• Elbow instability
• Osteochondritis dissecans of the head of the humeral condyle
• Traction apophysitis
• Deforming arthrosis of the elbow joint

Olecranon friction syndrome[edit | edit code]

Main features[edit | edit code]

• Clinically, the disease is similar to shoulder-elbow impingement syndrome.
• It manifests itself as pain in the posterior parts of the elbow joint during the peak phase of the throw.
• The reason is the friction of the posteromedial surface of the olecranon process against the fossa intended for this process on the humerus.
• Provoking factors include extension of the arm with excessive valgus load and valgus instability of the elbow joint.

Like glenohumeral impingement syndrome, olecranon friction syndrome is caused by extension of the elbow joint under valgus overload. Excessive abduction of the forearm is accompanied by the appearance of a torque in the posteromedial part of the olecranon and the occurrence of shear stress between the posteromedial surface of the olecranon and the olecranon fossa, which is manifested by pain in the middle phase of the throw. Prevention, clinical presentation, treatment and prognosis are similar to those for shoulder-elbow impingement syndrome (see above). Osteophytes are especially often detected on the medial surface of the olecranon.

Literary sources[edit | edit code]

Cain EL JG, Andrews JR: Arthroscopic management of posterior elbow impingement in throwers. Tech Shoulder Elbow Surg 2001;2:118.

Technique

The operation is performed under anesthesia, which is selected taking into account the patient’s sensitivity to drugs, indications and time of operation. Epidural, local anesthesia and general anesthesia are used. Under normal conditions, the operation lasts about 1 hour.

• A tourniquet is placed on the patient's thigh to reduce blood flow to the joint.
• In the knee area, 3 incisions of 4-7 mm are made to insert instruments.
• Perform cleaning and rinsing.
• Remove the instruments and pump out the saline solution.
• If necessary, a solution of antibiotics and anti-inflammatory drugs is administered.
• Sterile dressings are applied to the incisions, which are removed after three days and covered with a plaster.
• A pressure bandage is applied to the knee and ice is applied.

The advantages of knee lavage and debridement include a short period of restoration of joint function, the absence of long-term immobilization with plaster, and a short duration of painkillers. The operation can be performed under local anesthesia. With high efficiency, the cost of surgical intervention is lower than open surgery.