People often visit an orthopedist with complaints of pain in the knee or ankle. Discomfort in the lower extremities interferes with normal movement and complicates the usual way of life. If the problem affects the arms - shoulders, elbows, hands - few people rush to consult a doctor. However, degenerative processes often occur in the joints of the upper extremities, which means that without treatment in the long term this will also result in disability.
Arthrosis of the joints of the upper extremities is much less common than the knees
If the cause is injury
Most often, dystrophic changes in the joints of the upper extremities occur after injury and microtrauma.
- Shoulder.
Shoulder fractures account for 9-12% of the total number of fractures. Much more often, this joint suffers from dislocations (50-60% of the total number for all joints), since it is characterized by weakness of the ligamentous apparatus. Even after professional reduction, there remains a possibility of relapse, and if the problem recurs, a nerve or vessel is pinched, and the blood supply to the cartilage suffers. Favorable conditions are created for the development of arthrosis of the shoulder joint.
- Elbow.
The elbow joint suffers from monotonous activities. If a person performs the same type of hand movements while the body is in a static position, epicondylitis, or “tennis elbow,” develops. The epicondyles become inflamed, causing pain and stiffness. Other injuries to this joint are less common. However, elbow bruises are very painful because the radial nerve passes through it.
Elbows suffer not from injuries, but from the same type of activity
- Wrist.
Wrist injuries are also more likely to be caused by repetitive movements, such as working at a computer for long periods of time. We are not talking about bruises, fractures or dislocations, although they also happen when falling or playing active sports. “Tunnel syndrome” occurs much more often. Due to constant flexion and extension of the wrist, swelling is formed, which compresses the nerves, blood vessels and tendons, interfering with normal blood circulation.
- Brush.
Fingers are actively involved in daily manipulations, so they are also susceptible to fractures and dislocations. After such an injury, arthrosis of the wrist joint can develop several years later, so you should carefully monitor the condition of the hand and listen to the slightest symptoms.
Extreme hobbies automatically put you at risk for wrist and hand injuries
Symptoms
In children, exostoses rarely manifest themselves clinically, since they are usually completely cartilaginous structures and are small in size. Symptoms may occur during the period of active growth of the tumor, i.e. in adolescents. As a result, a lump may form on the hand. As a rule, it is painless, not adherent to the skin, dense and has a rough or smooth surface. This creates a cosmetic disadvantage, but is often the only manifestation of the disease.
Subungual exostoses of the fingers are extremely rare. In such cases, the neoplasm raises the nail plate, creating a risk of peeling or ingrowth.
In some cases, a growing osteochondroma provokes dysfunction of the joint next to which it is present, inflammation of its synovial bursa (bursitis) or tendons (tendinitis). The tumor can also compress nerves or blood vessels passing near it. This results in:
- discomfort or dull pain in the area of the formation of a tumor or joint, which occurs or intensifies when it is activated during movement;
- swelling, redness of soft tissues;
- restrictions of movement in the affected joint;
- sensations of numbness of the skin, goosebumps;
- hand muscle dystrophy.
Large exostoses can provoke deformation of the mother or neighboring bone, especially when they are located on the ulna or in the hand. The joint may also suffer. As a result, not only does the risk of fracture increase, but also the possible curvature of the upper limb. Sometimes in children, large exostoses injure the epiphyseal plates. This leads to disruption of their function and the growth of the affected bone lagging behind the healthy arm.
In isolated cases, rapid growth of osteochondroma is observed. This requires immediate contact with an orthopedic traumatologist, since such changes are characteristic of tumor malignancy. But if single exostoses degenerate into chondrosarcoma in less than 1% of cases, then with multiple osteochondromas the risk increases to 10%.
Other causes of arthrosis of the joints of the upper extremities
The joints of the upper extremities are subject to the same pathological processes as the lower ones. Arthrosis can develop in them for the following reasons:
- metabolic disorders, for example due to endocrine pathologies;
- genetic predisposition of cartilage tissue to damage;
- previous infection, intoxication of the body, which caused complications;
- rheumatoid arthritis;
- psoriasis;
- diabetes mellitus, etc.
If a person has already been diagnosed with arthrosis of the hip, knee or ankle, he automatically falls into the risk group for the joints of the upper extremities. Most likely, a malfunction has occurred in the body or some pathology has developed that aggravates the condition of the cartilage tissue and will soon affect other joints. The exception is when the cause of arthrosis is injury to a specific joint.
If the cause is diabetes or genetics, the risk of polyarthrosis increases
content .. 11 12 17 ..Bones of the upper limb and their connections (human anatomy)
In the process of long evolution, the hand lost its function of support and (especially the hand) became the most mobile apparatus of the human body, capable of performing a variety of movements that are particularly coherent and precise. The hand has become an organ of labor, so the structure of the bones and joints of the upper limb reflects its function.
The skeleton of the upper limbs is formed by the shoulder girdle and the skeleton of the free upper limbs. The skeleton of the shoulder girdle consists of two shoulder blades and two clavicles. The skeleton of the free upper limb (arm) is formed by the humerus, two bones of the forearm - the ulna and radius, and the bones of the hand.
Bones and joints of the upper limb girdle (human anatomy)
The clavicle (clavicula) has an S-shaped curved body and two thickened ends - the sternal and acromial (humeral). The contours of the collarbone are clearly visible under the skin, especially in thin people; you can always feel it.
The scapula is a flat triangular bone. There are three edges: superior, lateral and medial, and three corners: superior, inferior and lateral.
With its anterior recessed surface, the scapula is adjacent to the posterior wall of the chest between the II and VI ribs. On the posterior surface there is a scapular spine, which passes into the humeral process - the acromion; these bony protrusions can be felt through the skin of the back. The spine of the scapula divides the posterior surface into the supraspinatus and infraspinatus fossa. The scapula also has a glenoid cavity for articulation with the humerus and a coracoid process facing forward.
Joints of the bones of the shoulder girdle. The sternal end of the clavicle articulates with the sternum, forming the saddle-shaped sternoclavicular joint. Due to the presence of an intra-articular cartilaginous disc, the joint is spherical in function. It allows movements of the clavicle around the sagittal axis (up and down), the vertical axis (forward and backward) and rotation around its own axis. The lateral end of the clavicle is connected to the acromion by a flat, inactive joint. Of the ligaments that strengthen the joints, the most pronounced are the coracoclavicular and costoclavicular. Between the coracoid process and the acromion is a strong coracoacromial ligament, which acts as the arch of the shoulder joint.
Bones and joints of the free upper limb (human anatomy)
The humerus (humerus) is a long tubular bone, consisting of a body and two ends (epiphyses). The upper end is represented by a rounded articular head for articulation with the scapula. It is separated from the body by an anatomical neck. Here are the greater and lesser tubercles, separated by a groove. The narrowed part of the body closest to the head is called the surgical neck (the place most often susceptible to fractures). On the body of the humerus there is a tuberosity to which the deltoid muscle is attached; The spiral groove of the radial nerve runs here, and small openings for blood vessels and nerves (nutrient foramina) are visible. The lower end has a condyle with articular surfaces for articulation with the bones of the forearm and rough epicondyles - lateral and medial. Two fossae are visible above the condyle: in front - the coronoid fossa, in the back - the olecranon fossa.
The bones of the forearm are represented by two long tubular bones - the ulna and the radius.
The ulna (ulna) is located on the inside of the forearm on the side of the fifth finger (little finger), and can be easily felt under the skin along its entire length. Its upper end is thickened, has two notches - radial and trochlear. The trochlear notch anteriorly passes into the coronoid process, and posteriorly into the olecranon process. The lower end of the ulna has a head, an articular circumference, and a styloid process.
The radius is located on the outside of the forearm on the thumb side. Its upper end is formed by a cylindrical head with an articular fossa and an articular circumference. The lower end has a carpal articular surface, an ulnar notch, and a styloid process. The bodies of both bones of the forearm are triangular. The edges facing each other are pointed and are called interosseous.
The bones of the hand (ossa manus) are divided into the bones of the wrist, metacarpus and bones of the fingers (Fig. 29). The eight short carpal bones are arranged in two rows, four in each row. Counting from the thumb, the top row is formed by the scaphoid, lunate, triquetrum and pisiform bones. The bottom row consists of the trapezoid, trapezoid, capitate and hamate bones. The palmar surface of the wrist is concave and forms a groove. The ligament stretched over the groove turns it into the carpal tunnel, in which muscle tendons and nerves pass from the forearm to the hand.
Rice. 29. Bones of the right hand; back surface. 1 - scaphoid bone; 2 - lunate bone; 3 - triquetral bone; 4 - pisiform bone; 5 - trapezium bone; 6 - trapezoid bone; 7 - capitate bone; 8 - hamate bone; 9 - II metacarpal bone; 10 - proximal phalanx; 11 - middle phalanx; 12 - distal phalanx
The bones of the metacarpus are represented by five short tubular bones, which are counted from the side of the thumb (I, II, etc.). Each metacarpal bone has a base, a body and a head.
The skeleton of the fingers is formed by small tubular bones - phalanges. Each finger, with the exception of the thumb, consists of three phalanges. There are phalanges: proximal, middle and distal (nail). The thumb consists of only two phalanges - proximal and distal.
Connections of the bones of the free upper limb.
The bones of the free upper limb are connected to each other by joints: the shoulder, elbow and hand joints.
The shoulder joint (articulatio humeri) is formed by the head of the humerus and the articular cavity of the scapula, supplemented by a cartilaginous lip. This is a typical ball-and-socket joint, in which flexion and extension, abduction and adduction, inward and outward rotation, and peripheral rotation (circumduction) are possible. The joint capsule is free, strengthened by one coracobrachial ligament. The tendon of the long head of the biceps brachii muscle, enclosed in the synovial sheath, passes through the joint cavity.
The elbow joint (articulatio cubiti) is complex; three bones are involved in its formation: the humerus, radius and ulna. It consists of the humeroulnar, humeroradial and proximal radioulnar joints. These three joints have one common articular capsule, strengthened by lateral ligaments. The elbow joint belongs to the trochlear joints; Flexion and extension are possible in it.
The bones of the forearm are connected by an interosseous membrane and two (proximal and distal) radioulnar joints. The distal radioulnar joint is independent, the proximal one is part of the elbow joint. Both joints act as a single combined cylindrical joint. In this case, the radius rotates outward (supination) and inward (pronation) together with the hand around one longitudinal axis; the ulna remains motionless.
The wrist joint (articulatio radiocarpea) is formed by the distal end of the radius and three bones of the first row of the wrist. The joint is complex, elliptical in shape. It allows flexion and extension, abduction and adduction, as well as circular movement. The joint capsule is strengthened by lateral ligaments.
Connections of the bones of the hand. The midcarpal joint is located between the first and second rows of carpal bones, and the flat intercarpal joints form between the individual carpal bones. Together with the flat, inactive carpometacarpal joints (II to V), they form the solid base of the hand. The carpometacarpal joint of the thumb has a special structure. Saddle-shaped in shape, it allows abduction and adduction of the thumb along with the metacarpal bone, as well as its opposition to the little finger (opposition) and reverse movement (reposition). The metacarpophalangeal joints are spherical in shape, and the interphalangeal joints are typical block-shaped. The articular capsules of all of these joints are strengthened by ligaments. As noted, the structural features of the bones and joints provide the hand with amazing mobility, which is so necessary in the labor process.
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Treatment tactics for arthrosis of the joints of the upper extremities
The principles of therapy are the same for all large joints. The step-by-step scheme includes the following actions:
- eliminate stress on the damaged joint, for example, fix it with a bandage or bandage;
- relieve inflammation and eliminate pain;
- restore mobility.
For this purpose, various medications and physiotherapeutic methods are used. Pain and inflammation can be relieved with non-steroidal anti-inflammatory drugs in a short course, so as not to harm the gastrointestinal tract. Eliminate swelling using special ointments. To restore cartilage tissue, chondroprotectors are prescribed over a long course in the form of ointments or injections. If the joint is inflamed, corticosteroid hormones may be prescribed.
With limited mobility and pain, there is often a deficiency of synovial fluid in the joint. It does not sufficiently absorb the mechanical load, the cartilage rubs and is damaged even more. Therefore, for arthrosis of the shoulder joint and elbow, intra-articular injections of the Noltrex synovial fluid prosthesis are often prescribed to compensate for its deficiency.
Noltrex is part of a comprehensive treatment regimen for arthrosis of the shoulder and elbow
Treatment of hand exostosis
In the absence of clinical manifestations of osteochondroma, treatment is not carried out. In such situations, dynamic observation is sufficient to monitor the process of development of the tumor.
Conservative therapy is prescribed when bursitis, tendonitis or pain due to exostosis is diagnosed. It consists in the use of NSAIDs, sometimes in the intra-articular administration of corticosteroids, and in case of severe pain, in carrying out a drug blockade. Drug treatment can be supplemented with physiotherapeutic procedures, in particular:
- electrophoresis with the introduction of drugs;
- ultrasound therapy;
- Ural Federal District;
- laser therapy;
- magnetotherapy.
But conservative therapy is not able to lead to the resorption of osteochondral exostosis. It is aimed only at eliminating complications and improving the patient’s condition.
Will physical therapy help?
Physiotherapeutic methods are good in the first and second stages of arthrosis. They reduce pain, strengthen periarticular muscles and increase mobility. Depending on the clinical picture and location of osteoarthritis, the patient may be prescribed a course of the following procedures:
- electrophoresis with individually selected medications;
- paraffin therapy (stimulates blood circulation in the joint);
- laser therapy (destroys osteophytes and prevents the formation of new ones);
- mud compresses (eliminate atrophic changes in tissues);
- acupuncture (reduces pain and restores muscle tone);
- massage and therapeutic exercises.
Most physiotherapeutic methods are allowed only during remission
For shoulder pain, this simple set of exercises will help improve joint mobility:
Why is it important to eat right when you have arthrosis of the joints of the upper extremities?
Cartilage tissue in a normal and especially damaged state should receive enough vitamins and microelements. If they are deficient, it makes no sense to influence it in other ways: for example, chondroprotectors in tablets or injections will not be absorbed. With this diagnosis, it is important to establish a balanced diet, as well as add specific foods to the diet:
- red salmon fish;
- nuts;
- vegetable oils (source of polyunsaturated acids);
- wholemeal bread and sprouted cereals (contain vitamin B);
- beans, lentils;
- White cabbage;
- fermented milk products;
- fresh herbs;
- poultry meat;
- seafood.
If you have arthrosis, it is advisable to avoid high-calorie foods.
What are the forecasts
Unfortunately, neither arthrosis of the knee joint, nor of the elbow or shoulder is completely cured. However, this does not mean that you should despair and refuse any therapy. There are many diseases with which a person peacefully coexists, and arthrosis is one of them. Of course, it is necessary to adhere to many rules, monitor the condition of the joints and monitor the course of the disease.
You should not refuse injections of synovial fluid prosthesis if the orthopedist-rheumatologist insists on it. With the help of the drug, the doctor will restore the deficiency of the lubricant - the friction of the cartilage will stop. In the case of Noltrex, such courses need to be repeated infrequently - once every one and a half to two years. If this condition is met, you can rest assured: your joints will continue to serve you faithfully!