gǔ xìng guān jíe bìng
2 OverviewOsteoarthropathy is also known as osteoarthritis. It is characterized by primary or secondary degenerative changes in the articular cartilage of the capable joints and new bone formation at the joint margins, where the rate of degeneration exceeds the rate of repair and regeneration. The defect is currently considered to be the result of abnormal cartilage metabolism. Pathologic changes are not dominated by synovial thickening or inflammatory infiltration, but by degeneration and softening of the cartilage, and subchondral bone changes, so the name osteoarthropathy is currently used. Pathogenesis can be divided into primary and secondary two kinds: primary osteoarthropathy has no obvious cause, such as the hand of Heberden's knot by a single autosomal gene transfer, female dominant, male recessive, so there are obvious genetic factors; secondary osteoarthropathy is based on the original lesions, prompting the occurrence of osteoarthritis in some joints. Common factors are: ① congenital anatomical abnormalities of the joints, such as ligament laxity, excessive activity, joint surface position or shape abnormalities. ② Structural changes in the joints that occur during childhood, such as flat hip, slipped epiphysis of the upper femoral epiphysis. ③ Injury or mechanical wear and tear, such as intra-articular injury or fracture, poor alignment after fracture, habitual dislocation, long-term joint injury caused by occupational disease, obesity, etc. ④Crystal deposition intra-articular lesions, such as pyrophosphate arthropathy, gout, etc. ⑤ Metabolic abnormalities causing cartilage degeneration, such as brown-yellow disease. (6) Ischemic necrosis of bone in the joints. (7) Other causes of cartilage wear and tear, such as joint infections, hemophilia, hemochromatosis, neurogenic arthropathies, and so on.
3 EtiologyThe earliest lesions are microdegeneration of articular cartilage, which is characterized by a decrease in heterochromatic material, a decrease in the number of chondrocytes, fatty degeneration, and a change in the protofibrils of the collagen, presenting as an irregularity of the articular surface. Later, the morphology changes to a limited softening of the cartilage, the surface is patchy and protofibrillar. Abrasion of the protofibrous cartilage will cause progressive loss of the cartilage surface to the point of exposing the subchondral bone. Finally, ulceration of the cartilage occurs. Ultrastructures show an increase in matrix celllets with deposited hydroxyapatite crystals and new bone formation at the articular cartilage rim. This rim growth appears on radiographs as a bony spur or "bone spur". Other bony changes are seen as the formation of capsular cavities of varying sizes below the articular surface and remodeling of the subchondral bone.
Osteoarthropathy of the knee is seen in the femoral condyles, patellar articular surfaces, and tibia with erosion of the articular cartilage and exposure of the medullary tissue
Synovial changes are a late phase phenomenon and include fibrous degeneration, hypertrophy, and inflammation. It rarely undergoes inflammatory pathologic changes as in rheumatoid arthritis. Synovial villi can enlarge and new villi grow. These villi can form cartilage.
The fibrous tissue of the joint capsule may become denser. The joint capsule may become fibrocartilage or hyaline cartilage at the junction with the joint margin. Bony nodules sometimes appear under the synovium, protruding into the joint cavity. These nodules can later be detached into the joint, forming a joint rat, making the joint interlocked, but does not cause bony ankylosis.
4 Clinical manifestationsThe most prominent symptom of osteoarthropathy is pain. It is not proportional to the x-ray presentation. The pain can be aggravated during weight bearing and after a phase of inactivity, temporary stiffness can develop. When changing from one position to another, movement is inconvenient and painful; after activity, the joints instead feel comfortable and pain is reduced, but overactivity can cause pain and limited movement again. This is sometimes called rest pain.
Wear and tear and loss of cartilage in the joints, as well as bony hyperplasia will lead to the formation of bony encumbrances and joint deformities. There is a grinding sound in the joint on movement, localized tenderness, and a moderate amount of exudate. The disease may present differently in different joints:
4.1 Osteoarthropathy of the hipThis primary degenerative hip arthropathy, also known as senile hypertrophic hip arthropathy, is most commonly seen in patients over the age of 50 years, but occasionally in younger patients, and its cause is unknown. Secondary degenerative hip arthropathy is most often seen with some of the previously mentioned diseases of the joint itself. The main symptom is pain in the groin that radiates to the thigh or medial aspect of the knee during activity or weight bearing.
4.2 Osteoarthropathy of the kneeMostly seen in women, it is a common and major waste of disease. Exudate is sometimes not much, but the joint swelling is more obvious, which is mainly due to bone proliferation. A clear friction sound can be heard or felt during activity. Degenerative lesions are most pronounced in the medial compartment of the knee joint, resulting in a knee inversion deformity. Another manifestation is degenerative changes in the patellofemoral joint, also known as chondromalacia patella. In addition to knee pain, there is mild exudation, most often seen in young people with knee injuries.
4.3 Osteoarthropathy of the spineOsteoarthropathy can occur in both sets of joints of the spine, the intervertebral discs and the posterior articular processes. Osteoarthropathy can also occur in the cervical hook vertebral joints (i.e., the joints between the lateral aspects of adjacent vertebrae). Degeneration of the hook joint is a common cause of neck pain. Degeneration and disc herniation in the lumbar spine underlie the symptoms.
4.4 Cervical spineThe cervical nerve roots are very close to the hookspine joints, and any disturbance of the joints can *** or crush the nerve roots. The areas of greatest stress in the neck are at cervical 4-5 and cervical 5-. Osteoarthropathy of the cervical spine is also most common in this area. Osteochondroses at the articular margins of the hooked vertebrae can cause the cervical nerve roots to be compressed as they traverse the intervertebral foramina. Depending on the plane, it forms a group of painful and neurologic symptoms. Common sites of pain are the supraclavicular region and the upper region of the trapezius muscle, with several cervical lesions above that radiate to the occipital region, and those in the lower segments that radiate to the distal upper extremities. The pain will be exacerbated by movement of the neck, especially with rotation and side bending. When there is degeneration of the cervical discs, the hook spine joint prevents the discs from protruding laterally, but only centrally. This protrusion and subsequent bony reaction will directly compress the spinal cord and cause spinal cord pathology (see "Cervical spondylosis").
4.5 Lumbar spineSymptoms caused by degenerative changes in the lumbar spine are almost always disc-related. Herniation or bulging of the degenerated nucleus pulposus is a direct posterolateral compression on the nerve root or cauda equina. Common sites are lumbar 4-5 and lumbar 5 sacral 1. Pain tends to radiate to the lower extremities. The pain will be aggravated by flexion of the lumbar region to the painful side. There is paravertebral tenderness. Straight leg raising test is positive. Compression of the lumbar 5-sacral 1 nerve root will cause loss of ankle reflexes, hypesthesia of the posterior lateral calf and plantar aspect of the foot, whereas compression of the lumbar 4-5 nerve root will cause hypesthesia of the anterior lateral calf and dorsal aspect of the foot, and weakness of the extensor muscles of the toes (see "Lumbar Disc Herniation").
4.6 Circumferential hypertrophic osteoarthropathyThis is a polyarticular disease with a more inflammatory response than the usual osteoarthropathy, accompanied by Heberden's nodes in the fingers, and is most common in older women.
The most basic feature of this disease on X-ray is the formation of bony encumbrances on the joint margins. Earlier phenomena are narrowing of the joint space and subchondral osteosclerosis. This is due to destruction of articular cartilage. Areas of translucent cystic cavities of varying sizes are seen in the periarticular bone.
Laboratory tests are unremarkable. Blood sedimentation is normal. The synovial fluid is clear and thick with normal mucin coagulation test. The white blood cell count is within the range of 200 to 2000/mm3. Cartilage debris is sometimes seen in the synovial fluid.
Rheumatoid arthritis should be differentiated from rheumatoid arthritis, which is often accompanied by systemic lesions, with a pronounced inflammatory reaction of the joints, and symmetrical involvement of the hands and wrists. If there is inflammation in the joints of the lower extremities, the differential diagnosis is more difficult. In osteoarthropathy, the blood sedimentation is normal, the rheumatoid factor is negative, and the synovial fluid is seldom abnormal; Heberden's nodes are often found in the distal interphalangeal joints, so swelling of the proximal interphalangeal joints can exclude osteoarthropathy; ligamentous ossification of the dendritic spine is a characteristic of ankylosing spondylitis, which is most common in young males, and is seldom confused with osteoarthropathy (see "Ankylosing spondylitis"). "
5 Treatment) 5 TreatmentTreatment of osteoarthropathy varies according to anatomic location and degree of joint deformity. Most patients have a good prognosis; even without any treatment, the disease is not so severe that true ankylosis does not occur. In the elderly, after decades of activity and wear and tear, this degenerative change is a normal physiologic response. This is not to say, however, that no treatment is needed; if there is a nerve root *** or compression, it must be relieved and the pain eliminated. Treatment is not intended to eliminate the bone weakness, but to relieve the pain or bone *** lock.
5.1 MedicationNo medication can inhibit the progression of degenerative joint changes. The pain is usually mild and does not require any pain medication. A common problem in osteoarthropathy is intermittent episodes of severe pain. Anti-inflammatory drugs to relieve pain and muscle spasms can be used during these episodes.
5.2 SurgerySurgery is often performed on the hip, knee, and spine. There are many surgical procedures for the hip. Commonly used surgeries are arthroplasty, osteotomy and total joint replacement. Unilateral ones can be fused. This will be based on the severity of the lesion, age, occupation, lifestyle, and the patient's request, in conjunction with the general condition.
Surgery of the knee consists of arthrocentesis, osteotomy, and arthroplasty for joint prosthesis replacement. In order to preserve the mobility and stabilizing power of the deformed joint, high tibial osteotomy can effectively change the weight bearing line and provide pain relief. If the knee joint is severely disabled by deformity and instability, arthroplasty with prosthetic replacement can be performed, but it is not as effective as total hip arthroplasty.
Surgery is rarely indicated for osteoarthropathies of the spine, and is only considered after various conservative treatments have failed. There are many types of surgery, but they are limited to relieving nerve root or spinal cord compression.
5.3 Physical therapyThe purpose of this therapy is to: ① Reduce stress and load bearing on the affected joints. (ii) Maintain the normal relationship and movement of the joint. Patients with osteoarthropathy of the hip or knee should avoid excessive walking or walking up and down stairs, but not to the detriment of the necessary activities of daily living, especially non-weight-bearing exercises. Such exercises are very necessary to maintain muscle strength and joint mobility, especially in the elderly. Quadriceps exercises are more important for osteoarthrosis of the knee. Weight loss in overweight patients is important for lower extremity and spine osteoarthropathies to reduce stress on the affected joints. The use of a cane or crutches can reduce joint weight-bearing by up to 50%. In individual cases of knee instability, a brace may be worn.
Patients with spinal osteoarthropathy should be treated by reducing spinal activity. Excessive forward flexion and backward extension of the cervical spine should be avoided. Pillows should not be too high. Some patients with cervical osteoarthropathy can have intermittent or continuous traction. For acute exacerbations, pillow and jaw traction with slight forward bending of the head and a neck brace can be used to limit movement and reduce pain. Patients with lumbar osteoarthropathy should lie on a firm mattress and avoid bending and weight lifting activities. Graded postural exercises are done after the pain subsides. A lumbar girdle can reduce chronic pain. If accompanied by lumbar disc herniation, conservative treatment can be used first; if ineffective, surgery can be performed.
Acupuncture points for osteoarthropathy Lower KunlunYin kidney meridian Taixi corresponds to each other, so they cooperate with each other to treat gynecological diseases and ankle joint diseases. Kunlun acupoint has the effect of dispersing wind and activating collaterals. With its location on the upper also, and ...
Upper KunlunYin kidney meridian Taixi corresponds to each other, so each other in order to treat gynecological diseases and ankle joint disease. The Kunlun point has the effect of dispersing wind and activating collaterals. With its location in the upper also, and ...
Hip bonepain, that is, caused by adjacent tissue structure lesions such as lumbar disc herniation, lumbar spine arthropathy, etc., with bilateral kidney Yu, large intestine Yu, Chibian. Huanjiao acupuncture 2 ...
Inner KunlunTaixi of the Yin and Kidney meridians corresponds to each other, so they cooperate with each other to treat gynecological diseases and ankle joint diseases. The Kunlun point has the effect of dispersing wind and activating collaterals. With its location in the upper also, and ...
HuanjiaoPain, that is, caused by adjacent tissue structure lesions such as lumbar disc herniation, lumbar spine arthropathy, etc., with bilateral kidney Yu, large intestine Yu, Chibian. Ring jump acupuncture 2 ...
More Acupuncture Points for OsteoarthropathyProprietary Chinese Medicines for Osteoarthropathy Xiaowuoluodan
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