Enthesopathy of joints, tendons, ligaments, muscles and bones

Spondyloarthropathy, or enthesopathy, is a series of inflammatory pathologies of the musculoskeletal system that have common clinical and radiological characteristics, along with the absence of rheumatoid factor in the blood plasma of patients. Enthesopathies can develop in young and middle-aged people, significantly impairing their ability to work and vital activity.

Late or untimely diagnosis of the disease often leads to disability.

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Epidemiology

This pathology is considered to be quite common and is found in 60-85% of adults. According to experts, if a person has problems with joints, then in 60% of cases they are related to enthesopathy.

Patients gradually lose their ability to work as a result of severe pain. According to statistics, more than half of people suffering from one or another form of arthritis or arthrosis have enthesopathy of the periarticular tendons or other connective tissue structures.

Often the disease is diagnosed against the background of reactive urogenic inflammation of the joints, as well as Reiter's disease.

According to observations, 3/4 of active people who are professionally involved in sports are sooner or later diagnosed with this disease.

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Causes enthesopathies

Under the influence of many reasons, an inflammatory reaction may begin to develop in tissues adjacent to the joint. If the inflammation continues for a long time, then degenerative disorders in the connective tissue inevitably occur. As a result of the listed processes, the elasticity and density of ligaments, fascia, and tendons deteriorate. The degree of danger of damage increases: over time, joint function becomes worse.

The general range of causes of various types of enthesopathies is as follows:

• joint injuries due to impact or fall;
• performing wide-amplitude movements;
• regular excessive loads (both static and dynamic);
• congenital defects, deforming processes in bones, joints and/or muscles;
• infections, metabolic disorders (gout, articular psoriasis, osteoarthropathy, brucellosis, etc.).

An inflammatory reaction in the tissues around the joint can develop immediately after a traumatic injury. This can be the result of stretching, compression, or bruising. Such a reaction often occurs with existing inflammation of the muscle or joint, or with secondary damage to the tendons relative to the joints or muscles.

Risk factors include active and even professional sports, especially track and field and weightlifting, football, tennis, basketball, etc. The disease often affects people whose profession involves monotonous repetitive movements or regular lifting and carrying of heavy objects (builders, loaders, etc.).

Excess weight, bad habits, and poor nutrition also play a negative role.

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Pathogenesis

The term "enthesopathy" means the presence of a painful process in the entheses - areas where tendons, capsules and ligaments are attached to the bone. In a broad sense, enthesopathies also include tendinitis of the terminal tendon areas, as well as inflammatory processes in the adjacent mucous bursae.

The musculoskeletal function is one of the main functions of the human body. Without it, it is almost impossible to live a full life. The skeletal system has many connecting elements, which are ligaments and tendons of the muscles, they help maintain stable and clear connections between the bones. Such a structure, reminiscent of a lever apparatus, allows a person to make movements and lead an active lifestyle.

Mechanical damage to the components of these connections can provoke the development of inflammation in the connective tissue fibers. As a result, enthesopathy occurs, which develops as a variant of periarthritis. The disease process usually affects tendon elements, ligament apparatus, synovial bursa and fascial fibers.

Depending on the localization of the affected area, the following types of enthesopathies are distinguished:

• brachial (the long head of the biceps muscle is affected);
• elbow (represents epicondylitis);
• hip (occurs as trochanteritis);
• knee;
• ankle ("heel spur").

The term "entesopathy" is considered general, including various inflammations of periarticular tissue structures. Among other things, such inflammations can spread to other nearby structures, which leads to the development of a diffuse combined inflammatory process.

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Symptoms enthesopathies

The clinical picture of the inflammatory process in the joint tissues has its own characteristic features. Specificity can be determined by the nature of the damage and the location of the damaged focus.

Common clinical signs include:

• pain in the affected area, which may intensify when attempting active movement;
• formation of localized edema, swelling;
• slight redness of the skin over the area of inflammation;
• local increase in temperature;
• deterioration of joint motor function;
• pain when pressing on the affected area.

In most cases, the inflammatory reaction increases slowly, so the first signs are quite difficult to notice. With gradual progression of the disease, the function of the joint is impaired, contractures are formed.

The disease tends to have a sluggish, long-term course. Over time, other symptoms join the pain in the joint:

• violation of the integrity of ligaments and tendons;
• sprain;
• joint deformation;
• complete loss of motor function in the joint.

Without treatment, it is almost guaranteed that patients will lose their ability to work and their quality of life will deteriorate.

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Stages

The disease is divided into two stages:

1. The initial, or pre-radiological stage, in which pathological changes in the joint have already begun, but they cannot yet be identified using X-ray diagnostics.
2. The radiological stage is characterized by pronounced clinical and radiological signs of painful tissue damage.

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Forms

Enthesopathy is divided into a large number of types, depending on the localization of the pathology.

• Tendon enthesopathy is a classic form of the disease. Tendons connect muscles and bones. The longitudinal elastic tendon tissue serves as a protective shield against damage to the tendon. If elasticity is lost, then the endurance and strength of the joint are lost along with it.

During the pathological process, both degenerative changes and tissue ruptures may occur. These factors lead to pain, limited movement, and loss of activity.

The disease can damage the Achilles tendon, forearm extensors, lower leg, etc.

• Enthesopathy of the quadriceps tendon is the most common lesion of the tendon apparatus of the lower extremities. The quadriceps tendon is attached to the anterior and lateral surfaces of the patella and to the tuberosity of the tibia. This connection is considered very strong, but when the fibers are damaged, this strength is lost. The damaged tissues swell, and it becomes difficult for the patient to straighten the shin. Later, the patient experiences increasing difficulties with walking.
• Enthesopathy of the Achilles tendon initially manifests itself as pain when walking, running, jumping. Over time, the pain bothers with any attempts to lean on the heel. Patients describe this condition as a "nail in the heel." Externally, no changes are visible in the heel area, but it becomes difficult for a person to walk, his gait changes, additional calluses and corns appear on the heel.

Among the causes that cause enthesopathy of the Achilles tendon, we can additionally name diseases of the spinal column and flat feet.

• Muscle enthesopathy is a disease of the ligamentous-muscular system that occurs as a result of a long-term inflammatory process and dystrophic transformations that lead to the formation of ossified zones, to a change in the tendon structure (up to rupture). The pathology is formed in close proximity to any joints.

The main symptom is pain that occurs in the joints and intensifies with tension of the muscle fibers of the affected tendons. Edema does not form in all cases, but stiffness becomes a persistent symptom over time.

• Enthesopathy of the supraspinatus muscle occurs when the muscle tendons of the shoulder "rotator cuff" are damaged, which are the teres minor, supraspinatus, infraspinatus and subscapularis muscles. As a rule, the lesion is combined, which, in addition, can also affect nearby tissues - for example, the joint capsule and subacromial bursa. The supraspinatus muscle is damaged most often.
• Enthesopathy of the gluteal muscles is an inflammatory-dystrophic phenomenon affecting the tendons of the gluteal muscles. The pathology is determined by atrophy and weakness of the muscles, impaired motor ability, and problems changing the position of the body. The patient loses the ability to move fully: he feels pain and can hear crunching. In some cases, swelling and redness of the skin are detected during examination.
• Enthesopathy of ligaments is one of the variants of the concept of this disease, which indirectly reflects reality. Entheses are the places where tendons and bones connect. Ligaments are structural elements whose main function is to strengthen the joint. Ligaments connect bones to each other. Tendons are structural elements that are different from ligaments: they transmit the contractile impulse to the musculoskeletal system and connect muscles and bones to each other.

Bone enthesopathy develops with increasing dynamics, gradually, and is characterized by a long course. Over time, the integrity of the tendon-ligament system may be compromised, and the stability of the joint may be impaired. This leads to deformation and, in advanced cases, to complete inability to move.

• Enthesopathy of the shoulder joint is diagnosed in people actively involved in swimming and throwing sports. The painful reaction affects the muscular tendons of the rotator, or rotator cuff, which includes the small round, supraspinatus, infraspinatus and subscapularis muscles. The pathology can spread to other tissue structures, for example, to the joint capsule and subacromial bursa. The supraspinatus tendon is most often affected.

Among the main signs of such a disease, the following can be distinguished:

1. pain in the shoulder area (especially when trying to raise or move the upper limb);
2. increased pain at night, while sleeping on the affected side;
3. increased pain when shaking hands or trying to lift something.

• Enthesopathy of the greater tubercle of the humerus and the humeral head is diagnosed most often. The painful process in the tendons adjacent to the greater tubercle leads to local changes in the area of the greater tubercle. Periarticular damage can occur along with pathological disorders in the cervical spine - for example, in combination with cervical radiculitis, as well as with damage to periarticular soft tissues (subacromial bursitis, tendinitis). There is a persistent limitation of shoulder mobility with severe pain.
• Enthesopathy of the elbow joint is a disease often found in people involved in weightlifting, gymnastics, tennis, golf. The lesion is observed in both the wrist flexors and extensors. In such a situation, it is appropriate to diagnose medial or lateral tendonitis.

The symptoms of the disease are not much different from those in tendons located elsewhere. There may be a painful sensation when trying to bend or straighten the wrist joint: the pain is grouped inside and outside the forearm. The patient complains of problems holding objects, it becomes difficult for him even to shake hands. Subsequently, the listed movements become limited.

• Enthesopathy of the hands includes damage to the tendons of the finger flexors and extensors, as well as the annular ligament in the area of the interphalangeal joints. The damage is the result of an initial or secondary inflammatory-dystrophic process, which over time leads to loss of mobility. Swelling, pain and crunching in the damaged joints are typical for the disease.
• Pelvic enthesopathy is a somewhat vague concept that may include information about the lesion of the inferior pelvic aperture, limited by the ischial tuberosities, coccyx, pubic junction and inferior ramifications of the pubic bones.
• Enthesopathy of the lower extremities may include pathological changes in the hip joint, knee joint, ankle joint and foot. The lesion in most cases is isolated or combined.
• Enthesopathy of the lateral ligaments of the knee joint from the lateral or medial surface may accompany gonarthrosis. Diagnosis is often limited to palpation examination, which clearly reveals pain in the affected area. There may be two or more such areas, on both sides of the knee joint.
• Enthesopathy of the pes anserinus of the knee joint is otherwise called "anserine bursitis", this is a lesion in the area of attachment of the tibia to the tendon cord of the sartorius muscle, as well as the graceful and semitendinosus muscles, in the location of the small bag. The specified area is localized approximately 3.5 cm below the location of the knee-articular gap. The disease is typical for obese people suffering from knee arthrosis.

Enthesopathy of the left and right knee joint is characterized by pain that may intensify when climbing stairs (the difference from arthrosis is pain when descending stairs). Typical is the "starting" pain in the area of the anserine bursa, when the patient suddenly stands up and tries to walk.

• Enthesopathy of the patella, enthesopathy of the patellar ligament itself can be detected in isolation or in combination with damage to other tissues of the knee joint. Clinically, the pathology is characterized by pain and swelling in the anterior part of the joint.
• Enthesopathy of the medial collateral ligament is associated with damage to the connective tissue of the knee joint. The pathology is characterized by the appearance of pain on the affected side of the knee, especially when pressing on the side corresponding to the lesion.
• Enthesopathy of the hip is manifested by tendon damage to such muscles as the long adductor, abductor and iliopsoas. Sciatic enthesopathy is no less rare and affects mainly office workers.

The patient complains of pain on the outer side of the joint, which is especially disturbing when the hip is abducted, as well as when leaning on the leg while walking. Discomfort is also felt in the groin area, as well as in the lower segments of the thigh. The mobility of the hip joint is limited, and pain occurs when palpated.

• Enthesopathy of the greater trochanters of the femur may occur as a complication of sluggish osteoarthrosis in female patients aged 40-60 years. The pathology manifests itself as pain spreading along the entire outer surface of the femur. Patients may complain of pain at rest, especially at night, when trying to lie on the affected side of the body.
• Enthesopathy of the plantar aponeurosis is often associated with a "heel spur". The subcalcaneal bursa is located in the lower segment of the heel bone, in the zone of attachment of the plantar aponeurosis. Pain in the heel area is called talalgia: such pain can be caused by both an inflammatory reaction and degenerative changes. In most cases, an independent inflammatory process with heel pain is the only sign of seronegative spondyloarthropathy.

Enthesopathy of the calcaneus, calcaneal enthesopathy is almost always associated with degenerative processes that occur against the background of calcification of the enthesis. Such pathology is more typical for patients of the older age group.

• Enthesopathy of the femur occurs as trochanteritis or subtrochanteric bursitis. The disease manifests itself as pain that "radiates" to the outer part of the thigh. A characteristic symptom: the patient finds it difficult to lie down on a certain side of the body. A clear localized pain is detected in the femur area, the amplitude of hip rotation may be impaired or preserved.

Enthesopathy of the hip joints is often differentiated from subtrochanteric bursitis. However, such differentiation has no therapeutic value, since both cases require almost adequate treatment.

• Enthesopathy of the ankle joint usually manifests itself as tenosynovitis of the peroneal muscle. The tendinous part of this muscle is located below the lateral malleolus: in the inflammatory reaction, an elongated swelling along the sheath of the tendon can be seen. Patients complain of pain when walking.
• Enthesopathy of the ischial tuberosity is an inflammatory process in the area where the tendon attaches to the ischial tuberosity. The disease is often detected against the background of any seronegative spondyloarthritis, which include, for example, Bechterew's disease and reactive arthritis. The ischial tuberosity area is the lower segment of the buttock. This area is usually subject to considerable loads if the patient exercises in a sitting position - especially on a hard surface. A characteristic symptom of this pathology is pain when sitting, which is somewhat relieved during walking when raising the leg.
• Spinal enthesopathy is associated with increased loads on the spine, which usually occurs in athletes during intensive gymnastics, acrobatics, and weightlifting. This type of disease causes premature wear of the ligamentous system of the spinal column. The pathology is quite serious and requires constant medical supervision.
• Load enthesopathy is a term that implies the development of joint damage due to sudden and intense physical activity. This pathology often occurs in people who were not previously physically active, and then suddenly began to play sports. The musculoskeletal system simply cannot adapt to the loads so quickly, so microdamage to muscle and tendon fibers occurs, which causes pain of varying degrees.

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Complications and consequences

During the long course of enthesopathic lesions of any etiology, enthesophytes are formed. Enthesophytes are ossificates of entheses: in enthesitis, such pathology is often combined with erosive damage to the underlying bone tissue. Most often, erosions are found at the sites of attachment of the Achilles tendon to the calcaneus.

In the absence of necessary treatment, the disease leads to impaired mobility, immobilization of the joint, as well as impaired ability to work and disability.

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Diagnostics enthesopathies

Only a qualified specialist can establish an accurate diagnosis and refer the patient for diagnostics.

During the examination, the following signs are noticeable:

• limited range of motion;
• changes in the skin of the affected joint, presence of seals;
• pain when palpating the joint;
• swelling, redness.

Laboratory tests help to clarify the presence of an inflammatory process:

1. The blood test result may indicate a change in the amount of C-reactive protein in the plasma, the amount of total protein, and also detect a diphenylamine reaction and other changes. An increase in ESR will be an indicator of inflammation, and the presence of antinuclear antibodies will be an indicator of rheumatic disease. A sharp increase in uric acid levels is possible.
2. The results of urine analysis will show unfavorable indicators only in extremely severe pathological forms of joint damage.

Instrumental diagnostics, as a rule, does not require preliminary preparation, but is quite informative. This is especially true for radiation diagnostic methods.

• The X-ray method helps to visualize joint deformation and see the presence of pathological inclusions. This procedure is quick and painless, however, like other radiation methods, it is not recommended for patients during pregnancy.
• Arthrography is performed using contrast, which improves the image quality and allows the problem to be examined in more detail. The procedure lasts about ten minutes. Contraindications to its implementation include allergic reactions to iodine-containing drugs.
• Computer tomography also refers to X-ray methods, but is more informative, as it involves taking a large number of images in different planes. The image - a picture of the joint - can be viewed on the monitor screen or on pictures.
• Magnetic resonance imaging involves the use of radio waves and magnetic waves. This procedure is considered the most expensive, but also quite informative and safe. MRI is contraindicated for patients with metal implants and pacemakers.
• Ultrasound of joints is based on the use of ultrasound waves. This is the safest type of diagnostics, which can be prescribed even to patients during pregnancy.

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Differential diagnosis

Enthesopathy is a relatively difficult disease to diagnose, so it is very important to distinguish this disease from other joint pathologies. Differential diagnostics can be carried out with almost any disease affecting the joints. Enthesopathy is identified based on the detection of local pain at the moment of contraction of the corresponding muscles, especially with sharp amplitude movements. Both pain and tumors, growths can be determined by palpation.

With the help of radiological diagnostics, it is possible to distinguish this pathology by detecting enthesophytosis or its combination with bone erosion and osteosclerosis.

In many cases, it becomes difficult to differentiate between entheseal lesions and tendinitis and bursitis. Seronegative enthesopathy is often a combination of several inflammatory processes - for example, tendinitis and enthesitis of one tendon, or bursitis of a nearby synovial bursa. The disease is often detected against the background of diabetes mellitus.

Treatment enthesopathies

Treatment of the disease does not have a single scheme: treatment measures may vary, depending on the specific case. Usually, conservative, surgical treatment is used, as well as alternative methods - for example, folk recipes and homeopathy. The doctor should decide which method to choose, based on the individual characteristics of the problem.

Conservative treatment involves the use of at least two groups of drugs:

1. Etiotropic drugs are medications that directly affect the underlying cause of the pathology. For example, if enthesopathy is of an infectious and inflammatory nature, the doctor may use antibiotic therapy, and in the case of an autoimmune disease, hormonal agents are used.
2. Symptomatic drugs are medications for relieving the main symptoms of the pathology. The most popular drugs in this group are anti-inflammatory and pain-relieving drugs.

Medicines can be prescribed in any of the existing dosage forms: tablets, capsules, injection solutions, as well as medicines for administration into the joint cavity.

In addition to medications, it is appropriate to use physiotherapy, manual therapy, exercise therapy, etc.

Diet therapy is considered an invariable addition to treatment. It is no secret that nutritional disorders have a negative impact on metabolic processes – in particular, on protein and mineral metabolism. Weight control is also necessary: excess weight can lead to the fact that joints, under the influence of overload, wear out very quickly, ahead of the development of age-related changes in them.

Drug treatment

• Non-steroidal anti-inflammatory drugs are prescribed to slow the development of the inflammatory process:

1. Ibuprofen is prescribed in the amount of 400-600 mg up to 4 times a day;
2. Meloxicam is prescribed at 7.5 mg once a day, during breakfast.

Taking non-steroidal drugs should not be continued for a long time, as such drugs put a lot of stress on the liver and digestive system.

• Vasodilators may help if swelling or joint deformity causes narrowing or compression of blood vessels:

1. Actovegin is prescribed for internal use, 1-2 tablets three times a day before meals;
2. Pentoxifylline is prescribed orally, 2 tablets, three times a day, with a gradual reduction in dosage (at the discretion of the doctor).

Vasodilator medications can cause a number of side effects. The most common of these are low blood pressure and headache.

• Muscle relaxants help to relieve tension in the periarticular muscles:

1. Tolperisone is taken with a gradual increase in dosage, from 50 to 150 mg twice or three times a day;
2. Baclofen is prescribed according to an individually selected regimen.

When taking muscle relaxants, side effects usually occur at the very beginning of treatment and disappear on their own within a short time. To eliminate such a side effect as nausea, it is recommended to take the drug with food or a dairy product.

• Hormonal steroid drugs are used for severe pain and advanced inflammatory processes:

1. Diprospan is prescribed in an individual course, 1-2 ml daily.
2. Celestone is used according to an individually selected schedule, preferably in a short course.

A course of hormonal treatment should be prescribed only in extreme cases. The duration of the course should be as short as possible to avoid the development of negative side effects.

• Chondroprotective drugs allow the synthesis of cartilage tissue and restoration of mobility in the joint:

Chondroitin with glucosamine is taken for a long period of time, since the drug has a cumulative effect. The minimum course of therapy is two to three months.

Vitamins

For the health of the musculoskeletal system and for normal joint function, many different substances are needed to promote this. This primarily concerns vitamins and minerals. Calcium, phosphorus, iron, zinc, magnesium, B vitamins, cholecalciferol, vitamin K – these substances have a diverse effect on the body. They are often used in complex therapy for diseases of bones, ligaments, and joints.

Today, there is no need to take each necessary substance separately, since most pharmacies offer ready-made, selected complex vitamin and mineral preparations that include all the components important for health.

For joint diseases the following are especially recommended:

• Complivit;
• Calcium + brewer's yeast;
• Calcinate;
• Natekal.

Vitamins are usually supplied to the body with food in adequate quantities. However, if their supply is disrupted for some reason, then the use of ready-made preparations in the form of tablets, capsules, dragees will be quite justified.

Physiotherapy treatment

It is recommended to pay attention to the following physiotherapeutic methods that can help in treating the disease:

• Electrophoresis with medicinal preparations.
• Ultrasonic action.
• Magnetic therapy.
• Radiation therapy (infrared, ultraviolet, laser rays).

The duration of the treatment course and the frequency of procedures are determined by the doctor for each patient individually.

Contraindications to physiotherapy include the presence of malignant tumors, tuberculosis in the active phase, epilepsy, heart disease in the decompensation stage, pregnancy, fever, cachexia, and blood clotting disorders.

Folk remedies

In case the use of traditional medicine is impossible for some reason, many people resort to folk treatment. Over the past few decades, quite a lot of fans of this type of treatment have appeared. The reason for this may be that natural remedies have a softer effect on the body and practically do not cause the development of negative side effects.

• Heated wax is applied (layer by layer) to the affected joint: this helps to relieve sharp and unbearable pain.
• A fresh burdock leaf should be tightly tied to the sore spot immediately after taking a hot bath or after a sauna, at least twice a week (preferably at night).
• An external remedy is prepared based on 50 g of camphor, 50 g of mustard powder, 100 g of the protein part of a raw egg, 0.5 l of vodka. The remedy is rubbed into the affected areas every evening before bed.

Herbal treatment

In most cases, when treating diseases of the musculoskeletal system, they do not use individual plant components, but herbal mixtures that can contain up to ten or even more ingredients.

The following herbal infusions have the greatest effect:

• Calamus rhizome (1 part), lemon balm and eucalyptus leaves, pine buds (2 parts each), thyme and oregano herb, nightshade (3 parts each), violet flowers (4 parts), St. John's wort herb and hawthorn berries (5 parts each).
• Flaxseed (1 part), juniper berries, horsetail and yarrow herb (2 parts each), sweet clover herb, elecampane rhizome, St. John's wort and lily of the valley herb (3 parts each), wild rosemary herb (4 parts), succession (5 parts).
• Linden and mint leaves, dill seeds (1 tsp each), nettle leaves, sorrel, pine buds (2 tsp each), chamomile flowers, hop cones, St. John's wort and thyme (3 tsp each), wild rosemary and violet leaves (4 tsp each).

To prepare the medicine, take three tablespoons of any of the above mixtures, pour 0.4 liters of boiling water, and let it sit until it cools. The medicine should be taken before meals, three times a day.

Homeopathy

Homeopathy can be an alternative treatment for joint problems. It is also an excellent addition to taking non-steroidal and hormonal anti-inflammatory drugs.

For example, the German homeopathic remedy Traumeel C allows you to reduce the dosage of glucocorticoid drugs, and the complex remedy Ziel T can completely replace the use of NSAIDs.

Traumeel C contains a complex of components that together provide anti-edematous, analgesic, anti-inflammatory and restorative effects. The drug is available in the form of tablets, ointments and injections. The doctor decides which dosage form to choose.

Ziel T can be successfully combined with other types of treatment. The product combines well with non-steroidal drugs and chondroprotectors: Ziel T stops the progression of the disease, relieves acute symptoms, and prolongs the period of remission. The medicine can be purchased in the form of tablets, ointment, and injection solution.

Among other homeopathic remedies, it is recommended to pay attention to the following:

• Repisan – take for two months, three times a day, 10 drops, 60 minutes before meals;
• Benzoicum acidum - granules are dissolved in the mouth 30 minutes before meals;
• Aurum - dosage is determined individually.

Homeopathic remedies should not be used in the presence of tumor processes in the body, as well as during pregnancy.

Most patients tolerate homeopathic treatment well.

Surgical treatment

Most patients try to solve the problem using, first of all, conservative treatment methods. However, in some cases, it is impossible to avoid surgery. If surgery becomes necessary, the following types of surgical interventions can be used:

• Minimally invasive puncture is a minimal intervention in which the doctor inserts a needle into the joint to administer medicinal fluids.
• Arthroscopic debridement surgery is performed using elastic endoscopic instruments through small holes. During the surgery, the doctor removes necrotic tissue from the joint and washes the joint cavity with a medicinal liquid.
• Endoprosthetic surgery is a radical intervention in which the doctor replaces the damaged joint with a biocompatible prosthesis. This type of surgery is the most traumatic and requires a long time for the patient to recover.

Prevention

To prevent the disease, it is useful to focus on aerobic exercise in sports, reducing the amount of strength training.

If you are overweight, you need to take steps to reduce it: every extra kilogram increases the risk of developing the disease.

If a person’s professional activity involves stress on certain joints or limbs, then it makes sense to introduce short breaks into the work schedule, include industrial gymnastics, and also regularly massage the most vulnerable areas.

With regular heavy physical activity, it is recommended to periodically take calcium, vitamin and mineral supplements.

In addition, it is necessary to give up smoking and drinking alcohol: these negative habits have an adverse effect on metabolic processes in bone and cartilage tissues.

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Forecast

If the disease is not treated, over time the person will gradually lose the function of the affected joint, up to its complete loss.

With timely medical intervention, complete recovery most often occurs: surgery in most cases helps to eliminate a problem such as enthesopathy.

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