Enthesopathy of joints, tendons, ligaments, muscles and bones

Spondyloarthropathy, or enthesopathy, is a series of inflammatory pathologies of the musculoskeletal system, which have common clinical and radiological characteristics, along with the absence of rheumatoid factor in patients with plasma. Enthesopathies can develop in people of young and middle age, significantly worsening work capacity and vitality.

Untimely late diagnosis of the disease often leads to disability.

[1], [2], [3], [4]

Epidemiology

This pathology is considered 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 have to do with enthesopathy.

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

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

According to observations, 3/4 of active people, professionally involved in sports, sooner or later find out this disease.

[5], [6], [7], [8], [9], [10]

Causes of the enthesopathies

Under the influence of many reasons, the development of an inflammatory reaction in nearby tissues can begin. If the inflammation continues for a long time, then invariably occur and dystrophic disorders in connective tissue. Due to these processes, the elasticity and density of ligaments, fasciae, and tendons deteriorates. The degree of danger of damage increases: over time, the articular function becomes worse.

The general number of reasons for various kinds of enthesopathies is as follows:

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

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

Risk factors are active and even professional sports activities, especially light and heavy athletics, football, tennis, basketball, etc. Often, the disease affects people whose profession involves repetitive monotonous movements, or the regular lifting and carrying of weights (builders, loaders and t . P.).

A negative role is also played by excess weight, bad habits, and improper diet.

[11], [12]

Pathogenesis

The name "entesopathy" means the presence of a painful process in the entheses - zones in which the tendons, capsules and ligaments attach to the bone. In the broad sense of the word, enthesopathy is also referred to as tendonitis of terminal tendon sites, as well as inflammatory processes in a number of located mucous bursa.

The musculoskeletal function is one of the basic functions of the human body. Without it it is practically impossible to live fully. The bone system has a number of connective elements, which serve as ligaments and tendons of the musculature, they help to maintain stable and clear connections between the bones. Such a structure resembling a lever device allows a person to make movements and lead an active lifestyle.

Mechanical damages of the components of these compounds can trigger the development of inflammation in connective tissue fibers. As a result, there is enthesopathy, which develops as a variant of periarthritis. The painful process usually involves elements of the tendons, ligamentous apparatus, synovial bursa, and fascial fibers.

The localization of the affected foci is distinguished by such types of enthesopathies:

• shoulder (the long head of the biceps muscle is affected);
• ulnar (is an epicondylitis);
• hip (proceeds as trochanteritis);
• knee;
• ankle ("calcaneal spur").

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

[13], [14], [15], [16], [17], [18], [19]

Symptoms of the enthesopathies

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

Common clinical signs are:

• soreness in the affected area, which can be intensified when trying to actively move;
• formation of localized edema, swelling;
• slight reddening of the skin over the area of inflammation;
• local increase in temperature;
• deterioration of the motor function of the joint;
• Painful sensations when pressing on the affected area.

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

The disease is prone to sluggish prolonged course. Over time, painful joints are joined by other symptoms:

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

In the absence of treatment, the work capacity is practically guaranteed to be lost, the quality of life of patients is deteriorating.

[20], [21]

Stages

The disease is divided into two stages:

1. The initial, or dorotgenologicheskaya stage, in which pathological changes in the joint have already begun, but they still can not be recognized by X-ray diagnostics.
2. X-ray stage differs marked clinical and roentgenological signs of painful tissue damage.

[22], [23], [24],

Forms

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

• Tendon enthesopathy is a classic form of the disease. Tendons connect the muscles and bones. Protective tendon is protected from damage by a longitudinally elastic tendon. If the elasticity is lost, then together with it the stamina and strength of the joint are lost.

In the pathological process, there may be both degenerative changes and tissue tears. These factors lead to the appearance of pain, restriction of movement, loss of activity.

The disease can damage the Achilles tendon, extensors of the forearm, the lower segment of the shin, etc.

• Tendon enthesopathy of the quadriceps femoris is the most common lesion of the tendon apparatus of the lower limbs. The tendon of the quadriceps muscle is fixed on the anterior and lateral surfaces of the patella and on the tuberous part of the tibia. This connection is considered to be very strong, however, if the fibers are damaged, such strength is lost. Damaged tissue swells, it becomes difficult for the patient to unbend the shin. In the future, the patient is experiencing increasing difficulties with walking.
• The enthesopathy of the Achilles tendon is first manifested by pain when walking, running, jumping. Over time, the pain worries when any attempts to lean on the heel. Patients describe this condition as a "nail in the heel." Outwardly, no changes are visible in the heel area, however, it becomes difficult for a person to walk, his gait changes, additional calluses and corns appear on the heel.

Among the reasons that cause enthesopathy Achilles tendon, in addition can be called spinal column disease and flat feet.

• Muscle enthesopathy is a disease of the ligamentous musculoskeletal system due to a long-term inflammatory process and dystrophic transformations that lead to the formation of ossified areas, to a change in the tendon structure (up to the rupture). Pathology is formed in the immediate vicinity of any joints.

The main sign is the pain that arises in the joints and increases with the strain of the muscle fibers of the affected tendons. Edema is not formed in all cases, but stiffness with time becomes a stable symptom.

• Ennesopathy of the supraspinatus occurs when the muscular tendons of the shoulder "rotator cuff" are damaged, which is represented by a small round, supraspinatus, subacute and subscapular muscle. As a rule, the defeat is combined, which, among other things, can also grab nearby tissues - for example, the capsule of the joint and the subacromial bursa. The muscle of the muscle is damaged most often.
• Gluteal enthesis is a phenomenon of inflammatory-dystrophic type, affecting the tendons of the gluteal muscles. Pathology is determined by atrophy and muscle weakness, motor impairment, problems with the change in the position of the trunk. The patient loses the ability to move fully: he feels pain and can hear crunches. In some cases, the examination reveals swelling and redness of the skin.
• Enthesopathy of ligaments is one of the variants of the concept of this disease, which indirectly reflects reality. Enteases are the places of connection of tendons and bones. Bundles are structural elements, the main function of which is to strengthen the joint. With the help of ligaments, the bones are connected to each other. Tendons are structural elements other than ligaments: they transmit a contractile impulse to the musculoskeletal system and connect the muscles and bones to each other.

Bone enthesopathy develops with increasing dynamics, gradually, differing by a prolonged course. Over time, the integrity of the tendon-ligament system may be compromised, the stability of the joint may be impaired. This leads to deformation and - in neglected cases, to the total impossibility of movement.

• Enteropathy of the shoulder joint is diagnosed in persons actively engaged in swimming, throwing sports. A painful reaction affects the muscular tendon of the rotator, or the rotator humeral cuff, to which include a small round, supine, subacute and submapular muscle. Pathology can spread to other tissue structures, for example, the capsule of the joint and the subacromial bursa. Most often suffers from a tendon tendon.

Among the main signs of this disease can be identified:

1. tenderness of the shoulder zone (especially when trying to raise or withdraw the upper limb);
2. increased pain at night, during sleep on the affected side;
3. increased pain when shaking hands, trying to pick something up.

• The enthesopathy of the large tubercle of the humerus and the humerus head is diagnosed most often. The painful process in the tendons adjacent to the large tubercle leads to local changes in the zone of the large tubercle. Periarticular lesion 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 (pacarcum bursitis, tendonitis). There is a steady limitation of the mobility of the shoulder with a sharp pain.
• Entezopathy of the elbow joint is a disease often detected in people involved in weightlifting, gymnastics, tennis, golf. Defeat is observed, both in carpal flexors, and in extensors. In a similar situation, it is appropriate to diagnose the medial, or lateral tendinitis.

The signs of the disease differ little from those in tendons located elsewhere. There may be a painful sensation when trying to flex or unbend the wrist joint: soreness is thus grouped inside and outside the forearm. The patient complains of problems with the retention of objects, it becomes difficult for him even to shake hands. Subsequently, these movements become limited.

• Hand enzopathy includes damage to the tendons of the digital flexor and extensor, as well as the annular ligament in the area of the interphalangeal joints. Damage is the result of an initial or secondary inflammatory-dystrophic process, which eventually leads to loss of mobility. For the disease is typical swelling, pain and crunching in the damaged joints.
• Pelvic enthesopathy is a somewhat blurred concept that can include information about the lesion of the lower pelvic aperture, limited by the sciatic bumps, coccyx, pubic joint and lower branches of the pubic bones.
• Enthesopathy of the lower extremities can include pathological changes in the hip joint, in the knee joint, in the ankle and foot. Defeat in most cases is isolated, or combined.
• The enteropathy of the lateral ligaments of the knee joint from the lateral or medial surface may accompany gonarthrosis. Diagnosis is often limited to palpation, in which there is clearly a pain in the affected area. Such zones can be two or more, on either side of the knee joint.
• The enthesopathy of the goose leg of the knee joint is also called "anserine bursitis", it is a lesion in the tibia appendage to the tendon tendon of the sartorial musculature, as well as the elegant and semitendinous musculature, at the location of the small bag. This site is located about 3.5 cm below the location of the knee-joint gap. The disease is typical for fat people, suffering from knee arthrosis.

The enthesopathy of the left, right knee joint is characterized by pains that can increase during the ascent of the stairs (unlike arthrosis, pain during descent). Typical "starting" soreness in the field of anserinic bursa, when the patient suddenly rises and tries to go.

• The patellar entecopathy, the enthesis of a patellar patellar ligament can be detected in isolation, or in combination with the damage of other tissues of the knee joint. Clinically, the pathology is characterized by pain and swelling in the anterior part of the joint.
• The enthesopathy of the medial lateral ligament is associated with a lesion of the connective tissue of the knee joint. For the pathology, the appearance of pain from the affected side of the knee is typical, especially when pressing the side that corresponds to the lesion.
• Thyrosophagia enthesopathy is manifested by a tendon lesion of such muscles as the long adductor, diverting and ilio-lumbar. Equally rare is also ischial enthesopathy, which affects mainly office workers.

The patient complains of the soreness of the external side of the joint, which is especially worrisome at the time of hip withdrawal, as well as with an emphasis on the leg while walking. Discomfort is felt in the inguinal zone, as well as in the lower segments of the thigh. The mobility of the hip joint is limited, with the palpation of pain.

• The enthesopathy of large trochanteres of the femurs can arise as a complication of sluggish osteoarthritis in female patients 40-60 years old. Pathology manifests itself as a pain that spreads throughout the external femoral surface. Patients may complain about pain at rest, especially at night, while trying to lie on the affected side of the body.
• The enthesopathy of the plantar aponeurosis is often associated with a "calcaneal spur". A heel bag is located in the lower segment of the heel bone, in the zone of attachment of the plantar aponeurosis. Soreness in the heel region is called talalgia: such pain can be caused by both an inflammatory reaction and dystrophic changes. In most cases, an independent inflammatory process with heel pain is the only sign of seronegative spondyloarthropathy.

Enteroscopy of the calcaneus, heel enterosopathy is almost always associated with degenerative processes that occur against the background of calcification of entesis. This pathology is more typical for patients of the older age group.

• The enteropathy of the femur proceeds according to the type of trochanteritis, or susceptible bursitis. The disease is manifested by pain, which "gives" to the outside of the thigh. A characteristic symptom: the patient is difficult to lie on a certain side of the trunk. There is a clear localized pain in the femur area, the amplitude of hip rotation can be disturbed or preserved.

Intesopathy of the hip joints often differentiates with susceptible bursitis. However, this differentiation has no therapeutic value, since both cases provide for practically adequate treatment.

• Antexopathy of the ankle joint is usually manifested by tenosynovitis of the peroneal muscle. The tendon part of this muscle is located below the lateral malleolus: with an inflammatory reaction, one can observe oblong edema along the vaginal part of the tendon. Patients complain of pain while walking.
• Enthesopathy of the ischial hillock is an inflammatory process in the zone of attachment of the tendon to the ischial tubercle. The disease is often found against the background of any seronegative spondylitis, which include, for example, Bechterew's disease and reactive arthritis. The area of the ischial tuber is the lower segment of the buttock. This site, as a rule, is subject to considerable loads, if the patient is engaged in sitting position - especially on a hard surface. A characteristic symptom of such a pathology is pain in the sitting position, which is somewhat facilitated while walking while raising the leg.
• Entezopathy of the spine is associated with increased stress on the spine, which is usually the case for athletes with intensive training in gymnastics, acrobatics, weightlifting. This kind of disease causes premature wear of the ligamentous system of the spinal column. The pathology is serious enough and requires constant medical control.
• Loading enterosopathy is a term that implies the development of joint damage due to sudden and intense physical exertion. Such a pathology is often found in people who were not previously physically active, and then started to engage in sports. The musculoskeletal system simply can not so quickly adapt to the load, so there is a microdamage of muscle and tendon fibers, which causes pain in varying degrees.

[25], [26], [27], [28], [29]

Complications and consequences

In the course of a continuous course of enterosopathic defeat of any etiology, enterophytes are formed. Enthesophytes are ossificates of enthesis: in case of enthesitis, this pathology is often combined with erosive lesions of the underlying bone tissue. Most often, erosion is found in the attachment of the Achilles tendon to the calcaneus.

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

[30], [31]

Diagnostics of the enthesopathies

Only a qualified specialist who can refer the patient to a diagnosis can establish an accurate diagnosis.

During the examination, the following signs attract attention:

• limited motor amplitude;
• changes in the skin of the affected joint, the presence of seals;
• soreness with palpation of the joint;
• swelling, redness.

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

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

Instrumental diagnosis, as a rule, does not require any preliminary preparation, but it is sufficiently informative. This especially applies to radiation diagnostic methods.

• X-ray method helps to visualize the deformation of joints, to see the presence of pathological inclusions. This procedure is quick and painless, however, like other radiotherapy methods, it is not recommended for patients during pregnancy.
• Arthrography is carried out with the use of contrast, which improves the quality of the image and allows us to consider the problem in more detail. The procedure lasts about ten minutes. Contraindications to its conduct are allergic reactions to iodine-containing drugs.
• Computed tomography also refers to X-ray methods, but is more informative, since it involves carrying out a large number of images in different planes. Image - a picture of the joint - can be viewed on the monitor screen, or on the 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 also safe. MRI is contraindicated in patients with the presence of metal implants and pacemakers.
• Ultrasound of joints is based on the use of ultrasound. This is the most safe type of diagnosis, which can be prescribed even to patients during pregnancy.

[32], [33], [34], [35]

Differential diagnosis

Enterospaty is a relatively complex disease in diagnosis, so it is very important to distinguish such a disease from other articular pathologies. Differential diagnosis can be carried out with virtually any disease that affects the joints. Enthesopathy is identified based on the detection of local soreness at the time of contraction of the corresponding muscles, especially when the amplitude movements are abrupt. Palpable can be defined as pain, and tumors, growths.

With the help of radiation diagnosis, one can distinguish this pathology, due to the detection of enterosis, or its combination with bone erosion and osteosclerosis.

In many cases, it becomes difficult to find differences between defeat of enteroses, as well as tendonitis and bursitis. Seronegative enthesopathy is often a combination of several inflammatory processes - for example, tendinitis and enthesitis of one tendon, or bursitis near a located synovial cortex. Often, the disease is detected against the background of diabetes.

Treatment of the enthesopathies

Treatment of the disease does not have a single scheme: treatment activities can be different, depending on the specific case. Usually they use conservative, surgical treatment, as well as alternative methods - for example, alternative prescriptions and homeopathy. On which method to stop the choice, the doctor should solve, being based on individual features of a problem.

Conservative treatment implies the use of at least two groups of medicines:

1. Etiotropic drugs are medicines that directly affect the underlying cause of the pathology. For example, if enterosopathy has an infectious-inflammatory nature, then the doctor can use antibiotic therapy, and with autoimmune disease, hormones are used.
2. Symptomatic drugs are medicines to relieve the main symptoms of pathology. The most popular drugs in this group are anti-inflammatory and analgesic drugs.

Medicines can be prescribed in any of the existing dosage forms: tablets, capsules, injectable solutions, as well as medications for insertion into the joint cavity.

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

An indispensable addition to treatment is diet therapy. It's no secret that nutritional disorders negatively affect metabolic processes - in particular, protein and mineral metabolism. Control of body weight is also necessary: overweight can lead to the fact that the joints under the influence of overload wear very quickly, outstripping the development of age-related changes in them.

Medicinal treatment

• Nonsteroidal anti-inflammatory drugs are prescribed to inhibit the development of the inflammatory process:

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

The intake of non-steroidal agents should not last for a long time, since such drugs exert a heavy load on the liver and digestive system.

• Vasodilators can help if swelling or joint deformity leads to narrowing or squeezing of the vessels:

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

Vasculature medications can cause a number of side effects. The most common of these is a lowering of blood pressure and a headache.

• The muscle relaxants allow us to relax the tension of the periarticular musculature:

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

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

• Hormonal steroid drugs are used for severe pain and a neglected inflammatory process:

1. Diprospan is given an individual course, 1-2 ml daily.
2. Celeston is applied on an individually selected schedule, preferably - a short course.

The course of hormonal treatment should be prescribed only in extreme cases. The duration of the course is the minimum possible, in order to avoid the development of negative side effects.

• Chondroprotective drugs allow the synthesis of cartilaginous tissue and restore mobility in the joint:

Chondroitin with glucosamine take a long course, 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 the normal function of the joints, many different substances are needed that contribute to this. We are talking, first of all, about vitamins and minerals. Calcium, phosphorus, iron, zinc, magnesium, B vitamins, cholecalciferol, vitamin K - these substances have a multifaceted effect on the body. They are often used in complex therapy for diseases of bones, ligaments, joints.

To date, there is no need for a separate intake of each necessary substance, as in most pharmacies you can buy ready-made complex vitamin and mineral preparations that include all the important components for health.

When joint diseases are particularly recommended:

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

Vitamins usually enter the body with food in adequate quantities. However, if their receipt is violated for any reason, the use of ready-made drugs in the form of tablets, capsules, dragees will be fully justified.

Physiotherapeutic treatment

It is recommended to pay attention to such physiotherapeutic methods that can help in the treatment of the disease:

• Electrophoresis with medicinal products.
• Ultrasound impact.
• Magnetotherapy.
• Radiation therapy (infrared, ultraviolet, laser beams).

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

Contraindication to the physical therapy is the presence of malignant tumors, active tuberculosis, epilepsy, heart disease in decompensation, pregnancy, fever, cachexia, and clotting disorders.

Alternative treatment

If traditional medicine is not possible for some reason, many people resort to alternative treatment. Over the past few decades, there have been quite a few fans of this type of treatment. The reason for this may be that natural remedies have a milder effect on the body and practically do not cause the development of negative side effects.

• Apply heated wax (layerwise applied to the affected joint): this helps alleviate the sharp and unbearable pain.
• A fresh sheet of burdock should be tightly attached to a sore spot immediately after taking a hot bath or after a bath, at least twice a week (preferably at night).
• An external preparation is prepared on the basis of 50 g of camphor, 50 g of mustard powder, 100 g of a protein portion of a raw egg, 0.5 liters of vodka. The product is rubbed into the affected areas every night before going to bed.

Herbal Treatment

In most cases, in the treatment of diseases of the musculoskeletal system, not individual plant components are used, but herbal mixtures that can contain up to ten or even more ingredients.

The greatest effect is possessed by such vegetative gathering:

• Rhizome rhizome (1 hour), leaves of melissa and eucalyptus, pine buds (2 hours each), herbs of thyme and oregano, nightshade (3 hours each), violet (4 hours), St. John's wort and hawthorn 5 hours).
• Flaxseed (1 hour), juniper fruit, horsetail and yarrow herb (2 hours each), sweet clover grass, rhizome root, St. John's wort and lily of the valley (3 hours each), Labrador tea (4 hours), turn (5 h.).
• Leaves of linden and mint, dill seed (1 hour), leaves of nettle, sorrel, pine buds (2 hours each), chamomile flowers, hop cones, St. John's wort and thyme (3 hours each), leaves of Ledum and violets for 4 hours).

To prepare the medicine, you should take three tablespoons of any of the above fees, pour 0.4 liters of boiling water, insist until cooling. The medicine should be drunk before meals, three times a day.

Homeopathy

Alternative treatment of joint problems can be homeopathy. It is also a great addition to taking nonsteroidal 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 facility of Target T can completely replace the intake of NSAIDs.

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

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

Among other homeopathic medicines it is recommended to pay attention to such:

• Recorded - taken for two months, three times a day for 10 drops, 60 minutes before meals;
• Benzoicum acidum - granules dissolve in the oral cavity 30 minutes before meals;
• Aurum - the 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 perfectly tolerate the treatment with homeopathy.

Surgery

Most patients try to solve the problem with the use, first of all, of conservative methods of treatment. However, in certain cases, it is not possible to avoid the operation. If the operation becomes necessary, then the following surgical interventions are possible:

• Minimally invasive puncture is the minimal intervention, in which the doctor inserts a needle into the joint to inject medicinal fluids.
• Surgery for arthroscopic debridement is carried out using elastic endoscopic instruments, through small holes. During the operation, the doctor removes necrotic tissues from the joint and rinses the joint cavity with a medicinal liquid.
• Surgery for endoprosthetics is a radical intervention, in which the doctor replaces the damaged joint with a biologically compatible prosthesis. This operation is the most traumatic and takes a long time to restore the patient.

Prevention

For the prevention of disease it is useful in sports to focus on aerobic exercise, reducing the number of strength exercises.

In the presence of excess body weight, it is necessary to take measures to reduce it: every extra kilogram adds to the danger of developing the disease.

If a person's professional activity provides for the load on certain joints or limbs, then it makes sense to introduce small breaks into the work schedule, include production gymnastics, and regularly massage the most vulnerable areas.

With regular high physical exertion, it is recommended to periodically use a course of calcium, vitamins and minerals.

In addition, it is necessary to refrain from smoking and drinking alcohol: these negative habits adversely affect the metabolic processes in bone and cartilage tissues.

[36], [37], [38], [39]

Forecast

If the disease is not treated, then eventually the person will gradually lose the function of the affected joint, until its complete loss.

With the timely intervention of physicians most often comes a complete cure: a surgical operation in most cases helps to eliminate a problem such as enthesopathy.

[40], [41], [42]