Periarthritis: symptoms and treatment
The following connections are located around the joint: capsule, bursa, tendons, muscles, ligaments. When a person's entire periarticular region becomes inflamed, he is diagnosed with periarthritis. Thus, this term is understood as the simultaneous defeat of all periarticular tissues with the subsequent development of reactive inflammation in the nearby joints. Periarthritis is referred to as rheumatic diseases. The word itself is of Greek origin and consists of two roots: peri (around) and arthron (joint).
Periarthritis can affect all tissues and interosseous connections that are in the system of the musculoskeletal system. Most often, periarthritis is diagnosed in women over the age of 40-45, although men are also susceptible to this disease. Periarthritis accounts for up to 26.1% of all extra-articular inflammation of the soft tissues of the musculoskeletal system.
Periarthritis is the most common form of this degenerative process. It accounts for 80% of the total number of shoulder rheumatic diseases. This is due to the fact that the tendons at the point of attachment of the shoulder joint are constantly in functional tension. Less commonly, muscle tendons attached to the elbow, wrist, and hands are affected. The rarest type of periarthritis is inflammation of the tendons and muscles in the area of the joints of the lower extremities, since there the load falls on the joints, and not on their muscular frame.
Periarthritis is a disease that can seriously impair the patient's quality of life, making him half disabled. After all, bones, joints, muscles and bursae are located throughout the body. Therefore, it is necessary to navigate the causes and symptoms of the disease so as not to delay treatment and consult a doctor in a timely manner.
Content:
- Periarthritis symptoms
- Causes of periarthritis
- Diagnosis of periarthritis
- Periarthritis treatment
- Prevention of periarthritis
Periarthritis symptoms
Common symptoms of periarthritis:
- Muscle pain that occurs only when certain movements are performed.
- Slight swelling of the inflamed area, which does not have severe pain.
- Muscle tension that is present on an ongoing basis.
- The presence of painful palpable points.
- During the acute stage of inflammation, a slight increase in local body temperature, swelling and hyperemia of the damaged area are possible.
- Limitation of mobility in the joint is not excluded, but not complete, but partial.
- During X-ray examination, it is possible to detect calcifications and periostitis.
If, during periarthritis, only tendons are involved in the pathological process, then this will be manifested by the following symptoms:
- Swelling of tissues;
- Accumulation of infiltration;
- Adhesion of collagen fibers;
- The formation of sclerosed areas and calcifications.
When the periarticular bag is affected, the following symptom complex will be observed:
- Swelling of the skin over the site of inflammation;
- Hyperemia of the skin;
- Accumulation of serous exudate;
- Deformation of the walls of the synovial bag.
The symptoms of periarthritis will also differ depending on where the inflammation is located:
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Shoulder - scapular - this type of inflammation is diagnosed more often than others. When it occurs, the tendon muscle is damaged in the scapular supraspinous fossa. Less commonly, the head of the biceps muscle suffers.
Symptoms of the humeroscapular periarthritis:
- Painful sensations in the shoulder area, which can occur both against a background of stress (with a simple form of inflammation) and at rest (with an acute form of inflammation);
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Severe pain occurs when trying to rotate the hand or when trying to overcome resistance;
- The inability to raise your hand high up, put it behind your back or perform other complex movements;
- "Frozen shoulder syndrome", which is characterized by loss of sensitivity in the areas of the shoulder, scapula, arm;
- The acute form of the disease is characterized by subfebrile body temperature, the occurrence of insomnia, deterioration in working capacity, the presence of swelling and sharp pain;
- In the chronic form of the disease, fusion of the walls of the bag is often observed with the further development of capsulitis and calcification of the affected tissues, as a result, the mobility of the upper limb will be seriously limited.
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Algodystrophic syndrome "shoulder-hand", as a type of humeral-scapular periarthritis.
Its symptoms:
- The appearance of severe burning pain in the area of the affected elements;
- Trophic and vasomotor changes in the hand: blue skin, development of osteoporosis, muscle atrophy;
- As the disease progresses, it leads to the formation of finger contracture.
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Radiocarpal periarthritis. In this case, the tendon of the brachioradialis muscle is most often affected in the place of its attachment to the styloid process of the radius.
Disease symptoms:
Radiocarpal periarthritis - Pain localized above the wrist joint;
- They tend to be strengthened by the rotation of the joint surrounded by sore muscles;
- Most often, there is a mild swelling of the affected area;
- The disease has a persistent and prolonged course.
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Elbow. In this type of periarthritis, tendons become inflamed where the hands, fingers, and forearms meet. Most often, the area of the outer epicondyle of the humerus is affected, therefore ulnar periarthritis is also called "tennis elbow".
Disease symptoms:
- Pain in the epicondyle when trying to straighten the forearm;
- An increase in lymph nodes, their soreness is possible;
- The pain radiates both to the upper part of the arm and down;
- Passive movement becomes partially limited due to pain;
- Most often, after a few months, an independent recovery occurs, although subsequent relapses of the disease are not excluded.
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Knee
Symptoms:
Knee - The inflammation is localized in the inner part of the knee, below the knee bend, it is in this place that pain occurs;
- The pain increases with walking, bending the knee, or with prolonged static position;
- There may be swelling and redness of the skin in the area of inflammation.
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Hip. In this case, the inflammation is localized in the area of the hip joint.
Symptoms:
- Paroxysmal pain in the pelvic region that radiates to the thigh;
- An attack of pain proceeds as a painful crisis;
- On palpation, the maximum pain is observed in the region of the greater trochanter, and when pressure is applied to its posterosuperior angle, the pain becomes unbearable;
- When the pains are gaining their maximum strength, the person becomes practically immobilized.
- Ankle and foot. Dystrophic changes in the foot occur, heel spurs are formed. Most often, athletes and overweight people suffer from this type of periarthritis. A common symptom of inflammation is pain when pressing on the heel. Pain is a consequence of the development of heel bursitis.
Constant companions of periarthritis are conditions such as bursitis (inflammation of the bursa), capsulitis (inflammation of the joint capsule), tendonitis (inflammation of the tendon), fasciitis (local inflammation of the muscle). Also, periosteum, which is in contact with the affected tendons, often gives a reaction to periarthritis, which leads to the development of periostitis.
Causes of periarthritis
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Periarthritis can be caused by degenerative processes. Also distinguish between true inflammatory periarthritis, which is extremely rare and is a consequence of chronic arthritis.
The reasons leading to the development of dystrophic periarthritis:
- Repeated microtrauma of the tendons. They can be due to the peculiarities of a person's professional activity, or be the result of increased physical exertion during sports. People of such professions as painter, blacksmith, tennis player, etc. are prone to the formation of periarthritis.
- Metabolic disorders are another reason that can lead to the development of inflammation of the periarticular tissues. It should be noted that periarthritis is most often diagnosed in obese people.
- Disorders in the endocrine system contribute to the development of periarthritis. This is especially true for women who are on the verge of menopause, or have already entered it.
- Vascular disorders negatively affect the nutrition of the periarticular tissues and can cause the development of their inflammation. Periarthritis often occurs in people with coronary artery disease. In this case, inflammation of the tendons develops against the background of subsiding of the angina attack. Periarthritis also develops in 15% of patients who have had myocardial infarction.
- Neuroreflex disruptions in the body should not be overlooked.
The stress and frequent injuries of the periarticular tendons lead to the formation of foci of necrosis in them, which are further sclerosed and calcified. Very often, reactive inflammation develops in these areas, which spreads to the adjacent joint bags.
Additional risk factors that can influence the development of periarthritis are:
- Diabetes;
- Age over 40;
- Past infections that have had a severe course (periarthritis acts as a complication);
- Long-term exposure to cold and damp conditions;
- Congenital diseases of the musculoskeletal system.
Diagnosis of periarthritis
Diagnostics begins with examination and listening to the patient's complaints. The doctor should be extremely careful, since periarthritis is very easy to confuse with arthritis and arthrosis.
Evaluation criteria that distinguish periarthritis from true joint diseases:
| Diagnostic criterion | Periarthritis | Arthritis | Arthrosis |
| The nature of the pain | Occurs only when the patient makes certain movements | Pain occurs spontaneously, becomes more intense with any movement | Pain appears when any movement occurs, there are no spontaneous pains |
| The presence of swelling | The swelling is small, on palpation it can respond with mild pain | Spilled diffuse and painful puffiness that has no clear boundaries | No |
| Joint changes | The joints are not deformed | There is deformity of the joints, but it is not very pronounced. Deformation occurs due to changes in soft tissues. | Bone growths provoke pronounced deformation of the joints |
| Pain during palpation | Painful points are palpated | The pain is diffuse, quite intense | On palpation, weak pain occurs, or they are absent at all |
| Local temperature rise | Possibly, but insignificantly | Temperature is greatly increased | No |
| Limb movements (passive) | Not broken | Limited | Not violated or weakly limited |
| Joint movement (active) | Partially limited | Severely limited | Retained in full |
| Change in blood picture | Within normal limits. In the acute phase, an increase in ESR and CRP is possible | A jump in ROE, fibrinogen, seromucoid, detection of C-reactive protein in the blood | Within normal limits |
| X-ray | It is possible to detect calcifications and periostitis, but only in the advanced stage of the disease | The joint gap is narrowed, osteoporosis of the pineal glands is traced, the articular surfaces are covered with erosions | The joint gap is narrowed, osteophytes are present, subchondral osteosclerosis |
Patients can complain of pain in the muscles surrounding the joint to such specialists as a therapist, surgeon, rheumatologist, orthopedist, and neurologist.
After collecting anamnesis and examination, the doctor will send the patient to undergo a number of additional examinations:
- Radiography.
- Ultrasound.
- MRI.
As a rule, x-rays show changes in the joints (deposits of calcium crystals, the development of osteoporosis of the head of the bone) with prolonged and progressive periarthritis.
Invasive diagnostic techniques such as arthrography and arthroscopy may only be useful when the patient is about to undergo surgery.
Periarthritis treatment
Regardless of where exactly the inflammatory process is localized, the treatment of periarthritis should be comprehensive.
It is carried out in the following areas:
- Elimination of symptoms of the disease.
- Restoration of the volume of lost muscle movements.
- A set of measures aimed at preventing the recurrence of the disease and the development of complications.
- Elimination of destructive changes in the joints.
- Treatment of comorbid conditions, if any.
It is worth considering that periarthritis tends to become chronic, so treatment should be persistent. Experts recommend eliminating the load from the affected tendon as much as possible, which is especially important in the acute stage of inflammation. Bandages are used to immobilize the limb. If the case is severe, plaster may be applied.
Pain relievers
To eliminate pain, pain relievers and anti-inflammatory drugs are used: Aspirin, Analgin, Indomethacin, Brufen, Reopirin, Butadion. Do not exceed the recommended therapeutic dose.
Topical ointments can be used to relieve pain. For this purpose, anabolic, warming and pain relievers are used. Among these drugs: Diclofenac ointment, Ibuprofen, Indomethacin, camphor, methyl salicylate.
In the acute phase of periarthritis in the presence of severe pain, infiltration of the affected area with hydrocortisone and novocaine is necessary. Injection frequency: every 5-10 days. They continue to be administered until the pain is relieved.
Acute pain requires a short-term course of treatment with glucocorticosteroids. For this, the patient will take Prednisolone orally (10-20 mg per day) for 10-15 days. Gradually, the dose should be reduced, up to a complete rejection of the drug. Additionally, the doctor may prescribe muscle relaxants, angioprotectors, chondroprotectors.
Physiotherapy treatment
Physiotherapy is also indicated from the first days of the patient's request for help.
For periarthritis, the following treatments are applicable:
- Phonophoresis with hydrocortisone.
- Microwave therapy.
- Ultrasound treatment.
- Cryotherapy, laser therapy.
- Shock wave therapy and acupuncture have proven effectiveness.
- Electrophoresis with painkillers and drugs aimed at improving blood circulation.
- Hydrogen sulfide and radon baths give an excellent effect in the treatment of chronic periarthritis.
Physiotherapy
A separate area in the treatment of periarthritis is therapeutic gymnastics. It must be started very carefully, with passive movements.
The main goals pursued by physiotherapy exercises:
- Reducing the intensity of pain attacks;
- Restoring limb mobility;
- Relaxation of the sore muscle;
- Normalization of muscle tone and muscle strength.
Gymnastic complexes can be performed at home, as well as in a hospital. The emphasis is on exercise that does not cause pain. The joints around which periarthritis has developed should be worked out, but you should not overload the diseased limb.
Massage for periarthritis is contraindicated! It is possible to carry it out with a mild course of the disease with the obligatory bypass of the inflamed area.
Surgery and prognosis
The operation is performed only when all methods of treating inflammation are ineffective, and the disease continues to progress.
Other indications for surgery:
- Inability to relieve pain with corticosteroid injections;
- Recurrent pain that does not subside after 6-8 months of treatment;
- Patients over 40 years old, whose work is associated with a load on the joint, in the area of which the inflammatory process occurs;
- Tendon damage leading to joint deformation;
- Damage to peripheral nerve fibers.
The surgeon dissects the adhesions to restore the movement of the diseased tendon. Spurs, salt deposits and other pathological growths are removed in parallel.
As for the prognosis for recovery, in most cases it is favorable. If the treatment is carried out in a complex and in the system, then the necrotic foci and calcifications gradually dissolve. In parallel, pains go away, limb mobility is normalized. Nevertheless, for a successful recovery, it is necessary to consult a doctor in a timely manner. The long course of the disease can lead to the formation of fibrous adhesions of the tissues surrounding the joint. As a result, it will not be possible to fully restore his mobility, which means that the person will receive a permanent disability and will lose the skills of everyday and professional activities.
Prevention of periarthritis
To minimize the risks of developing periarthritis, you must adhere to the following recommendations:
- Engage in physical education, but exercise should be moderate.
- Do not overuse the load on a specific joint. If this cannot be avoided due to the nature of professional activity, then the overloaded joint should be provided with sufficient rest. Massage is an excellent prevention of illness.
- Infectious diseases must be treated with high quality and in a timely manner.
- Situations that injure the joint must be avoided. Moreover, the danger is posed not only by macro-, but also by microtrauma.
- Prevention of diseases of the musculoskeletal system as a whole is equally important.
To simplify the therapy of periarthritis and make it as fast as possible, in the event of pain in the joint area, one should not self-medicate, but immediately go to see a specialist.
Author of the article: Kaplan Alexander Sergeevich | Orthopedist
Education: diploma in the specialty "General Medicine" received in 2009 at the Medical Academy. I. M. Sechenov. In 2012 completed postgraduate studies in Traumatology and Orthopedics at the City Clinical Hospital named after Botkin at the Department of Traumatology, Orthopedics and Disaster Surgery.
