Stiff joints

Contractures and ankylosis of the joints

Rigid joints are symptoms that range from mild functional impairment to complete stiffness of the joints. Basically, joint stiffness can occur in all joints, but the function restriction for certain joints, which are exposed to particularly high loads in everyday life, increasingly observed. These include above all the large joints, such as the knee joint, hip joint, shoulders and elbows. Since in many forms of joint stiffness without therapeutic countermeasures threatens a permanent deterioration in joint function, in the case of stiff joints as soon as possible medical assistance should be claimed.

contents

definition
Symptoms of stiff joints
Causes of stiff joints
Infections as a cause of joint stiffness
Inflammatory polyarthropathies
Osteoarthritis as a cause
Congenital joint stiffness
Other causes of stiff joints
diagnosis
treatment

definition

The colloquial term "stiff joint" describes limitations in the ability to move in the joints, which can range from minimal functional impairment to extremely painful complete joint stiffness. In the medical community, the stiff joint can be in so-called contractures, which describe a functional impairment of the joint due to impairments of the surrounding tissue structures (ligaments, muscles, tendons, fascia), and distinguish the joint stiffness directly caused by damage in the joint. The latter, for example, can also be due to damage to the bone substance. In both cases, the active mobility of the joints is limited and under certain circumstances the joints can not be moved passively or only in pain to the usual extent.

Symptoms of stiff joints

Stiffness of the joints is a widespread complaint, the symptoms range from minimal movement impairments to complete fixation of the joints. Often the symptoms are associated with pain, which occur especially during exercise or stress. Sometimes, however, a pain in the joint area also appears at rest. In various joint diseases, the joints also appear reddened and overheated.

Depending on the affected joints, the severity of the joint stiffness and the causes of the complaints, different degrees of impairment in the everyday life of the patients are shown. For example, in terms of joint stiffness in the hip joint, the affected persons are often severely restricted in their ability to move, which makes their everyday life much more difficult. Stair climbing is often hardly possible and even going to the toilet can be associated with painful complications. A detailed presentation of the symptoms, including the accompanying symptoms, will then be made in connection with the explanations on the causes of joint stiffness.

Causes of stiff joints

The possible triggers of stiff joints are extremely complex, including both congenital diseases and acute joint disease, and sometimes even psychogenic factors. The following detailed description of the individual causes of joint stiffness shows the wide range of potential triggers in the diagnosis. The joint diseases (arthropathies), which can bring about joint stiffness, are roughly subdivided into infectious arthropathies, inflammatory polyarthropathies, non-inflammatory osteoarthritis and other joint diseases.

Often, inflammatory processes cause an increasing destruction of the joints, which is associated with joint pain and restricted mobility. An example of this is rheumatoid arthritis. (Image: bilderzwerg / fotolia.com)

Infections as a cause of joint stiffness

If bacteria enter the joint via open wounds (for example in the course of an operation) or via the bloodstream and settle on here, a purulent bacterial arthritis is threatened, which is associated with a strong inflammatory reaction in the joint area. If superficial joints are affected, they are often reddened, swollen and overheated. The patients feel permanent joint pain, which increases with exercise or stress. Often sufferers tend to a restraint due to the pain. The mobility of the joint is increasingly limited in the course of purulent arthritis and there is no therapeutic care, threaten irreversible damage to the joint structures. After a relatively short time, the destruction of the articular cartilage begins. In the worst case, the bacterial infection can spread to life-threatening blood poisoning (sepsis).

Also, general infectious diseases can affect the joints and cause here an arthritis with appropriate joint stiffness. A possible cause is, for example, a meningococcal infection, in which further symptoms such as high fever, chills, body aches, nausea and vomiting or even disturbances of consciousness can occur. Other infectious diseases such as rubella, mumps, tuberculosis, Lyme disease, typhus or gonorrhea can also cause arthritis. The accompanying symptoms are very different in the various infectious diseases and the stiff joints are by no means a leading symptom. The sufferers often show significant additional discomfort and the joint problems are more of a by-product. An essential indication of most infectious disease is concomitant fever. If, in addition to the joint stiffness, the body temperature is elevated, a doctor should be consulted urgently. It is not uncommon to experience discomfort in the joints only after an infectious disease has been overcome. These are called so-called reactive arthritis.

Inflammatory polyarthropathies

Often inflammatory processes develop in the joints even without infection, the most common form being rheumatoid or chronic polyarthritis. Typically, not only individual joints are affected here. At the beginning of the relapsing disease, the symptoms manifest as pain in the finger and toe joints. In addition to the pain, especially in the morning after getting up often shows a pronounced joint stiffness. In addition, there are nonspecific general symptoms, such as chronic fatigue, fatigue and increased nocturnal sweating. During the relapses, the joints are clearly swollen and overheated. As a rule, the symptoms occur symmetrically on both halves of the body, ie on the left hand the same joints are affected as on the right. On the right foot, the same as on the left.

In the long term, the joints are destroyed by rheumatoid arthritis and sufferers show complete joint stiffness with fixed malposition. Also, in the late stage of the disease, an increasing loss of muscle begins. In the end, many patients can not do even the simplest everyday tasks with their hands. The less frequently observed transition from chronic polyarthritis to the larger joints leads here too to an increasing loss of function. Depending on which joints are affected, for example, knee pain, hip pain or ankle pain may occur as a concomitant symptom. If the cervical spine is affected in the context of the disease, may threaten compression of the spinal cord. Also, the chronic polyarthritis can pass on the organs and so for example, a vascular inflammation, pericarditis (pericarditis), inflammation of the heart lining (endocarditis) or pneumonia with appropriate complaints.

Among the inflammatory polyarthropathies also includes the so-called juvenile arthritis, which describes a occurring without apparent cause joint inflammation in childhood. The affected children look battered, are whiny and avoid exercise. They may also take a restraint due to the pain, which in turn can lead to contractures in the long run. Occasionally, the growth of joint-forming bones is impaired. In addition, the sufferer occasionally plagues an irregular, itchy rash. Juvenile arthritis is accompanied by concomitant swelling of the lymph nodes, liver and spleen. In the worst case, the disease leads to irreversible growth and organ damage in children.

The metabolic disease gout, too, leads to a painful inflammation of the joints, whereby the deposition of uric acid crystals in the joint area is regarded as a significant trigger. Basically, all joints can be affected by gout, but most of the complaints are in the area of ​​the toe, hand and finger joints. As accompanying symptoms in an acute attack of gout, in addition to the typical joint complaints, general symptoms such as fever or even headache can be observed. Other diseases, such as chondrocalcinosis, are also associated with crystalline deposits in the joints and associated joint discomfort ...

Other potential causes of inflammatory polyarthropathy include, for example, so-called hip flu (coxitis fugax) and diseases such as hyperthyroidism (hypothyroidism), thyroid hyperfunction (hyperthyroidism) or congenital sickle cell anemia. Diabetes mellitus can also trigger a long-term neuropathic arthropathy. In addition, sarcoidosis (also called Boeck's disease connective tissue disease) leads in rare cases to inflammatory processes in the joint area and corresponding joint stiffness. This applies in a similar way for special forms of so-called amyloidoses (pathological protein deposits in the cell space). Numerous other factors are considered triggers of non-infectious joint complaints into consideration, a full list at this point would go beyond the scope. However, stiff joints associated with inflammatory processes can usually be attributed to one of these causes.

The arthrosis of the hip joint is a relatively widespread symptoms, which brings significant limitations of Bewegungsfäheit with it. (Image: Henrie / fotolia.com)

Osteoarthritis as a cause

Osteoarthritis refers to a wear of the joints, which in the long run can lead to considerable functional impairment or even a complete loss of function of the affected joints. Cause are usually incorrect loads in the joint area, which lead to increased signs of wear of the cartilaginous tissue or the joint-forming bone. The trigger of the incorrect load is usually a so-called dysplasia, so a malposition in the joint area. This can be innate or, for example, an accident. An example of congenital dysplasia is hip dysplasia, which is one of the most common causes of relatively common hip osteoarthritis.

Osteoarthritis usually develops over a long period of time, with pain occurring under stress being a typical symptom in the early stages. In the further course of the disease swelling and deformations of the joints as well as increasing joint stiffness can be added. Also typical are the joint noises that occur during movement. With age, joint wear generally increases. Accordingly, most osteoarthritis patients are already advanced. Years of improper loading in the joint area show their consequences here. However, acute injuries, for example in the context of an accident, can also lead to premature wear of the joints. This so-called post-traumatic arthritis sometimes overtakes people of younger age. As another possible trigger of osteoarthritis, the use of certain antibiotics and anticoagulants is discussed, which can lead to permanent damage to the cartilage tissue and decrease in bone density.

The joint wear in all forms of osteoarthritis usually extends over a longer period of time before the sufferers complain of stiff joints or other complaints. Therefore, the irreversible damage to the joint in osteoarthritis is often well advanced before medical attention is claimed. A complete restoration of the joint function is thus in many cases much more difficult or impossible.

Congenital joint stiffness

Some people suffer from birth under the so-called arthrogryposis multiplex congenita (AMC), a special form of joint stiffness. The typical malformations of the disease usually occur between the eighth and eleventh week of pregnancy. The severity of the disease can vary significantly. While some children show only adhesions of individual joints, in others numerous joints and other organs are malformed. The growth impairments also affect the muscles, tendons and fascia in the joint area, which additionally limits the ability to move. The children are born with conspicuous contractures and deformities of the joints. The joints in the arm and leg area are increasingly affected here. Shoulder joints, elbows, wrists, and individual finger joints, as well as the hip and knee joints, have changed very frequently in the course of the disease. The causes of the disease are still largely unknown, although AMC is one of the more common growth disorders in newborns.

Other causes of stiff joints

Numerous other triggers of joint stiffness come into consideration in addition to the previously mentioned factors. For example, movement restrictions of the joints can also be observed in connection with neurogenic diseases such as polio. Occasionally, the contraction of the outer layers of the skin, for example due to scarring after a burn, leads to stiffening in the joint area. Shortening the vision can also cause a contracture. The same applies to the shrinkage or contraction of fascia, for example, after an injury or prolonged immobilization. Also known in the art so-called psychogenic contracture in which affected, for example, due to a traumatic event, a joint consciously or subconsciously do not move. In the case of bed-laying, a false storage of the immobile patient can also lead to permanent contracture.

diagnosis

On the basis of the description of the symptoms and the externally visible changes (redness, swelling, overheating, deformation), the cause of the stiff joints can usually be clearly limited. Some simple exercises can provide more important information. Many forms of contractures can already be identified relatively clearly in this way. Ultrasound examinations reveal pathological changes in the joint area, such as purulent arthritis. Also, blood tests or evidence of increased inflammatory levels in the blood can serve to secure the diagnosis. Imaging procedures such as x-rays, computed tomography and magnetic resonance imaging may also be required for the diagnosis (for example, in osteoarthritis).

As a further investigation method for suspected joint damage, a minimally invasive arthroscopy is available, in which by means of an endoscope, a view into the interior of the joints is made possible ... This not only the diagnosis secure, but also minor therapeutic interventions can already be done in the context of the investigation , This so-called therapeutic arthroscopy is used relatively frequently today.

treatment

The treatment of the joint stiffness is always to be aligned to the respective causes of the complaints and can therefore vary significantly. For example, while bacterial arthritis is often treated with antibiotics, medications promise little relief in osteoarthritis. Physiotherapy is of particular importance here, which is not helpful in most forms of arthritis. Purulent arthritis often requires surgical intervention to prevent the permanent destruction of the affected joints and the development of life-threatening blood poisoning. Surgery can also be used in osteoarthritis patients to restore joint function. In case of doubt, the implantation of a prosthesis, such as an artificial hip joint. However, sometimes the joint function can be restored with the minimally invasive procedure of arthroscopy.

Physiotherapy is the first choice of treatment options in the treatment of contractures. At the same time, the stiff joints should regain their original mobility through active and passive exercises. Accompanying massages and heat therapies can be used. Special rails and bandages are used to prevent the occurrence of contracture in everyday life. In the field of naturopathy, manual methods such as osteopathy or Rolfing are particularly suitable for the treatment of contractures. Also, acupuncture is often used here. This is also often used in the naturopathic treatment of arthritis. However, if the above measures are not effective, arthritis removal surgery is often the last resort.

In inflammatory joint complaints, naturopathy often accompanies a regulation in the acid-base balance or the reduction of a possibly present hyperacidity, since a connection with the inflammatory processes in the organism is suspected here. Also, various medicinal plants are used, depending on the suspected cause of joint stiffness, for example, an excitement of metabolic functions (for example, nettle or dandelion tea), a blood circulation (for example, rosemary, mustard seeds, ginger, juniper, St. John's wort) or an anti-inflammatory ( Arnica, willow bark, frankincense, camphor). In addition, pain relieving medicinal plants such as devil's claw or goldenrod are used in various joint diseases. In general, the herbal treatment of stiff joints should be equally focused on the causes, as the entire therapy of joint stiffness. (Fp)
Picture 1: Andrea Damm