ICD code osteoarthritis of the hands and hip joints. Osteoarthritis - description, causes, symptoms (signs), diagnosis, treatment. Treatment of bruised wrist joint

Osteoarthritis is a heterogeneous group of diseases of various etiologies with similar biological, morphological, clinical manifestations and outcome, which are based on damage to all components of the joint (cartilage, subchondral bone, synovial membrane, ligaments, capsules, periarticular muscles). It is characterized by cellular stress and degradation of the extracellular matrix of all joint tissues, occurring against the background of macro- and microdamage, while abnormal adaptive restorative responses are activated, including pro-inflammatory pathways of the immune system. Changes initially occur at the molecular level, followed by anatomical and physiological changes (including cartilage degradation, bone remodeling, osteophyte formation, inflammation).

Causes

According to modern concepts, the disease develops as a result of the interaction of various internal (age, gender, developmental defects, hereditary predisposition) and external factors (trauma, excessive sports and professional stress, excess weight).
In the development of the disease, a key role is played by pro-inflammatory mediators and cytokines produced not only by chondrocytes and synoviocytes, but also by fat cells (adipocytes) and bone tissue (osteoblasts). The chronic inflammatory process leads to a change in the metabolism of the cellular structures of all joint tissues (chondrocytes, synoviocytes, osteoblasts) and an imbalance between anabolic and catabolic processes in tissues towards the predominance of the latter, which ultimately leads to the development of the disease.

Basic forms

Primary and secondary osteoarthritis - develops against the background of various diseases and joint injuries. Primary occurs, as a rule, after 45 years. The most common and characteristic locations are the knee joints, interphalangeal joints of the hands, spine, first toe and hip joints. Women more often than men suffer from arthrosis of the knee joints and joints of the hands.

Secondary arthrosis in its clinical manifestations does not differ from primary arthrosis, develops in almost any joint and has a specific cause of the disease.

Risk factors

Overweight occupies a special place among the risk factors for development. Thus, osteoarthritis of the knee and hip joints develops 4 times more often in obese women. It has been established that excess weight contributes not only to the onset of the disease, but also to its more rapid progression, leading to disability.

Schools for patients

Patients with osteoarthritis are recommended to attend Schools for patients, where they can receive comprehensive information about their disease, the advisability of losing weight (if they are overweight), learn physical therapy (physical therapy), proper nutrition and lifestyle. Specialists will explain the principles of therapy and answer your questions.

It must be remembered that weight loss measures must be combined with exercise therapy. Physical methods play an important role in the treatment of the disease, as they help improve joint function and increase endurance and muscle strength. Regular exercise therapy classes lead to a reduction in pain and improvement in joint movements, but it is best to start classes under the guidance of a specialist in physical therapy, for example, in health groups. Physical exercises should be carried out without static loads (sitting, lying down, in the pool). Patients with severe joint pain and contractures need to consult a physical therapy specialist to create an individual exercise program.

The main principle of exercise therapy is frequent repetition of exercises throughout the day. You should not do exercises while overcoming pain. Perform the exercises slowly, smoothly, gradually increasing the load. You need to exercise for at least 30–40 minutes a day, 10–15 minutes several times during the day. For osteoarthritis of the knee joints, the main ones are exercises that help strengthen the thigh muscles (for example, raise a straight leg by 25 cm while lying on your back and hold it for several seconds); exercises aimed at increasing range of motion (“air bike”); exercises that help improve the general aerobic condition of the muscles (walking on level ground at a moderate pace).

Physical exercise

Walking should begin at a distance that does not cause pain, and gradually increase the duration of walking to 30-60 minutes (5-7 days a week). These aerobic exercises also promote weight loss. Patients should be aware of the peculiarities of the motor regime, the main principle of which is to unload the affected joint. Long walking and standing, and frequent climbing of stairs are not recommended.

Precautionary measures

With osteoarthritis, it is extremely important to reduce the load on the joints, which is achieved by using various devices. You should wear shoes with low, wide heels and soft elastic soles, which helps absorb the shock that spreads along the leg when walking and injures the cartilage. Shoes should be wide enough and soft on top. If the knee joints are affected, experts advise wearing knee pads, which fix the joints, reduce their instability, and slow down the progression of the disease. To reduce the load, it is recommended to walk with a cane, which should be held in the hand opposite the affected joint. In addition, it is very important to choose the right height of the cane - the handle should be at the level of the base of the first finger of the hand. In case of bilateral severe damage to the hip or knee joints, walking with the help of Canadian-type crutches. If you have flat feet, it is recommended to constantly wear special shoes (at home and on the street) with arch supports (insoles that support the arch of the foot and reduce the load on the joint), and in certain cases - custom-made insoles.

Treatment consists of a comprehensive approach to the disease, which involves the use of non-drug and medicinal methods, and, if necessary, surgical intervention. Although osteoarthritis is a chronic disease, treatment interventions tailored to each patient can reduce pain and inflammation, improve joint movement, and slow progression. It is important that the diagnosis be made by a doctor, since there are a number of other joint diseases that have similar symptoms to osteoarthritis.

As for drug therapy, it is stage-by-stage and individually selected by a specialist. Do not self-medicate and seek help. The more correct and timely the treatment is prescribed, the greater the chance of regaining the lost quality of life.

Osteoarthritis (OA)- a heterogeneous group of diseases of various etiologies with similar biological, morphological and clinical manifestations and outcome, which are based on damage to all components of the joint, primarily cartilage, as well as the subchondral portion of the bone, synovial membrane, ligaments, capsule, periarticular muscles.

Code according to the international classification of diseases ICD-10:

Statistical data. Prevalence: 20% of the world's population. The predominant age is 40-60 years. Radiological signs of OA are found in 50% of people aged 55 years and older. The predominant gender is female for gonarthrosis, male for coxarthrosis. Incidence: 8.2 per 100,000 population in 2001.
Etiology. A discrepancy between the mechanical load on a joint and its ability to withstand that load. The biological properties of cartilage can be genetically determined or changed under the influence of exogenous and endogenous acquired factors. Genetic factors.. The role of type II collagen gene defects is discussed.. Autosomal dominant type of inheritance of erosive OA in women and recessive in men. Acquired factors.. Excess body weight.. Estrogen deficiency in postmenopausal women.. Acquired diseases of bones and joints.. Joint injuries.. Joint surgeries.

Causes

Pathogenesis
The pathogenesis is based on the predominance of catabolic processes over anabolic ones, leading to the loss of the biological properties of cartilage.
. The key role belongs to chondrocytes.. Chondrocytes in osteoarthritis are characterized by overexpression of COX-2 (an isoenzyme of cyclooxygenase necessary for the synthesis of PG) and the inducible form of nitric oxide synthetase (nitric oxide has a toxic effect on cartilage).. Under the influence of IL-1, chondrocytes synthesize matrix proteinases , destroying collagen and proteoglycans of cartilage.. The synthesis of anabolic mediators of chondrocytes (insulin-like growth factor, transforming growth factor ) is impaired in conditions of osteoarthritis.
. The connective tissue matrix, along with chondrocytes, forms the basis of articular cartilage. The connective tissue matrix includes molecules of type II collagen and aggrecan (a proteoglycan consisting of a protein core and peripheral chains of chondroitin sulfate, keratan sulfate and hyaluronic acid). The connective tissue matrix provides the unique shock-absorbing properties of cartilage. Matrix remodeling is under the control of chondrocytes; however, in conditions of osteoarthritis, their catabolic activity exceeds anabolic activity, which leads to negative changes in the quality of the cartilage matrix.
. Inflammation in osteoarthritis is not as intense as in arthritis, however, in OA there are proinflammatory mediators, acute phase proteins (in low concentrations), as well as mononuclear infiltration.

Classification
. Primary (idiopathic) osteoarthritis. Localized (affecting less than three joints): joints of the hands, joints of the feet, knee joints, hip joints, spine, other joints. Generalized (affecting three joints or more): affecting the distal and proximal interphalangeal joints, with damage to large joints, erosive OA.
. Secondary osteoarthritis. Etiological factors of secondary osteoarthritis: .. post-traumatic.. congenital, acquired, endemic diseases.. metabolic diseases: ochronosis, hemochromatosis, Wilson-Konovalov disease, Gaucher disease.. endocrinopathies: acromegaly, hyperparathyroidism, hypothyroidism, diabetes.. calcium (phosphate) deposition disease calcium, hyroxyapatite) .. neuropathy.. other diseases: avascular necrosis, rheumatoid arthritis, Paget’s disease, etc.). Classification of osteoartosis according to radiological signs. 0—no radiological signs; . I - questionable radiological signs; . II - minimal changes (slight narrowing of the joint space, single osteophytes); . III - moderate narrowing of the joint space, the presence of multiple osteophytes; . IV - pronounced radiological changes (the joint space is almost not visible, rough osteophytes).

Symptoms (signs)

Clinical picture. Most patients suffer from dull pain localized deep in the joint areas, aggravated by physical activity and relieved by rest. Pain at rest (as well as morning stiffness) indicates the presence of an inflammatory component. The source of pain is not cartilage, but bone (microinfarctions, osteophytes), synovial membrane (inflammation), periarticular tissues (local hypertonicity of regional muscles, tendonitis). Morning stiffness, unlike inflammatory joint diseases, is short-lived and lasts no more than 30 minutes. Crepitus. It is felt and even heard when performing passive movements in the joints in full; due to incongruence of articular surfaces. Restriction of movement in the joint due to pain, synovitis or blockade by the “articular mouse” (a fragment of articular cartilage that has fallen into the joint cavity). Osteoarthritis is often accompanied by venous diseases (varicose veins of the lower extremities, thrombophlebitis). Most often affected.. Knee joints (75%) .. Joints of the hand (60%) - distal interphalangeal (Heberden's nodes), proximal interphalangeal (Bouchard's nodes) .. Lumbar and cervical spine (30%) .. Hip joints (25 %) .. Ankle joint (20%) .. Shoulder joint (15%) . Varus or valgus deformities, joint subluxations are observed in the later stages of the disease. Swelling and effusion are observed more often in the knee joints, and the development of a Baker's cyst is possible. The development of extra-articular manifestations is not typical.

Diagnostics

Laboratory data. Blood: ESR is within normal limits, no RF is detected. Synovial fluid: high viscosity, leukocytes less than 2000 per 1 μl, neutrophils less than 25%.
Instrumental data. X-ray examination reveals narrowing of the joint spaces, osteosclerosis, marginal osteophytes, subarticular cysts, “spotted” cartilage calcification (a sign of hydroxyapatite deposition) in the distal interphalangeal and knee joints.

Diagnostic criteria osteoarthritis American College of Rheumatology
. Gonarthrosis.. Pain + crepitus + morning stiffness<30 мин + возраст старше 38 лет (чувствительность 89%, специфичность 88%) .. Боли в коленном суставе + наличие остеофитов (чувствительность 94%, специфичность 88%) .. Боли в коленном суставе + возраст более 40 лет + утренняя скованность <30 мин + крепитация (чувствительность 94%, специфичность 88%).
. Coxarthrosis.. Pain + presence of osteophytes of the femoral head and/or acetabulum (sensitivity 91%, specificity 89%).. Pain + narrowing of the joint space + ESR<20 мм/час (чувствительность 91%, специфичность 89%).
. Osteoarthritis of the small joints of the hand. Pain or morning stiffness in the small joints of the hand + the presence of three of the four following signs: 1. Overgrowth of hard tissue in more than one of the ten following joints: ... the second and third distal interphalangeal joints of both hands ... the second and the third proximal interphalangeal joints of both hands... the first carpal-metacarpal joints of both hands. 2. Overgrowth of hard tissue in more than one of the ten distal interphalangeal joints. 3. The presence of edema in no more than two metacarpophalangeal joints. 4. Deformity of at least one of the ten joints listed in point 1. Sensitivity 92%, specificity 98%.

Treatment

TREATMENT
General tactics. Treatment should be aimed both at reducing the severity of pain and inflammation, and at correcting changes in cartilage tissue.
Regime and diet. It is important to reduce body weight in order to reduce the mechanical load on the joint. Physical overload and trauma to the joints, soft chairs and placing pillows under the joints should be avoided; It is recommended to use chairs with a straight back and a bed with a hard wooden base. Adaptations, easing mechanical loads on the affected joints - corset, cane, knee pads. Performing special exercise therapy complexes.

Drug treatment
Symptomatic fast-acting drugs. Non-narcotic analgesics of central action.. paracetamol (up to 4 g/day) are prescribed periodically to patients with moderate intermittent pain without signs of inflammation.. tramadol 200-300 mg/day.
NSAIDs. NSAIDs are prescribed for severe persistent pain and signs of synovitis, for a short period of time, in lower doses than for arthritis. Local use in ointments and gels is possible. Non-selective COX inhibitors: ibuprofen 1200-1400 mg/day, ketoprofen 100 mg/day, diclofenac 75-100 mg/day NB: indomethacin should not be used due to increased degenerative processes in cartilage.. Selective inhibitors COX - 2 (especially for elderly patients or in the presence of risk factors for the development of NSAIDs - gastropathy): meloxicam 7.5 mg / day, nimesulide 100 mg 2 times / day, celecoxib 50-100 mg 2 times / day.
Disease-modifying drugs. Chondroitin sulfate 500 mg 2-3 times a day, course 3-6 months. Glucosamine 1500 mg 1 time / day, course 6 weeks, breaks between courses 2 months. Alflutop (extract of marine organisms containing chondroitin sulfate, keratan sulfate, hyaluronic acid and trace elements) 1 ml IM daily, for a course of 20 injections. It is possible to administer 1-2 ml intra-articularly into large joints, for a course of 5-6 injections, then continue intra-articularly at 1.0 ml. Repeat the course after 6 months.
The following medications are also indicated: . for erosive OA - long-term use of aminoquinoline drugs (hydroxychloroquine 200 mg/day). intra-articular injection of GC - only in the presence of secondary synovitis; injections should be carried out no more than 3 times a year (see Rheumatoid Arthritis).
Non-drug therapy. Physical factors - ultraviolet radiation in erythemal doses, ultrasound irradiation, laser therapy, diadynamic currents - for synovitis; paraffin and mud applications - in the absence of synovitis. Resorts with sulfur, hydrogen sulfide, radon springs, therapeutic mud or brine.

Surgery- joint replacement. Complications: thromboembolism, joint infection (5%).

Forecast. The prognosis for life is favorable. Disability is highest with coxarthrosis.
Synonyms. Osteoarthritis. Arthrosis. Deforming osteoarthritis is an outdated term.
Reduction. OA - osteoarthritis.

ICD-10. M15 Polyarthrosis. M16 Coxarthrosis [arthrosis of the hip joint]. M17 Gonarthrosis [arthrosis of the knee joint]. M18 Arthrosis of the first carpometacarpal joint. M19 Other arthrosis.

Of course, if there is exposed bone sticking out of your right arm, you shouldn't expect that you are dealing with a bruise of the right wrist joint. Unfortunately, or fortunately, there are different types of fractures, and a closed fracture, especially without displacement of the bones or when a small piece breaks off from the main bone (the so-called marginal fracture), is very easy to confuse with a bruise - both of these can be quite painful, accompanied by swelling, etc.

Let’s try to present the main differences between a bruise and a fracture, which can help you calm down or, on the contrary, rush to the hospital in the first hours after receiving the injury.

Fracture healing

The International Classification of Diseases, or ICD, describes the codes for all diagnoses accepted in medicine. For example, a healed ankle fracture has not one ICD 10 code, but several:

• M84.0 – poor healing of the fracture;
• M84.1 – fracture non-union or pseudarthrosis;
• M.84.2 – delayed fracture healing.

These codes apply not only to traumatic injuries to the ankle, but also to fractures of other bones.

The body puts all its efforts into restoring damaged tissues. Over the course of two to three days, the released blood forms clots; over time, they are filled with special cells that play an important role in the formation

These cells also create a special structure that eliminates the possibility of displacement of bone fragments. In medicine it is called the granular bridge.

It will take at least ten days for the resulting callus to strengthen. Complete restoration of the ankle bone's blood supply takes about a year.

What can reduce the rate of bone recovery:

• complexity of injury, location;
• peculiarity of ankle bone tissue;
• correct first aid;
• patient's age;
• compliance with the doctor's recommendations;
• a history of chronic diseases, inflammatory processes, excess body weight;
• psychological state of the patient.

Experts also identify factors that slow down the formation of calluses:

• deficiency or excess of vitamins;
• disruption of the endocrine glands;
• lack of weight;
• taking certain medications.

In children, the process of bone fusion is much faster than in adults. At the same time, due to their nature, it is difficult for children to strictly adhere to bed rest. It is also difficult for them not to lean on the injured limb for a long time. Excessive activity negatively affects tissue fusion, slowing it down and causing complications.

Women who are pregnant or breastfeeding take a very long time to recover from an ankle injury. Fusion slows down due to the fact that the level of calcium and other important minerals decreases during this period.

The rate of healing of displaced ankle fractures is influenced by the following factors:

• how accurately and correctly the surgeon combined the fragments;
• compliance with bed rest after surgery;
• whether all particles of muscle and connective tissue have been removed from the crack.

Closed and open fractures heal differently, but in both cases much depends on the patient. By following your doctor's recommendations, not putting stress on your leg and eating right, you can significantly speed up recovery.

ARTHROSIS M15-M19

Note In this block, the term “osteoarthritis” is used as a synonym for the term “arthrosis” or “osteoarthrosis.” The term “primary” is used in its usual clinical meaning. Excludes: spinal osteoarthritis (M47.-)

M15 Polyarthrosis

Included: arthrosis of more than one joint Excluded: bilateral involvement of the same joints (M16–M19)

M15.0 Primary generalized (osteo)arthrosis M15.1 Heberden's nodes (with arthropathy) M15.2 Bouchard's nodes (with arthropathy) M15.3 Secondary multiple arthrosis. Post-traumatic polyarthrosis M15.4 Erosive (osteo)arthrosis M15.8 Other polyarthrosis M15.9 Polyarthrosis, unspecified. Generalized osteoarthritis NOS

M16 Coxarthrosis

M16.0 Primary coxarthrosis bilateral M16.1 Other primary coxarthrosis Primary coxarthrosis: NOS unilateral M16.2 Coxarthrosis as a result of dysplasia bilateral M16.3 Other dysplastic coxarthrosis Dysplastic coxarthrosis: NOS unilateral M16.4 Post-traumatic coxarthrosis bilateral M16.5 Other post-traumatic coxarthrosis Post-traumatic coxarthrosis roses: NOS single-sided M16.6 Other secondary coxarthrosis bilateral M16.7 Other secondary coxarthrosis Secondary coxarthrosis: NOS unilateral M16.9 Coxarthrosis unspecified

M17 Gonarthrosis

M17.0 Primary gonarthrosis bilateral M17.1 Other primary gonarthrosis Primary gonarthrosis: NOS unilateral M17.2 Post-traumatic gonarthrosis bilateral M17.3 Other post-traumatic gonarthrosis Post-traumatic gonarthrosis: NOS unilateral M17.4 Other secondary gonarthrosis bilateral M17.5 Other secondary gonarthrosis Secondary gonarthrosis: NOS unilateral M17.9 Gonarthrosis unspecified

M18 Arthrosis of the first carpometacarpal joint

M18.0 Primary arthrosis of the first carpal-product joint bilateralm18.1 Other primary arthrosis of the first carpal-paths joint primary arthrosis of the first carpal-breed joint: OPEA unilateral arthrosis of the first carpal-product joint two-sided artillery artillery arthrotes joint Post-traumatic arthrosis of the first carpometacarpal joint: NOS unilateralM18.4 Other secondary arthrosis of the first carpometacarpal joint, bilateralM18.5 Other secondary arthrosis of the first carpometacarpal joint Secondary arthrosis of the first carpometacarpal joint: NOS unilateralM18.9 Arthrosis of the first carpometacarpal joint unspecified

M19 Other arthrosis

Excluded: spinal arthrosis (M47. -) rigid big toe (M20.2) polyarthrosis (M15. -)

M19.0 Primary arthrosis of other joints. Primary arthrosis BDUM19.1 Post-traumatic arthrosis of other joints. Post-traumatic arthrosis BDUM19.2 Secondary arthrosis of other joints. Secondary arthrosis BDUM19.8 Other specified arthrosis M19.9 Unspecified arthrosis

When there is a possibility of becoming disabled

The code for post-traumatic arthrosis according to ICD 10 is encrypted under the letter M 19.1 and implies a certain set of therapeutic effects, rehabilitation measures and, if necessary, reconstructive operations.

In case of persistent pain syndrome, severe impairment of walking function and refusal of endoprosthetics, the temporary disability certificate, after 4 months, is closed and the question of conducting an MSE is raised to determine the disability group.

Despite the seriousness of the problem of post-traumatic arthrosis, it is treatable. Try not to delay visiting a doctor in case of injury. And, of course, take care of yourself.

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Localization of destructive-dystrophic disease

To make it easier and faster for the doctor to find out at what request the patient will come for an examination, he can look at the person’s medical record, in which the ICD 10 code is written, indicating arthrosis of a certain localization. Code M15 is assigned to polyarthrosis, affecting several joints simultaneously.

Coxarthrosis (arthrosis of the hip joint) is assigned code M16 (M16.0-M16.7, M16.9). The disease affects the femur and ilium, the spherical head of the femur, the fibrous capsule and the synovial membrane. According to ICD 10, coxarthrosis can appear as a consequence of trauma, infarction of the hip joint, due to congenital pathologies or osteoporosis.

The disease arthrosis of the knee joint is coded M17. Destructive-dystrophic pathology affects cartilage, fibula and femur, ligaments, tendons, and patella. Osteoarthritis of the knee joint can be unilateral or bilateral. Of the admitted patients, 75% were diagnosed with gonarthrosis. Pathology codes range from M17.0 to M17.4, M17.9. ICD 10 also makes room for code M18, by which doctors understand arthrosis of the carpometacarpal joint. To quickly prescribe treatment and diagnosis, separate codes have been identified for forms of the disease - M18.0-M18.5, M18.9.

Arthrosis of the ankle joint ICD 10 is coded M19. It belongs to the block of other arthropathies of the musculoskeletal system. This disease refers to damage to the fibula and tibia, anterior talofibular and calcaneofibular ligaments, talus and calcaneus, metatarsus, toes, tarsus and other joints of the foot. Arthrosis of the shoulder joint is also code M19. This section contains information about primary arthrosis (M19.0), post-traumatic disease (M19.1), as well as secondary (M19.2), specified (M19.8) and unspecified forms of pathology. The shoulder is affected in 15% of all cases.

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Forms of chronic inflammatory disease according to nosology

There are 3 forms of chronic disease according to nosology and you should know them

According to the International Classification of Diseases, 10th revision, in the “Nosology” section, more than one form of arthrosis is distinguished. Classification:

1. Primary form. The etiology of deforming arthrosis of this form is unknown. It is characterized by destruction of the structure of cartilage and joint capsule. The disease is characterized by multiple joint damage.
2. Secondary arthrosis progresses against the background of a decrease in the stability of cartilage tissue. The reasons for its development are most often known. Its formation is promoted by injuries, obesity, weakness of ligaments and muscles. Various factors and pathologies contribute to the emergence of the secondary form.
3. Unspecified species. The essence of the pathology is the complete destruction of cartilage tissue. Affects the knee and hip joints.

Post-traumatic arthrosis is detected after damage to the joint (impact, bruise, fracture). It can also appear as a result of surgery. Post-traumatic arthrosis occupies the following codes according to ICD 10:

• coxarthrosis - M16.4, M16.5;
• gonarthrosis - M17.2, M17.3;
• first carpometacarpal joint - M18.2, M18.3;
• other arthrosis of the joints - M19.1.

Each form of arthrosis has its own signs and symptoms. Most patients complain of pain localized deep in the joint areas, which intensifies with physical activity.

What is post-traumatic form of arthritis?

Inflammation in the ankle joint is diagnosed in the presence of the following conditions and factors:

• increased load (body weight, heavy lifting, long walking), as well as blows, bruises, fractures;
• flat feet, which entails a change in the center of gravity in the foot and, consequently, an increase in the load on the ankle joint;
• the presence of an infection of bacterial or viral origin in the body;
• pronounced allergic reactions that cause the development of autoimmune processes;
• metabolic disorders caused by gout and psoriasis.

A clear understanding of the causes allows you to correctly prescribe treatment.

Features of post-traumatic arthritis

Traumatic arthritis is a fairly common pathology. The disease develops due to insufficient attention to one’s own health. Avoiding this complication is not at all difficult; you just need to consult a doctor if you receive an injury and provide rest to the damaged joint for a while.

Most often, professional athletes or people whose activities involve increased stress on the joints experience post-traumatic arthritis.

A feature of post-traumatic arthritis is a slow increase in symptoms. The disorder develops against the background of injuries received over a long period of time. Pathology leads to a slowly developing disorder of motor activity in the affected joint

The difficulty is that a person often does not pay attention to pain and decreased range of motion, associating these symptoms with a recent injury. Most people believe that the discomfort will go away on its own after some time is needed to recover from the injury.

During this time, arthritis slowly progresses, destroying bone and cartilage tissue.

Due to the way the human body distributes stress, traumatic arthritis most often affects the lower legs, knees, and small joints of the feet.

ICD 10. CLASS XIII. DISEASES OF THE MUSCULAR SYSTEM AND CONNECTIVE TISSUE M00-M49

This class contains the following blocks: M00–M25 Arthropathy M00–M03 Infectious arthropathy M05–M14 Inflammatory polyarthropathies M15–M19 Arthrosis M20–M25 Other joint lesions M30–M36 Systemic connective tissue lesions M40–M54 Dorsopathies M40–M43 Deforming dorsopathies M50–M54 Other dorso pathies M60–M79 Soft tissue diseases M60–M63 Muscle lesions M65–M68 Lesions of synovial membranes and tendons M70–M79 Other soft tissue lesions M80–M94 Osteopathies and chondropathy M80–M85 Disorders of bone density and structure M86–M90 Other osteopathies M91–M94 Chondropathy

M95–M99 Other musculoskeletal and connective tissue disorders

The following categories are marked with an asterisk: M01* Direct infection of the joint in infectious and parasitic diseases classified elsewhere M03* Post-infectious and reactive arthropathy in diseases classified elsewhere M07* Psoriatic and enteropathic arthropathy M09* Juvenile arthritis in diseases classified elsewhere M14* Arthropathy in other diseases classified in other headings M36* Systemic connective tissue lesions in diseases classified in other headings M49* Tissue spondylopathies in diseases classified in other headings M63* Muscle lesions in diseases classified in other headings M68* Lesions of synovial membranes and tendons in diseases classified in other headings in other sections

M73* Soft tissue lesions in diseases classified elsewhere M82* Osteoporosis in diseases classified elsewhere M90* Osteopathy in diseases classified elsewhere

LOCALIZATION OF MUSCULOSCULAR LESIONS In Class XIII, additional symbols have been introduced to indicate the location of the lesion, which may optionally be used with the appropriate subdivisions. Since the location of distribution or special adaptation may vary in the number of numerical characteristics used, it is intended that the additional subclassification by localization should be placed in an identifiable separate position (for example, in an additional block) The various subclassifications used to specify knee injuries, dorsopathies or biomechanical disorders not classified elsewhere are given on pages 659, 666 and 697, respectively.

0 Multiple localization

1 Shoulder region Clavicle, Acromio- ) scapula clavicular, ) humerus, ) joints sterno- ) clavicular )

2 Shoulder Humerus Elbow joint bone

3 Forearm, radius, wrist joint - bone, ulna

4 Hand Wrist, Joints between these fingers, bones, metacarpus

5 Pelvic Gluteal Hip joint, region and hip region, sacroiliac, femoral joint, bone, pelvis

6 Tibia Fibula Knee joint, bone, tibia

7 Ankle Metatarsus, Ankle joint, tarsal joint and foot, other joints of the foot, toes

8 Others Head, neck, ribs, skull, torso, spine

9 Localization unspecified

Treatment of bruised wrist joint

A bruise of the wrist joint does not require such serious treatment as a fracture, but it is still definitely worth taking care of. Actually, we can say that such an injury goes away on its own; our task is to provide rest to the injured limb and alleviate the unpleasant symptoms caused by tissue damage.

Applying cold

As mentioned, cold compresses are best for relieving pain and swelling. In addition to cold, you can also use alcohol and novocaine compresses. Applying the drug dimexide also helps with bruises.

Special compresses on the wrist should not be kept for longer than 60 minutes.

Limb fixation

In order for the bruised joint to fully recover, at least during the first few days after the injury, the arm must be tightened with an elastic bandage or other fixing device. The duration of such “torment” depends on the severity of the condition: if the pain is gone and the tumor is not visible, after a week you can slowly return to normal life, but in difficult cases the recovery period can last for a month.

Use of ointments and gels

These ointments should be used by vigorously rubbing them into the bruised wrist several times a day, especially at night.

Warming the injury site

If for the first three days we intensively cool the bruised hand, then from the fourth day we begin, on the contrary, to warm it up. For thermal compresses, a heating pad, paraffin (you can buy it at a pharmacy) or regular table salt are suitable:

1. pour it into a clean, dry frying pan;
2. warm up well;
3. pour into a linen bag;
4. tie it tightly, make sure the salt is not too hot, and carefully apply it to your hand.

It is allowed to warm up the bruised wrist in a saturated salt bath, the temperature of which should be comfortable for the hand (up to 40 °C).

The exposure time of heat compresses is from half an hour to 40 minutes. The procedure can be repeated several times during the day.

Treatment

The first and second degrees of post-traumatic arthrosis are treated with conservative methods; in grade 3, surgical intervention is used.

Conservative treatment of post-traumatic arthrosis of the ankle joint is aimed at relieving pain, reducing the inflammatory reaction of the periarticular tissues, restoring ankle mobility, as well as improving metabolic processes leading to the restoration of damaged cartilage tissue. Conservative treatment methods include:

• taking medications to relieve pain and reduce inflammation (NSAIDs or corticosteroids);
• use of chondroprotectors;
• physiotherapeutic treatment;
• physiotherapy;
• massage;
• acupuncture;
• if necessary, treatment of a general somatic disease aggravating the manifestations of arthrosis, and reduction of excess weight;
• wearing the right shoes;
• rejection of bad habits.

Medicines for the treatment of post-traumatic arthrosis are prescribed by a doctor. The drugs used belong to the group of non-steroidal anti-inflammatory drugs of various release forms: tablets, capsules, ointments, creams, gels. According to indications, intra-articular administration of glucocorticoids - hormonal anti-inflammatory drugs - is allowed.

The action of chondroprotectors is aimed at improving the nutrition of cartilage, promoting their healing and restoration. Treatment is carried out in courses under the supervision of a doctor.

Physiotherapeutic methods are always prescribed in combination with drug therapy. Magnetic therapy, phonophoresis, electrophoresis, UHF, microwave therapy, and thermal procedures are used.

On a note!

Therapeutic exercises and massage are aimed at increasing the tone of the muscles that provide movement in the ankle and improving mobility. At first the intensity of the load is insignificant, then it is gradually increased. A set of exercise therapy exercises can be performed at home.

If conservative treatment does not help, then surgical treatment is resorted to. There are several options for operations:

• arthrodesis (during surgery, part of the cartilage is preserved and ankylosis is formed - joint immobility);
• endoprosthetics (replacement with a prosthesis).

The doctor gives precise prescriptions on how to treat post-traumatic arthrosis of the ankle based on collecting all the information about the patient’s health condition.

Brief description of the pathology. Statistical data

In most rheumatological diseases, the final damage to the joints manifests itself in the same way - deformities, ankylosis, limitation or loss of mobility.

But according to the mechanism of its occurrence, arthrosis, unlike arthritis, is not an inflammatory process, but a destructive one. That is, it is accompanied by the destruction of the cartilage that lines the surfaces of the bones, and not by damage to the joint by immune cells.

It is called deforming when the process is chronic, progressive, and there is a high risk of bone exposure and deformation. Another name for the disease is osteoarthritis.

If inflammation occurs along the way, then we are talking about arthrosis.

Arthrosis is common in the ankle joint, since this area undergoes high loads throughout a person’s life and is susceptible to injury.

Bandages and orthoses

Immobilization of a damaged joint after a fracture is one of the main conditions for treatment and rehabilitation. In this case, a special ankle brace or orthosis may be useful. This device is designed to reduce the load on the injured leg and protects the cartilage from possible destruction.

The use of bandages should be discussed with your doctor, and you can choose one only based on his advice, since such devices have a medical purpose and are used for the prevention and treatment of pathologies of the ankle joint.

The ankle brace is available in 2 types, soft and hard. Elastic bandages are indicated for wearing for mild to moderate injuries; rigid ones are needed in extremely severe cases.

There are several types of bandages:

• Protective bandage - used in case of an open fracture, as it has bactericidal properties and prevents contamination of the wound.
• Medicinal bandage - it looks like a bandage, but the material is impregnated with a medicinal substance that promotes healing.
• A pressure bandage is an excellent remedy for hemarthrosis. It is able to stop bleeding from small vessels.
• An immobilizing bandage is perfect for a bruise or after realigning a joint. This type of bandage is actively used by athletes.

After the injury and provision of the necessary assistance, the doctor will recommend applying a cast, which will more reliably protect the damaged joint, muscles and cartilage tissue from any damage during recovery.

An orthosis on the ankle joint allows you to fix the leg and redistribute the load; it also does not provoke strong compression on the damaged joint and ankle, preventing additional displacements.

An ankle orthosis is a modern orthopedic device that firmly fixes the joint in case of various injuries. In appearance, the orthosis resembles a sock or boot, but the toes remain open when worn.

Modern orthoses are made of fabric, metal and plastic, and are secured with lacing, Velcro or fasteners.

Doctors have developed several types of orthoses that have different degrees of rigidity and have different purposes: preventive, rehabilitative and functional. The first type of orthosis is used to prevent injuries; the rehabilitation type is worn when a leg is injured for a faster recovery.

A functional orthosis can be prescribed for patients with changes in the joint, who must walk with it almost always.

According to the degree of rigidity, orthoses are divided into soft, medium-hard and hard; they are actively used for injuries of the ankle joint and fractures of the tibia. Photo showing a rigid orthosis, excellent for immobilizing an injured ankle joint if it is fractured, or if the ankle is injured.

Traditional treatment

Of course, you can self-medicate only if you are completely sure that there is no fracture. A hand bruise can easily be treated at home.

If the left wrist joint is bruised, such procedures are, of course, easier to carry out, because our left hand is initially less involved in active life and therefore, being at complete rest, recovers faster.

Traditional medicine usually helps to cope with the symptoms of a bruise using the same compresses and rubbing, the only difference is that instead of medications, the gifts of nature are used here.

For compresses you can use:

• a mixture of alcohol or onion tincture with alcohol and freshly squeezed horseradish juice;
• a mixture of wine vinegar (can be replaced with apple cider vinegar), vodka (5:1), several cloves of freshly squeezed garlic and essential oil of pine trees (it is first recommended to leave the base for the compress in the dark for several days);
• freshly cut burdock root, goldenrod, mixed with sunflower oil (heat for 30 minutes in a water bath, strain, cool).

• a mixture of alcohol tincture from aloe leaves and a small amount of goldweed juice;
• evaporated for 30 minutes in a water bath and strained butter with freshly squeezed garlic.

Clinical picture of the pathology

The symptoms of the inflammatory process vary for each patient. In some patients, the pain syndrome manifests itself clearly, in others it is less pronounced. The correct diagnosis most often allows for a general dysfunction of the joint.

The clinical picture of arthritis can be formulated as follows:

• pain occurs constantly and intensifies while walking;
• movement is difficult due to disruption of the process of flexion and extension;
• deterioration of condition;
• upon examination, a visual change in the volume of the ankle joint, a change in the color of the skin is detected, and it is tactilely hot.

If the course of the inflammatory process has the features of an acute form, the patient’s temperature rises sharply, and motor activity is limited not gradually, but sharply. The chronic form proceeds much more slowly and is not as pronounced.

Signs of the disease

Traumatic arthritis is the result of a traumatic impact on a joint. Its symptoms completely repeat the symptoms of rheumatoid arthritis or a disease of another nature, with only one difference - the symptoms of post-traumatic arthritis slowly increase some time after the joint injury.

Characteristic symptoms:

• pain in the affected joint;
• crunch in the joint;
• stiffness of movement after sleep;
• swelling and swelling at the site of inflammation.

Unlike rheumatoid arthritis, traumatic arthritis is asymmetrical, meaning it affects only one joint. In this case, the lack of timely treatment can lead to damage to the symmetrical joint due to impaired motor function and improper distribution of the load on the body. For example, if the disease develops after an injury to the left meniscus, arthritis affects the left knee. Due to impaired flexion function of the joint, over time the disease will also affect the right knee.

Pain syndrome in arthritis after injury is moderate. It is aching in nature, intensifies in the morning and weakens in the evening, after the person “disperses.” When flexing and extending the joint, crunching and creaking are noted, indicating an inflammatory process. The affected area may experience swelling and increased skin temperature. Over time, arthritis, which develops as a result of damage and after injury to the joint, leads to limited mobility. If the lower limb is affected, there is a change in gait, pain when walking, which decreases after prolonged load on the affected joint.

DOA, or arthrosis deformans, is a disease in which deformations of the bones that form the articular joint occur. Diseases in this group are among the most common reasons why people seek medical help. One of the main criteria by which they are classified is localization. Osteoarthritis also includes damage to the shoulder joint, in which the cartilage is first destroyed, then the articular surface of the bones undergoes changes. The result is limited movement in the joints and impaired hand function. There are such names for this disease as shoulder arthrosis, osteoarthritis of the glenohumeral joint; in the ICD 10 classification it is classified under the heading M19.

Joint diseases in ICD-10

In medical reference books you can find detailed descriptions of various diseases. They contain a list of causes and risk factors, information about the mechanism of disease development. Along with a description of diagnostic methods, symptoms and treatment are described, and a prognosis is given. More detailed information regarding drug treatment is contained in the reference book of drugs and medical products. The ICD is a reference book of a different kind, a classifier. Search in ICD 10 is a search not for detailed information, but for standardized codes that are assigned to individual diseases and groups of diseases.

In the international classification of diseases, 10th revision, which has been used since 1994 in WHO member states, and since 1999 in Russia, all diseases are divided into 21 classes. ICD-10 has been translated into 36 languages.

Codes from this classifier can be used to designate diseases in medical documentation throughout the Russian Federation. Any doctor who gets acquainted with a medical record (medical history) is primarily interested in what patient was diagnosed or what disease code is indicated in the document. Each code is a set of characters; it consists of a letter and at least two numbers. The letter denotes a class, so diseases of the musculoskeletal system and connective tissue correspond to class M or 13. A patient with any joint disease is given a diagnosis, the code of which begins with the letter M.

The next step in the hierarchical structure of the classifier is the ICD 10 classes M00-M25, arthropathy. This is the collective name for articular pathologies, with the exception of diseases of the spine, which the ICD classifies as dorsopathies. This block includes 4 more blocks of diagnoses, including osteoarthritis, M15-M19. The use of the term arthrosis and the terms osteoarthrosis, osteoarthritis in the ICD is equivalent. This is the name for non-inflammatory degenerative-dystrophic diseases of the peripheral joints, including the shoulder. This block is divided into 5 sections.

Arthrosis in ICD

A disease in which degenerative-dystrophic changes in the tissues of more than one joint occur is classified as polyarthrosis. Within this heading (M15), further classification is carried out according to the form of the disease and its etiology. This includes, in particular:

• generalized osteoarthritis;
• polyarthrosis of the proximal interphalangeal joints (Bouchard's nodes);
• polyarthrosis of the distal interphalangeal joints (Heberden's nodes).

Separate sections cover diseases of the hip, knee, and first carpometacarpal joints (M16, gonarthrosis M17 and rhizarthrosis M18). Arthrosis of the shoulder joint is combined into one category with less common types of osteoarthritis that affect the joints of the foot, ankle, elbow, wrist, acromioclavicular and a number of others. Section M19 is called: Other arthrosis. In ICD-10, it is mandatory to divide up to 4-digit subcategories; within the M19 heading, 5 such subcategories are distinguished.

The basis for classification is etiology; in the codes it is indicated by the first digit after the dot:

• number 0 – primary;
• number 1 – post-traumatic;
• 2 – secondary, with the exception of post-traumatic;
• 8 – other specified;
• 9 – unspecified.

The number 9 after the dot is used if the study of anamnesis and other research methods do not allow one to unambiguously classify arthrosis as primary (idiopathic) or secondary (caused by an established cause).

Arthrosis of the shoulder joint

Localization is not indicated in any of the subheadings of the Arthrosis of other joints section. If we use a four-digit code system, it turns out that code M19.0 can mean primary arthrosis of any joint of the hand, except the first carpometacarpal, foot, ankle, and even the TMJ - the only movable joint of the skull bones, the temporomandibular joint. How to clarify the diagnosis? The second digit after the dot is for this purpose. The system of digital designation of localization is the same for all diseases of class 13, therefore in different sections the same number can indicate a joint, bone, or muscle.

Here are some subcategory designations for the upper limbs:

• 1 – shoulder girdle, clavicle, scapula, shoulder, acromioclavicular, clavicular-sternal joints;
• 2 – localization: shoulder, humerus, elbow joint;
• 3 – section of the forearm, ulna and radius bones, wrist joint;
• 4 – hand, bones, muscles, ligaments, joints of the wrist, metacarpus.

Thus, the number 1 is used to designate shoulder arthrosis. It must be taken into account that the word shoulder in medicine and in everyday life is used in different meanings; we are accustomed to calling shoulder what doctors and anatomists call clavicle. And the shoulder, from an anatomical point of view, is a section of the arm, which is based on the humerus. Articulating with the scapula, it forms the shoulder joint, and if the radius and ulna articulate with it, it forms the elbow. Therefore, arthrosis of the large joints of the arm on both sides of the shoulder are indicated by different numbers. Code M19.12 denotes other joints, localization - shoulder (elbow), and M19.11 - post-traumatic arthrosis of the shoulder joint. Likewise, arthrosis of the wrist and wrist are discussed under different subheadings.

If you see a five-digit code in your medical history that begins with the characters M19 and ends with one (M19.*1), it means that arthrosis has affected the shoulder joint. This disease is often combined with osteoarthritis of the AC joint, which is designated by the same code. However, for the patient the name and code of the disease are not so important.

The main thing is to limit the load on the affected joints, take medications and medications recommended by your doctor for treatment, and follow other instructions. Although arthrosis is an incurable chronic disease, if you notice its signs and deviations in a timely manner, you can maintain your ability to work longer.

Unfortunately, now many people know what kind of disease it is - osteoarthritis. And although the disease more often manifests itself in old age, it often occurs in young people. Osteoarthritis (ICD-10 code) is a joint disease that occurs in 80% of older people. This disease affects the articular cartilage, which first becomes deformed and then becomes thinner. But cartilage performs an important function - it acts as a shock absorber, protecting the surface of the bones. Special diagnostic criteria help determine the presence of the disease, after which the doctor prescribes treatment.

Degrees of osteoarthritis

There are 4 main degrees of osteoarthritis. Treatment of each of them requires a special approach from a doctor, so self-medication is not recommended. The main reason for the appearance of the disease is that the body does not get enough vitamins. In particular, this occurs due to a lack of calcium. But only a doctor can determine the cause and prescribe treatment. Diagnostic criteria will help him do this.

initial stage

This disease practically does not manifest itself. In the morning, the patient feels a slight stiffness in the joints, but after walking it goes away. Sometimes pain appears when starting to walk after a long rest. If you make a sudden movement, you can hear a crunch, but there will be no pain. Pain syndrome usually occurs after long periods of exercise, but after rest it completely disappears.

Second degree

Osteoarthritis grade 2 is characterized by more severe symptoms. The pain becomes stronger, joint mobility decreases. Due to daily stress, the patient may feel constant fatigue, pressure in the joints, and partial destruction of cartilage begins. The patient's ability to work is reduced, so he cannot perform certain types of work. You can find out about the disease using x-rays. Other diagnostic criteria that the doctor recommends may also be useful in this regard.

Third degree

This degree is considered severe as several more symptoms are added. Bone overgrowth and fluid accumulation lead to significant deformation of the bone. Movements become limited and constrained. Inflammation of the joints begins, which is why pain is observed not only during movement, but also during rest. The muscles located around the affected joint atrophy.

Fourth degree

If grade 4 arthrosis is allowed to develop, the joint will completely cease to perform its functions. Any movement will cause severe pain, which is why “joint blockade” occurs. The patient will not be able to move independently. Only implantation of an artificial joint will help prevent disability.

Arthrosis of the foot

Arthrosis of the talonavicular joints of the foot (ICD-10 code) leads to severe swelling of the foot. During its movement, a crunching sound is heard, and unbearable pain is felt when bending and straightening the foot. The same thing happens during a long walk. Such pain makes it difficult for the patient to move, resulting in injury to the muscles located next to the talonavicular joint of the foot. Therefore, inflammation is transferred to other areas. As a result, the patient cannot move his leg freely.

Arthrosis of the talonavicular joint of the foot can be primary or secondary. The disease can appear at any age. The treatment will also depend on this. Immediately after the first signs of illness appear, it is imperative to go to the hospital. The doctor will order an x-ray and all the necessary tests to determine the presence of the disease.

Primary arthrosis of the wrist joint (ICD-10 code) is rare, as it appears as a complication after a fracture at any age. Moreover, arthrosis does not occur immediately, but several weeks or months after the injury.

With arthrosis of the wrist joint, there is a crunching sound when it moves and severe pain when trying to bend it. At rest, there is usually no pain. The mobility of the wrist joint also decreases by 30-50%. It is impossible to determine the disease externally, since the bone does not change in any way.

Arthrosis of the elbow joint

With arthrosis of the elbow joint (ICD-10 code), there is pain that appears during flexion and extension of the arm. At first, these symptoms are mild and become apparent only after prolonged exercise (weight lifting, intense gymnastics, fitness, etc.). As the disease progresses, pain in the elbow joint becomes stronger and is observed even during rest. Sometimes such pain even radiates to the cervical spine, so the disease is often mistaken for cervical osteoarthritis.

When the elbow joint moves, a rough crunching sound is heard, which is caused by the friction of the bones against each other. As the disease progresses, this crunch becomes more noticeable. Limitation of elbow joint mobility can also be observed. It is difficult to perform rotational movements with your hand. This becomes the result of muscle spasms.

Also, with arthrosis of the elbow joint (ICD-10 code), Thompson's symptom may appear. In this case, the patient cannot hold the hand bent and clenched into a fist. Vetla's symptom is also characteristic of arthrosis of the elbow joint. If the doctor asks the patient to bend and straighten his arms to the forearms at the level of the chin, he cannot do this.

In addition, in case of illness, modification of the affected elbow joint occurs. The reason for this is the proliferation of osteophytes and an increase in the amount of synovial fluid. Inflammation leads to swelling and the appearance of small bumps in the elbow joint. To make it easier for a doctor to determine the presence of a disease, diagnostic criteria help him.

Osteoarthritis of the knee

The disease can be of two types: primary and secondary gonarthrosis (ICD-10 code). The reasons for the development of primary knee arthrosis are unknown (the same applies to arthrosis of the elbow joint). As a rule, this disease is more common in old age. It often affects both joints at once.

Secondary gonarthrosis appears as a result of knee pathology that was previously suffered. It can occur at any age and usually affects only one knee.

Kellgren's disease

Generalized osteoarthritis is a disease that results in damage to several joints located symmetrically. The disease appears as a result of damage to hyaline cartilage. It thins out, changes and completely disappears.

Generalized osteoarthritis (ICD-10 code) can be early or late. In the first case, the cartilage becomes thinner and its structure changes. In the case of a late stage, bone destruction begins. The disease can appear in the area of ​​the elbow, hip, talonavicular, and knee joints.

Prevention

In old age, bone density decreases, so they become less strong. To avoid any arthrosis at any age, its prevention is necessary.

In women, the disease manifests itself much more often than in men, so they need to take care of themselves much more. It is necessary to include vitamins in your diet that are found in fresh vegetables and fruits.

It is better to give up smoking and alcohol, as these two bad habits often lead to arthrosis. It is better to replace these two components with healthy vitamins.

Diagnostics

Diagnostic criteria for arthrosis (ICD-10 code) allow the doctor to quickly determine the presence of the disease in the patient. But before making a diagnosis, the doctor must prescribe tests and x-rays to the patient.

The following diagnostic criteria are distinguished:

• pain in the talonavicular joint of the foot, which hinders movement;
• deformation of the joint, which causes thinning of the cartilage tissue;
• narrowing of the joint space;
• The urine test is not abnormal.

Diagnostic criteria may vary depending on the form and course of the disease. Of course, the patient must also help the physician make a diagnosis. After all, a doctor can only learn symptoms such as pain and joint stiffness from the patient.

Treatment

Treatment of talonavicular arthrosis of the foot (ICD-10 code) should be prescribed by a doctor. Therapy should be comprehensive, including several components: taking medications, wearing special restorative devices, gymnastics, and proper diet. But if the disease in the area of ​​the talonavicular joint of the foot has become chronic, then it can only be treated surgically.

Medicines include tablets, ointments, and injections that relieve inflammation. But taking medications can lead to deterioration in the functioning of some internal organs. Therefore, along with medications, the doctor prescribes a special diet that contains the vitamins the body needs. You should take medications cyclically: for 10-15 days, and then take a short break. To prevent dystrophy of the muscles located next to the talonavicular joints of the foot, special physical therapy is necessary. If the treatment is to be performed by another doctor, he must be provided with a medical history.

When a patient comes to the hospital with joint pain, the doctor performs diagnostic tests to determine whether the disease is present. After this, the doctor prescribes treatment. It is necessary to ensure that the patient’s joints are saturated with chondroprotectors. The doctor also prescribes gymnastics, which should restore mobility to the articular bones. Among the treatment methods, compresses, massages, laser therapy, therapeutic mud, and the like are actively used.

Traditional treatment is also used effectively. But all prescriptions must also be agreed with the attending physician. Medical history may also affect the ability to use traditional methods.

Treatment of the wrist joint: diagnoses and methods

Quite often, the wrist joint begins to cause discomfort to a person. Moreover, it is significant, since hands are involved in all spheres of our lives, from everyday life and self-service to working capacity, which provides us with the means to subsist.

Many patients are interested in why the wrist joint is located on the forearm and not on the hand. The answer is simple: it connects both sections of the arm. Strictly speaking, this joint does not belong to either the hand or the forearm, since it is located at their junction. But it ensures the multifunctionality of the limb and the ability to make very precise movements, operate with small objects and at the same time be able to lift and hold significant weights. Naturally, the wrist joint alone cannot be used to solve all these problems. It must be accompanied by strong ligaments, developed muscles, reliable bones - and skills that are implanted in a person’s brain, instincts and subconscious from the moment of his birth.

Such a multifunctional part of the body cannot be simple in design. The wrist joint includes dozens of small “parts.” And the pathology of each of them leads to the loss of a certain proportion of the functionality of the hand as a whole.

At-risk groups

In principle, each of us may need treatment for the wrist joint - treatment that will restore the hands to their former mobility, the ability to lift your own child, pet a dog, or easily perform professional duties. But for some people, the risk of becoming semi-disabled for a long time (and sometimes even without the prefix “semi”) is much higher than that of their fellow citizens. These include:

• those who are engaged in heavy physical labor, where the load falls mainly on the hands. For example, rowers, loaders, lumberjacks;
• office workers, from secretaries to programmers. Here the risks even increase, since many of these employees work in non-design conditions. For example, the ratio of the height of the table and the chair is not observed - and there is constantly excess pressure on the wrists;
• athletes who actively and constantly work their hands - badminton players, tennis players, boxers (the latter are at greatest risk in terms of injuries to the wrist joint);
• people whose profession requires the constant use of fine motor skills. These include seamstresses and lacemakers; signers of dishes, eggs, cups; musicians, especially those specializing in stringed instruments and dealing with the piano.

However, treatment of the wrist joint may also be required by ordinary people - those, for example, who cannot imagine life without playing online games. Spending a lot of time at the computer, such people have to make a huge number of monotonous movements with the hand, which seriously overload the radial joint. At a certain stage, this approach to one’s own hands results in acute illnesses, sometimes turning into chronic forms.

Major diseases

It would be quite a long process to list all the ailments that can affect the wrist joint. Let us dwell on those that doctors encounter especially often.

Carpal Tunnel Syndrome

The disease is caused by compression of the mentioned canal, the nerves passing through it are under pressure from the swollen tissues. Swelling can be caused by inflammation or stress - monotonous and monotonous, or short but excessive.

A typical manifestation of the syndrome is an increase in pain intensity during night rest. Many patients complain of persistent numbness, which in most cases affects the middle, index and thumb. Weakness and clumsiness of the entire hand or part of it are also common.

Osteoarthritis

It develops due to wear and tear of the cartilage tissue that covers the surface of the joint. In later stages, bone damage also develops. The wrist joint becomes deformed and loses mobility. The process is slow and is accompanied by pain that gradually increases in intensity.

Typical symptoms include:

• decreased hand mobility, especially noticeable in the morning;
• swelling in the joint area;
• pain not only during movement, but also at rest;
• crunching in the joint;
• rise in temperature in the affected area;
• pain on palpation of the joint.

Osteoarthritis develops as a result of injury, prolonged poor hand position, or age-related tissue degradation.

Tenosynovitis

With this disease, the tendons and tendon sheaths become inflamed. The reasons for its development are still the same: tension in the hand, excessive one-time or chronic, from monotonous movements, or microtrauma.

Signs of tenosynovitis include: pain when palpating muscles and tendons, thickening at the site of the lesion, local increase in temperature, pain with even slight tension (for example, when clenching your palm into a fist).

Lack of timely diagnosis and proper treatment can lead to unpleasant consequences. Tenosynovitis, of course, does not threaten death, but partial loss of working capacity does. In this regard, it is enough to recall Robert Schumann, a composer and music critic who began as a pianist, but lost the opportunity to play music precisely because of chronic tendovaginitis.

Arthritis of reactive and rheumatic nature

They are a consequence of prolonged inflammation in the patient’s body, the presence of chronic pathologies, primarily tonsillitis, myocarditis and pyelonephritis.

More details

The same consequences can be caused by systemic diseases that affect the connective tissue or epidermis - gout, psoriasis, ankylosing spondylitis or lupus erythematosus. But it is worth noting that in these cases the pain is not localized exclusively in the wrist joint. It also affects the ankle, knees and spine. In the morning hours, a feeling of stiffness covers the whole body, and the pain syndrome, especially intense at this time, gradually subsides and disappears completely by the evening.

Arthrosis of the wrist joint

It occurs as a result of inflammation, injury, stress caused by occupational specifics, and age-related changes. It is difficult to diagnose arthrosis of the radial joint in the early stages - the pain is mild, and the patient usually does not pay attention to it. As well as the crunch that appears when moving. The patient goes to the doctor only when the pain becomes constant and causes discomfort. Swelling with arthrosis is almost never observed, nor is there a rise in temperature, even local. The pain is especially noticeable with maximum flexion of the hand, lifting something heavy, or leaning on the palm.

Hygroma

This is the name of a cyst on the wrist that looks like a lump. It forms gradually, at first it does not cause painful sensations and does not limit movements, so the patient simply does not notice the hygroma. As it grows, tissues and nerve endings are compressed; At first there is discomfort, later it gives way to pain. Failure to take action at this stage leads to protrusion of the formation by 2-5 centimeters and significant limitation in the mobility of the hand.

Most often, hygroma occurs in those who are at risk. However, it can also appear as a result of a hereditary predisposition, as well as physical damage: an unsuccessful fall with emphasis on the wrist, sprain of one of the ligaments, dislocation or fracture. But sometimes such a lump can form without any reason (at least visible) or prerequisites. Moreover, hygroma develops in people of any age, from small children to very old people.

Injuries

They can be easily diagnosed by the victim himself - the pain is very vivid, sometimes reaching the level of unbearable. Of course, only a physician can determine what exactly is injured in the wrist joint, since the head of the bone may shift, the tendon may rupture, or the wrist itself may break. The last injury is considered the most difficult.

With a traumatic injury to the wrist joint, there is acute pain, rapid swelling of the soft tissues, limited mobility of the hand or a complete inability to move it. Sometimes there is deformation of the forearm.

Principles of treatment

Therapy directly depends on the diagnosed disease and the nature of its course. But most often, the first step recommended by the doctor is to ensure immobility of the affected joint. A plaster cast or orthosis may be applied for immobilization.

Acute pain is relieved with painkillers; Quite often and for many diseases, novocaine blockades are used. To relieve swelling and, again, reduce pain, cold is applied to the affected area. In some cases, the doctor prescribes antiseptic drugs.

The inflammatory process is stopped with non-steroidal drugs, and chondoprotectors are prescribed to restore cartilage tissue.

Treatment of joints Read more >>

In some cases, the course of treatment includes antibiotics; if the nature of the disease of the wrist joint is rheumatoid in nature, their course will be quite long.

Concomitant treatment is also being carried out. The patient may need to restore immunity, he may need to maintain and restore the functioning of the heart muscle, kidney therapy, or eliminate a gout attack. For hygroma, if it is not advanced, puncture can be used as treatment. During the procedure, a needle is inserted into the formation, and the liquid accumulated in its capsule is pumped out with a syringe. However, modern medicine rarely uses this technique. After the puncture, the membrane of the hygroma remains in place. Therefore, after some time it may arise again. But for analysis and predicting the course of the disease, the puncture remains invaluable.

When the acute phase of the disease is leveled, other methods of its recovery can be introduced. They support and consolidate the effect that the primary treatment of the wrist joint was able to achieve. Treatment in the second stage again depends on the diagnosis. So, with tendovaginitis, the emphasis is on laser therapy, shock wave exposure and UHF; for arthrosis and arthritis, more attention is paid to manual practices; During the treatment of carpal tunnel syndrome, contrast baths in combination with massage have a good effect.

With hygroma, it makes sense to apply all physiotherapeutic procedures only at the earliest stage of the disease. In advanced cases (which is what doctors usually have to deal with), only radical methods will be effective.

In a hopeless situation

In case of purulent inflammation of the wrist joint, drainage is placed, and in most cases this is enough for a complete cure. However, in some cases this technique does not produce results. And under other circumstances, with different diagnoses, conservative treatment may be ineffective. If remission is incomplete, and relapses are too frequent, if joint degradation progresses, surgical intervention is required. During the operation, excision of the tendon sheaths that are subject to inflammation is performed; in the case of hygroma, the capsule of the neoplasm is excised or it is burned out with a laser. Treatment is carried out under local anesthesia. After surgery, a tight bandage is mandatory, and in some cases, immobilization of the hand. Sutures are removed between the fifth and seventh day after the intervention. Typically, the postoperative period requires injection of antibiotics.

For the final rehabilitation of the wrist joint, physiotherapeutic procedures will be required, which may include mud applications, paraffin therapy, electrophoresis, ozokerite and laser exposure. Exercises aimed at restoring full mobility of the hand and developing the joint itself will be prescribed. Limiting the load on the affected arm can last for quite a long time.

Take care of your hands, and you will never need treatment for your wrist joint. But if you already feel discomfort from your hands, please go for an examination so as not to lose the ability to self-care and not be left without work.

Gonarthrosis of the knee joint, ICD-10 code: M15-M19 Arthrosis

Deforming osteoarthritis, abbreviated as DOA, refers to chronic joint diseases. It leads to the gradual destruction of articular (hyaline) cartilage and further degenerative-dystrophic transformation of the joint itself.

ICD-10 code: M15-M19 Arthrosis. These include lesions caused by non-rheumatic diseases and affecting mainly peripheral joints (extremities).

• Spread of the disease
• Development of DOA
• Symptoms
• Diagnostics

Arthrosis of the knee joint in the international classification of diseases is called gonarthrosis and has the code M17.

In practice, there are other names for this disease, which are synonyms according to the ICD10 code: arthrosis deformans, osteoarthrosis, osteoarthritis.

Spread of the disease

Osteoarthritis is considered the most common disease of the human musculoskeletal system. More than 1/5 of the population of our planet faces this disease. It has been noted that women suffer from this disease much more often than men, but with age this difference smooths out. After the age of 70, more than 70% of the population suffers from this disease.

The most “vulnerable” joint for DOA is the hip. According to statistics, it accounts for 42% of cases of the disease. Second and third places were shared by the knee (34% of cases) and shoulder joints (11%). For reference: there are more than 360 joints in the human body. However, the remaining 357 account for only 13% of all diseases.

A joint is the articulation of at least two bones. Such a joint is called simple. The knee joint, a complex joint with two axes of motion, articulates three bones. The joint itself is covered with an articular capsule and forms an articular cavity. It has two shells: outer and inner. Functionally, the outer shell protects the articular cavity and serves as an attachment point for ligaments. The inner lining, also called synovial, produces a special fluid that serves as a kind of lubricant for rubbing bone surfaces.

A joint is formed by the articular surfaces of its constituent bones (epiphyses). These endings have hyaline (articular) cartilage on their surface, which performs a dual function: reducing friction and shock absorption. The knee joint is characterized by the presence of additional cartilage (menisci), which perform the functions of stabilization and attenuation of impact impacts.

Development of DOA

The development of arthrosis begins with damage to the tissues of the articular cartilage (ICD-10 code: 24.1). The process occurs unnoticed and is usually diagnosed with significant destructive changes in the articular cartilage.

Etiology

The main factors contributing to the development of arthrosis: increased physical load on the articular cartilage, as well as its loss of functional resistance to normal loads. This leads to its pathological changes (transformation and destruction).

Factors contributing to the development of the disease determine the main prerequisites for its occurrence. Thus, loss of resistance can be caused by the following circumstances:

• Hereditary predisposition;
• Endocrine and metabolic disorders;
• Age-related changes (especially after 50 years of age);
• Diseases of the musculoskeletal system with a different etiology.

Increased stress on articular cartilage occurs as a result of:

• Chronic microtraumatization. This may be due to professional activities, sports activities or household reasons;
• Overweight, obesity;
• Joint injuries of various origins.

Pathogenesis of articular cartilage

Destruction of articular cartilage is caused by long-term microtraumas of articulated bone surfaces or simultaneous trauma. In addition, some developmental disorders, for example, dysplasia, contribute to changes in the geometry of articulated bone surfaces and their compatibility. As a result, articular cartilage loses its elasticity and integrity and ceases to perform its functions of shock absorption and friction reduction.

This leads to the formation of cords from the connective tissue, designed to compensate for changes in the kinematics of the joint. The consequence is an increase in the amount of synovial fluid in the joint cavity, which also changes its composition. The thinning and destruction of articular cartilage leads to the fact that the bone endings begin to grow under the influence of loads in order to distribute them more evenly. Osteochondral osteophytes are formed (ICD-10 code: M25.7 Osteophyte). Further changes affect the surrounding muscle tissue, which atrophies and leads to deterioration of blood circulation and an increase in pathological changes in the joints.

Symptoms

The main symptoms of the development of DOA include:

Painful sensations

Joint pain is the main reason for a visit to a specialist. Initially, it appears irregularly, mainly during movement (running, walking), hypothermia, or prolonged uncomfortable body position. Then the pain becomes non-disappearing and its intensity increases.

Difficulty moving

At an early stage, gonarthrosis is characterized by a feeling of “stiffness” that appears after a long period of rest (sleep, rest). The knee joint becomes less mobile, its sensitivity decreases and pain of varying intensity is felt. All these manifestations decrease or completely disappear with movement.

Another characteristic symptom is creaking, clicking and other extraneous sounds that occur during prolonged walking or a sudden change in body position. In the future, these sounds become a constant accompaniment when moving.

Loose joint

Often arthrosis of the knee joint leads to its pathologically hypertrophied mobility. According to ICD 10 code: M25.2, this is defined as a “loose joint.” This manifests itself in linear or horizontal mobility that is unusual for it. A decrease in the sensitivity of the end parts of the limbs was noted.

The main functions of the knee joint are movement (motor function) and maintaining body position (support function). Arthrosis leads to functional impairment. This can be expressed both in limited amplitude of its movement and in excessive mobility, “looseness” of the joint. The latter is a consequence of damage to the capsular-ligamentous apparatus or hypertrophied muscle development.

With the development of the disease, the motor function of the diarthrosis joint degrades, and passive contractures begin to appear, characterized by limited passive movements in the joint (ICD code 10: M25.6 Stiffness in the joint).

Musculoskeletal dysfunction

The degenerative-dystrophic changes that occur over time develop into dysfunction (motor and support) of the entire lower limb. This manifests itself in lameness and stiffness of movement, unstable functioning of the musculoskeletal system. Irreversible processes of limb deformation begin, which ultimately leads to loss of ability to work and disability.

Other symptoms

These non-main types of symptoms include:

1. Change in the size of the limb, its deformation;
2. Joint swelling;
3. Excessive presence of joint fluid (to the touch);
4. Visible changes in the skin of the extremities: increased pigmentation, characteristic capillary network, etc.

Diagnostics

The problem with diagnosing arthrosis is that the appearance of the main symptoms with which the patient comes to a specialist already indicates certain serious changes in the joint. In some cases, these changes are pathological.

Preliminary diagnosis is made on the basis of a detailed medical history of the patient, taking into account his age, gender, profession, lifestyle, presence of injuries and heredity.

A visual examination allows you to see those characteristic symptoms of arthrosis that were discussed: swelling, increased local skin temperature. Palpation allows you to determine pain and the presence of excess joint fluid. It is possible to determine the amplitude of movement of the affected area and understand the degree of limitation of motor function. In some cases, characteristic deformities of the limbs are noticeable. This occurs with a long course of the disease.

Instrumental examination methods

The main methods of instrumental diagnosis of DOA include:

1. Radiography;
2. Magnetic resonance and computed tomography (MRI/CT);
3. Scintigraphy (injection of radioactive isotopes to obtain a two-dimensional image of the joint);
4. Arthroscopy (microsurgical examination of the joint cavity).

In 90% of cases, radiography is sufficient to diagnose arthrosis. In cases that are difficult or unclear for diagnosis, other instrumental diagnostic methods are in demand.

The main signs that allow diagnosing DOA using radiography:

• Pathological growths in the form of osteochondral osteophytes;
• Moderate and significant narrowing of the joint space;
• Hardening of bone tissue, which is classified as subchondral sclerosis.

In some cases, radiography can reveal a number of additional signs of arthrosis: articular cysts, joint erosions, dislocations.