What are the soft tissue joints? Soft tissue rheumatism: symptoms and treatment methods

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The knee joint is the largest in size and the most complex in structure among all the joints of the skeleton. It consists of various tissues: bone, cartilage, connective. In the lumen of the joint there are additional cartilaginous formations - menisci, which serve to cushion under load. The ligamentous apparatus is represented by both external and internal ligaments, and the capsule has many inversions and bags. In addition, it experiences the greatest physical activity- both dynamic and static.

All of these factors contribute to inflammation knee joint occurs more often than in other joints. Latin name any inflammation - arthritis (from the Greek arthron - “joint”, the ending itis means “inflammatory process”). Inflammation of the knee joint is called gonitis (from the Greek gonato - “knee”).

Except anatomical features, the following factors predispose to inflammation of the tissues of the knee joint:

1. Injuries.
2. Overweight.
3. Frequent hypothermia.
4. Physical inactivity, weakness muscular system.
5. Inflammatory and infectious diseases.
6. Allergic conditions.
7. Chronic diseases connective tissue, organs of movement.

Important! It must be borne in mind that the knee joint most often suffers in athletes and physical workers, so it is necessary to take preventive action, for example, protect with knee pads.

Types of inflammation

Inflammation of the knee joint can have various causes, depending on this, the following types of arthritis are distinguished:

• post-traumatic;
• infectious;
• rheumatic;
• rheumatoid;
• lupus;
• psoriatic;
• gouty;
• tuberculous;
• gonorrheal;
• allergic.

Depending on the element of the joint in which inflammation has developed, there are:

• synovitis- inflammation of the synovial membrane;
• meniscitis — ;
• ligamentite- inflammation of the knee ligaments;
• bursitis- inflammation of the joint capsule of the knee joint (bursa);
• arthrosis-arthritis- inflammation of cartilage and bone tissue;
• periarthritis- inflammation of periarticular tissues.

Usually the inflammatory process begins with one tissue, then spreads to the entire joint. Special and dangerous form inflammation of the tissues of the knee joint is purulent arthritis, which affects all its elements.

Clinical signs

Symptoms of inflammation of the knee joint are:

1. Pain.
2. Increase in volume of the joint.
3. Redness of the skin.
4. Local increase in temperature.
5. Impaired function.

All these symptoms can be expressed differently, depending on the nature of the inflammation and the clinical course; it can be acute or chronic.

Pain syndrome

Acute arthritis is characterized by intense pain during movement and at rest. If the inflammation is purulent, the pain has a pulsating, bursting character. At chronic forms arthritis is characterized by pain when walking, bending the joint, they are more aching in nature. There may also be night pain, “ache” in the joint when the weather changes.

Increase in joint volume

Any inflammation causes swelling of the soft tissues of the joint and, as a result, its enlargement. Volume is also created by an increase in the amount of joint fluid produced by the synovial membrane.

Skin redness

This symptom is characteristic of acute inflammation of the joint, especially if the process is purulent in nature. In chronic arthritis, the skin over the joint is usually unchanged.

Increased skin temperature

In acute inflammation, as well as in exacerbation of chronic arthritis, the joint feels warmer to the touch than other parts of the body. For example, with purulent arthritis it increases quite noticeably - by several degrees.

Dysfunction

Restriction of movement in the joint with arthritis always occurs, but is expressed in varying degrees. The more acute the process, the more limited movements are and the more difficult it is to walk. The range of motion in the joint is measured with a special goniometer. Normally, extension should be at an angle of at least 165-180°, and the flexion angle should be no more than 90°.

Except local symptoms arthritis, there may also be general manifestations: increased body temperature, headache, general weakness and fatigue. They are more typical for acute arthritis.

Important. When the most initial signs inflammation of the joint should not be delayed until seeing a doctor. An advanced inflammatory process is more difficult to treat and can lead to complications.

Treatment of the disease in the clinic

Inflamed knee joints are very unpleasant illness, which can throw you out of your usual life rut and lead to the development of complications. Therefore, it is necessary to consult a doctor as soon as possible to undergo examination and treatment. Only a doctor can decide how to treat inflammation of the knee joint in each specific case. For example, the treatment of inflammation of the knee ligaments will differ from the treatment of inflammation of the joint capsule.

The cause of the inflammatory process is of great importance. For example, if it is rheumatism, psoriasis or tuberculosis, then the main treatment is prescribed by a rheumatologist, dermatologist or phthisiatrician, respectively. If the arthritis is purulent, its treatment is always surgical - puncture or opening of the joint, rinsing with antiseptics, antibiotic therapy.

In most cases, driving is not associated with a specific infection, and its treatment is carried out according to the following scheme:

• joint immobilization(splint, orthosis, elastic bandage);
• anti-inflammatory and painkillers(“Voltaren”, “Diclofenac”, “Ibuprofen”, “Butadione” and other analogues);
• local impact: rubbing in anti-inflammatory gels and ointments;
• physiotherapeutic procedures(iontophoresis, ultrasound, infrared laser therapy;
• Exercise therapy, massage- after acute inflammation subsides.

With inflammation of the inner lining of the joint (synovitis), as well as with knee bursitis punctures are performed to evacuate accumulated fluid and administer medications.

Treatment methods at home

It is hardly possible to find a person with inflammation of the knee joints who has not tried to use at least once home treatment folk remedies, did not heed the advice of friends, advertising or information on the Internet. Unfortunately, there are cases when such treatment produces exactly the opposite effect.

Without in any way detracting from the importance of traditional medicine, doctors still warn that their use should be selected individually and agreed with a doctor. To treat inflammation of the knee joint at home, you can use:

1. Cold applications(for acute inflammation), but only for first aid.
2. Joint bandaging wide elastic bandage to create peace.
3. Warming treatments(heated salt, sand, blue lamp, heating pad), except acute stage inflammation.
4. Applying compresses and lotions(with honey, cabbage leaf, chestnut decoction, infusion of lilac flowers, St. John's wort, yarrow, garlic).
5. Rubbing natural ointments , prepared from turpentine, radish, mustard, horseradish, honey, mumiyo, celandine.
6. Taking decoctions internally: teas and infusions from St. John's wort, elecampane, nettle, bay leaf, parsley.

Note. This is not a complete list folk remedies for the treatment of inflammation of the knee joint. Their choice must be agreed with the doctor.

The main treatment for inflammation of the knee joint should be prescribed by a specialist. using folk remedies is a good addition to the main course of treatment, but it must be agreed with a doctor.

Soft tissue diseases include a group of pain syndromes of the musculoskeletal system, which develop as a result of pathological processes in extra-articular tissues ( skeletal muscles, tendons and their synovial sheaths, fascia, aponeuroses, synovial bursae). Changes in soft tissues can be one of the manifestations of systemic diseases, including inflammatory (rheumatoid arthritis, seronegative spondyloarthritis), endocrine ( diabetes, hypothyroidism), metabolic (gout, hyperlipidemia, etc.).

Much more often they occur as a result of local overloads, microtraumas and overstrain, especially against the background of congenital or acquired skeletal anomalies (scoliosis and kyphosis of the spine, hypermobility syndrome, axial bone deformations, etc.).

Damage to extra-articular soft tissues can be either local (bursitis, tendinitis, tenosynovitis, tendovaginitis, enthesitis, fasciitis) or diffuse (fibromyalgia, myofascial syndrome). The most difficult for diagnosis and treatment is the diffuse nature of damage to extra-articular soft tissues.

Fibromyalgia

In the ICD-X it is classified under “unspecified rheumatism”. However, now it is one of the most frequent illnesses V outpatient practice, occupying 2-3rd place among all reasons for visiting a rheumatologist in developed countries peace. The prevalence of FM in the population reaches 6-8%. As a result of the long-term course of FM, about 30% of patients lose their ability to work. In the USA, 11% of patients with FM receive financial assistance, which is $5.2 billion.

FM is most often diagnosed in women (70-90% of all patients). Average age is 35-50 years old, but the development of FM has been described in both old age and childhood.

FM was described as a clinically defined syndrome in 1904 by W. Govers, who first characterized it as “fibrositis.” Since that time, different terms have been used: “myofibrollosis”, “myositis”, “neurosteofibrosis”, “vegetomyositis”, “muscular rheumatism”, “soft tissue rheumatism”, etc. Most of these names were a reflection of previously dominant views on the nature of this symptom complex as inflammatory disease predominantly the muscular system. Subsequently, numerous studies were able to confirm the inflammatory nature of FM. The description of her clinical picture was supplemented by information about the presence of severe affective disorders, especially depression and anxiety.

The etiology of FM is unknown. Reports of familial aggregation of the disease indicate the possible involvement of a hereditary factor in the development of FM. Thus, among first-degree relatives, FM occurs in 26-50%, which exceeds its prevalence among the general population. Abnormalities of allelic genes encoding the functioning of the serotonergic system have been described in FM. Trauma can precede the development of FM syndrome, psychological stress past infectious diseases, Epstein-Barr virus, Coxsackie, parvovirus B19, hepatitis C virus, etc.

In the pathogenesis of FM they are important the following violations peripheral musculoskeletal system: muscle microtrauma, lack of muscle training, substance P, A2 - adrenergic receptors. To date, it has not been proven that patients with FM have inflammatory or metabolic disorders in skeletal muscles. It is believed that untrained muscles are more often damaged by injury. Microtraumas can cause severe pain, which dramatically reduces physical activity patients, and a vicious circle is formed: decreased muscle contractile activity - microtrauma - pain.

Currently, several mechanisms of the pathogenesis of pain in FM are being discussed (Table 10.1).

♦ Nociceptive mechanism of pain. Nociceptors are free nerve endings and react only to pathological stimuli, i.e. they are excited during muscle contraction under the influence of algic substances under ischemic conditions. The main role in this belongs to microcirculation disorders and muscle energy deficiency. Deficiency of ATP and phosphocreatinine leads to dystrophy muscle fibers. In turn, ischemia causes the release of peripheral algogenic substances, which supports the sensitization of nociceptors, which is accompanied by their pathological response to physiological stimuli.

♦ Reactive pain occurs in response to muscle dysfunction that develops due to arthritis or root compression spinal cord. Painful muscle spasm is a common symptom of FM. Its cause may be disturbances of nervous regulation due to structural or functional defects of the spine. Thus, according to the results of an X-ray examination, signs of scoliosis are detected in FM in 80% of cases. Patients with FM syndrome exhibit a significant predominance of spondylosis, spina bifida, as well as signs of joint hypermobility.

♦ Psychosomatic genesis pain syndrome. Patients with FM often associate the appearance of muscle pain with stressful situations. In the genesis of FM, there is an altered reaction to stressors, an inability to control one’s behavior under conditions of psycho-emotional stress, which reduces pain threshold. In families of patients with FM, marital discord and divorce are more common, low level education, obesity, tendency to smoke, alcoholism, which can contribute to the formation of chronic psycho-emotional stress.

♦ Impairment of the central mechanism of pain modulation, as a result of decreased inhibitory control spinal neurons(dysfunction of the descending antinociceptive system), which is accompanied by the constant release of neurotransmitters such as serotonin, catecholamines and opiates, which are involved in the mechanisms of pain in FM.

Table 10.1. Mechanisms of pain development in FM

In recent years, the important role of serotonin in the functioning of the descending antinociceptive system has been shown.

A lack of serotonin leads to sleep disturbances, the development of depression, as well as dysregulation of the processes of vasoconstriction and dilation. Patients with FM showed a significant decrease in the level of serotonin in the blood serum compared to healthy individuals and patients with local pain.

Substance P, which is formed in excess in the spinal cord upon stimulation of nociceptive C-fibers and activates the central nociceptive pathways, also takes part in the modulation of pain in FM. It is obvious that the constant release of substance P from the dorsal root ganglion of the spinal cord leads to synaptic disturbances (the phenomenon of neuroplasticity) with subsequent hyperalgesia and the development of new receptor fields, which contributes to the development of generalized pain syndrome.

• Which doctors should you contact if you have extra-articular rheumatism?

What is Extra-articular rheumatism

Rheumatic processes in periarticular tissues refer to extra-articular diseases of the soft tissues of the musculoskeletal system, often combined under common name"extra-articular rheumatism." This large group of pathological processes, different in origin and clinical picture, includes diseases of both tissues located in close proximity to the joints, i.e., periarticular tissues (muscle tendons, their sheaths, mucous bursae, ligaments, fascia and aponeuroses), and tissues located at some distance from the joints (muscles, neurovascular formations, subcutaneous fatty tissue).

The most studied are diseases of the periarticular tissues, which have clearly defined localization and clinical manifestations, while diseases of soft tissues not related to the periarticular tissues are less clearly defined. clinical symptoms and often of uncertain localization. As a result, in this section we will only touch on diseases of soft periarticular tissues.

These processes primarily include tendonitis, tendovaginitis, bursitis, tendobursitis, ligamentitis, and fibrositis.

Diseases of soft periarticular tissues are very common. In a survey of 6,000 people, they were detected in 8% of individuals. Damage to the periarticular apparatus most often occurs in women aged 34-54 years, especially in those who work physically.

What causes extra-articular rheumatism?

Etiology independent diseases of periarticular tissues are very similar to the etiology of arthrosis. The main cause of these painful syndromes is professional, household or sports microtrauma, which is explained by the superficial location of soft periarticular tissues and their high functional load. It has been established that long-term repeated stereotypical movements lead to the development of a degenerative process in tendons, collagen fibers and ligaments, followed by slight reactive inflammation in nearby well-vascularized formations - sheaths and serous bursae. This is evidenced by frequent development periarthritis, tendovaginitis, bursitis in athletes, dancers, painters, violinists, typists. Severe physical strain and direct trauma can also cause periarthritis and other soft tissue lesions.

Neuroreflex and neurotrophic influences are of great importance, which impair the trophism and nutrition of soft periarticular tissues and contribute to the development of the degenerative process in them. The neuroreflex genesis of diseases such as glenohumeral periarthritis during myocardial infarction, neurotrophic shoulder-hand syndrome, and shoulder tendinitis during cervical spondylosis is an established fact.

However, the possibility of the development of painful syndromes in soft periarticular tissues in individuals under normal load on these tissues (not exceeding physiological) and in whom there is no influence of neuroreflex factors, indicates that there are a number of reasons that reduce tissue resistance to normal physiological load. These primarily include endocrine metabolic disorders, as evidenced by the frequent development of diseases in women in menopause especially those suffering from obesity, liver disease and biliary tract. This is evidenced by the frequent combination of periarthritis and arthrosis, which have a similar genesis. As with arthrosis, in this process one cannot exclude the significance of a genetic factor, congenital weakness of the tendon-ligament apparatus or its increased reactivity to action various factors, worsening the nutrition and trophism of periarticular tissues. The specific mechanisms of influence of these causes on the development of the degenerative process in the periarticular tissues have not yet been studied, but their significance is confirmed by practice.

There are a number of provoking factors that contribute to the development of this pathology. The effect of cooling and dampness is well known, which is associated with overirritation of skin receptors and spasm of capillaries, disrupting microcirculation in the periarticular tissues, local metabolism and trophism. Clinical experience shows that the provoking factor in the development of diseases of periarticular tissues in some cases is focal infection. In most cases, the occurrence of painful syndromes in the periarticular tissues is the result of the combined effects of several pathogenetic factors.

Pathogenesis (what happens?) during extra-articular rheumatism

Pathogenesis and pathological anatomy. Diseases of soft periarticular tissues can be inflammatory or degenerative.

Inflammatory diseases of these tissues are most often secondary and arise as a result of the spread of the inflammatory process from the joint in arthritis of various origins. Independent, primary diseases of the periarticular tissues are based primarily on a degenerative process, very similar to that observed with arthrosis. Since the causes of the degenerative process in articular and periarticular tissues are identical, simultaneous development is often observed degenerative changes in these tissues, i.e. arthrosis is often accompanied by periarthritis, tendovaginitis and other lesions of the periarticular apparatus. However, a degenerative process (followed by slight reactive inflammation) can just as often occur in the soft periarticular tissues with completely intact joints.

The similarity of the pathogenesis of degenerative diseases of joints and periarticular tissues gives rise to some authors to consider arthrosis and primary disease periarticular tissues like clinical options single pathological process.

The primary degenerative process of the periarticular apparatus is most often localized in the tendons (which constantly bear a heavy load). Due to constant tension and microtrauma in poorly vascularized tendon tissue, ruptures of individual fibrils are observed with the formation of foci of necrosis with hyalinization and calcification of collagen fibers. Subsequently, sclerosis and calcification of these foci occur, and in nearby well-irrigated synovial formations (vaginas, tendons, serous bursae), as well as in the tendons themselves, signs of reactive inflammation appear, similar to those found in arthrosis.

The processes described above most often develop at the site of attachment of tendons to bone, in the so-called tendon insertions. In this case, an isolated tendon lesion (tendinitis) quite quickly turns into tendobursitis due to the inclusion of a nearby serous bursa in the process. At the same time, due to the reaction of the periosteum, tendoperiostitis develops at the site of contact of the affected tendon.

Histologically, in the focus of tendon necrosis, depolymerization of glycosaminoglycans (mucopolysaccharides) is observed with the formation of fibrinoid substance, leukocyte and histiocytic reaction around and subsequent sclerosis and calcification. Most often, insertions of short and wide tendons that bear a large load, such as the short rotator cuff tendons, are affected.

With reactive bureitis in the serous bursa, hyperemia and edema with rapid accumulation of serous or purulent exudate in the cavity of the bursa are observed. The outcome of this process is mostly favorable: foci of necrosis, exudate and calcifications resolve. However, in some cases, residual phenomena occur in the form of fibrous fusion of the walls of the bursae and tendon sheath, which makes it difficult for the tendon to glide during contraction and relaxation and leads to functional disorders.

Although damage to synovial formations (synovial sheaths, serous bursae) is most often combined with damage to tendons, it can also occur in isolation, sometimes spreading to nearby tendons and causing secondary tendinitis. The degenerative process in the tendons is very often combined with similar damage to the ligaments, especially in cases where long and thin tendons pass through narrow ligamentous canals (on the hands and feet). The anatomical relationships here are so close that it is sometimes difficult to resolve the issue of the primacy of the damage to one or another tissue, i.e., primary tendovaginitis or ligamentitis develops. In these cases, both terms (tenosynovitis and ligamentitis) are often used as synonyms.

Damage to aponeuroses and broad fascia (fibrositis) is characterized by a predominance of fibrosclerotic processes. They can be widespread (for example, damage to the entire palmar aponeurosis) or focal (formation of fibrous nodules). In the initial phase, a serous fibrous effusion is observed, which is replaced by pronounced fibroblastic proliferation with the formation of nodules and subsequent fibrous scar changes, sometimes leading to the formation of persistent contractures.

The variety of pathomorphological changes also determines the large polymorphism of clinical manifestations of diseases of the periarticular tissues. Thus, the following main processes of periarticular tissues are distinguished.

• Tendonitis is an isolated degenerative lesion of the tendon (with minor secondary inflammation). This is usually the first short phase of the degenerative process in the periarticular tissues.
• Tenosynovitis (tenosynovitis) is often the second phase of the pathological process, which develops as a result of contact of the affected tendon with well-irrigated synovial tissues.
• Ligamentitis is an inflammatory lesion of extra-articular ligaments; most often the ligamentous canal through which the tendon passes in the area of ​​the wrist and ankle joints.
• Calcification is the deposition of calcium salts in foci of necrosis and in serous bursae.
• Bursitis is a local inflammation of the serous bursa, most often developing as a result of contact with the affected tendon (tenobursitis).
• Tendon lesions, in addition, are usually classified according to the predominant localization of the pathological process. The combination of damage to the tendon insertion and adjacent formations - the periosteum and serous bursa - is called periarthritis. This process most often develops in short and wide tendons that bear a large functional load. Damage to the middle part of the tendon and its sheath (most often these are thin and long tendons) is designated as tenosynovitis or tenosipsitis. A lesion localized in the area of ​​the tendon muscle ligament is called myotendinitis.
• Fasciitis and aponeurositis are diseases of the fascia and aponeuroses - usually called general term"fibrositis".

Symptoms of extra-articular rheumatism

With lesions of the tendon apparatus, clinical manifestations - pain and limitation of movements - are observed only after the inclusion of synovial formations - the tendon sheath and serous bursae - in the pathological process. Primary isolated damage to the tendon itself usually does not manifest any clinical symptoms. Clinical manifestations of diseases of soft periarticular tissues have some features that allow differential diagnosis with diseases of the joints, which is sometimes difficult due to the close topography and sometimes close contact of articular and extra-articular tissues (for example, insertion muscle tendons and periosteum of the epiphyses). The pain that occurs when tendons are damaged, firstly, occurs or intensifies only with movements associated with the affected tendon, while all other movements, due to the intactness of the joint itself and other tendons, remain free and painless. Secondly, they appear only during active movements, when there is tension in the affected tendon. Passive movements due to the lack of contraction of this tendon, they are painless.

When palpating the affected area, non-diffuse pain or pain along the joint space is determined; as is observed with joint disease, and local pain points corresponding to the places of attachment to the bone of the tendon insertion or anatomical location the tendon itself. A small and fairly well-defined swelling is detected in the area of ​​the affected tendon or serous bursa (as opposed to diffuse in arthritis).

The localization of lesions of the periarticular tissues is determined by the intensity of their functional load. The tendons of the hands are mainly affected, which is associated with the variety and variety of functions of the upper extremities, leading to almost constant voltage these tendons. Degenerative joint diseases are localized, on the contrary, most often in the joints of the legs, which are supporting joints and therefore bear a large functional load.

The most common localization of periarthritis in the upper limb is the shoulder area, where the short rotators of the shoulder and biceps tendons are constantly exposed to high functional load, and under difficult conditions (passage of tendons in a narrow space). This causes the frequent occurrence of periostitis of the supraspinatus and infraspinatus muscles, subacromial tendobursitis and tenosynovitis of the long head of the biceps muscle.

In the area of ​​the elbow joint, periarthritis occurs less frequently. Typically, tendoperiostitis develops in the area of ​​attachment of the extensor and supinator tendons of the forearm to the lateral condyle of the shoulder (external epicondylitis). Less common are tendobursitis of the tendons that attach to the internal condyle of the shoulder (internal epicondylitis) and tendoperiostitis of the biceps tendon that attaches to the acromion (acromyalgia).

A common localization of the degenerative process in the upper extremities is the long and thin tendons of the wrist and hand, which pass in narrow fibro-osseous canals. Various painful syndromes- tenosynovitis of the tendons of the muscles that abduct and extend the thumb (de Quervain's disease), tenosynovitis of the extensor ulnaris of the hand (ulnar styloiditis), tenosynovitis of the flexor fingers (syndrome) carpal tunnel) etc. Damage to the palmar aponeurosis with the development of flexion contracture of the fingers is much less common.

On lower limbs damage to the tendon apparatus and ligaments is much less common. In area hip joint Tendobursitis may develop gluteal muscles at the site of their attachment to the greater tuberosity (trochanteritis) and the iliopsoas muscle at the site of its attachment to the lesser tuberosity.

In the knee area, tendobursitis develops in the tendons that attach to the inner surface of the knee and to the tibial tuberosity.

The foot and ankle area are the most common localization of the degenerative process in the tendons, which, like on the hand, pass in narrow ligamentous canals, as well as at the site of attachment of the Achilles tendon to the heel tubercle (achillodynia) and at the site of attachment to calcaneus plantar muscles and plantar aponeurosis(with the development of heel bursitis).

The listed lesions of tendons, ligaments and aponeuroses, complicated by the reaction of serous bursae and tendon sheaths, can be observed both in isolation and in various combinations.

In 30-40% of patients, radiographs reveal calcifications along the affected tendon, as well as a periosteal reaction - compaction and small osteophytes at the site of attachment of the tendon to the bone (tenoperiostitis).

Treatment of extra-articular rheumatism

No other disease offers such a wide choice medicinal products- from rubbing with antirheumatic drugs, ointments based on medicinal plants, ointments with various skin irritating components, the use of heat and cold in the most in different forms, massage, electrotherapy up to acupuncture and other therapeutic techniques.

Taking antirheumatic drugs medicines has an auxiliary value - non-steroidal antirheumatic drugs are widely used here to suppress pain and inflammation. This does not apply to polymyalgia rheumatica, in which, as we noted above, it is quite typical to take anti-inflammatory hormones of the adrenal cortex - corticosteroids (prednisolone). Pain in tendon diseases is treated in a similar way - by injecting these hormones directly into the places where pain is felt.

The most popular medications for extra-articular rheumatism include medicinal ointments and solutions (even Svejk in the first chapter of Hasek’s book smeared his knees with opodeldok - a solution containing camphor and mint), that is, substances that cause irritation of the skin and a reflex increase in the supply of blood to tissues, which gives a good therapeutic effect. Ointments (thicker than solutions) contain various non-steroidal anti-rheumatic drugs and are rubbed into the skin until they are absorbed.

An excellent treatment is topical or general use heat. Heat sources can be a Sollux lamp, hot bath with medicinal additives (solfatan, peat), electric heating pad, warm compress or wax applied to the skin, healing mud, including from Piestany, applied in the form of a fabric compress, which should be “heated” at home as written in the instructions. Sometimes the patient prefers cold compresses.

Doctors often prescribe electrotherapeutic procedures such as iontophoresis (injection medicinal substances into the skin through exposure electric current), diathermy (works using electrical waves, most often short ones, which are similar to radio waves), ultrasound (an ultrasound device produces a certain sound so high that human ear does not distinguish it, but the tissues of the body sense its vibrations, and thereby their blood supply increases).

Treatment techniques for a sore shoulder are somewhat more complex. First of all, it is necessary for the doctor to determine the cause of the disease. Patience is required here, and you need to realize that in the final stage the result of treatment will always be improvement, although sometimes you have to wait several months. During treatment, you should first give preference to rest and not engage in too active development of the shoulder. The shoulder should be spared, sometimes using a sling for the arm. After the first attack of the disease has passed, the shoulder can be developed with swinging movements or with the help of a healthy arm. These exercises are also suitable for other types of rheumatic diseases. It is advisable to first take introductory classes under the guidance of a rehabilitation specialist.

Rheumatic diseases of periarticular soft tissues (synonym extra-articular)

are characterized pathological changes various tissues located in the immediate vicinity of the joints - tendons and their sheaths, synovial bursae, ligaments, fascia, aponeuroses, subcutaneous tissue.

There are primary rheumatic diseases- actual diseases of the periarticular tissues, dystrophic and (less commonly) inflammatory in nature occurring in intact joints or combined with osteoarthritis. In their origin, the main role is played by, due to professional, household or sports loads, as well as other endocrine-metabolic disorders (diabetic, obesity), neuroreflex and autonomic-vascular influences that worsen the trophism of periarticular tissues (for example, with spinal osteochondrosis), congenital inferiority of the tendon-ligamentous apparatus (hypermobility of the joints), . Secondary rheumatic diseases - mainly inflammatory lesions periarticular formations caused by the transition of the pathological process from the changed joints; are often a manifestation of systemic diseases (for example, Reiter's syndrome, rheumatoid arthritis, gouty arthritis).

The pathological process is localized, as a rule, in the tendons that bear the greatest load, where, as a result of mechanical overstrain, defects of individual fibrils, foci of necrosis, secondary, followed by sclerosis, hyalinosis and calcification occur. Initial changes usually occur at the sites of tendon attachment to the entheses. The term " " applies to changes of various nature, arising in places of attachment to bones not only of tendons, but also ligaments, joint capsules, aponeuroses.

The process may be limited or spread to other areas and the vagina (tenosynovitis), (bursitis). Primary or secondary damage may occur () through which the tendons pass, and sometimes the joint itself (), which sharply limits its function. To designate these changes, which can be clinically difficult to differentiate due to the anatomical proximity of the listed tissue formations, the general term “” (“periarthrosis”) is used.

Dupuytren's contracture- compaction of the palmar aponeurosis, leading to contracture of the fingers (see Dupuytren's contracture).

Rheumatic diseases of the periarticular soft tissues of the lower extremities. Periarthritis of the hip joint is caused by damage to the tendons of the gluteus medius and minimus muscles at their attachment to the greater trochanter femur, as well as the synovial bursae of this area. The reasons are, physical, static violations(shortening of the limb, various diseases of the hip joint). Pain in the upper outer thigh occurs when walking and subsides with rest. On palpation, local pain is detected in the area of ​​the greater trochanter of the femur. X-rays can reveal areas of the greater trochanter, as well as areas of calcified tendons.

Periarthritis of the knee joint characterized by pain in the area of ​​the inner surface of the knee joint, appearing during movement and subsiding at rest. On palpation on the medial side of the knee joint below the projection of the joint space, limited tenderness of the soft tissues is determined, sometimes a slight swelling and.

Popliteal cyst (popliteal bursitis, Baker's) occurs, as a rule, with various diseases of the knee joint. In the popliteal fossa, a local, limited, various-sized bulge of round-shaped tissue containing fluid is determined. large sizes can descend along the intermuscular spaces to the back surface of the lower leg, and also rupture. In the latter case, it is noted sharp pain in area calf muscle, pain on palpation and tissue hyperthermia.

Tendinitis of the calcaneal tendon, plantar aponeurosis and bursitis synovial bursae in the heel bone are characterized by local pain and tenderness on palpation. At x-ray examination calcification of the calcaneal tendon, plantar aponeurosis can be detected at the attachment points in the calcaneus, and in the case of chronic course inflammatory changes in these structures in ankylosing spondylitis and other seronegative spondyloarthritis - superficial destruction (erosion) of the calcaneus.

Other rheumatic soft tissue diseases. Diffuse zosinophilic (Shulman) systemic fascia, inflammatory (autoimmune) nature, characterized by edema, cellular infiltration, a tendency for the tissue of the affected fascia to adhere to the subcutaneous tissue and underlying muscles, and the development of fibrosis. Morphological features are a sharp thickening of the fascia and the presence of cellular infiltrates large number eosinophils (the latter is not observed in all cases). not clear. In a number of patients, the disease is preceded by excessive.

The onset is often acute. Patients note swelling and a feeling of stiffness mainly in proximal parts one or more limbs, limitation of movements. Dense swelling can also spread to. In some places (usually in the area of ​​the shoulders and hips), the skin becomes orange peel due to its adhesion to the superficially located altered fascia. Muscle weakness not visible. Characterized by transient increase in ESR, hypergamma globulinemia. In some cases, differential diagnosis is carried out with systemic scleroderma (Scleroderma) and dermatomyositis. In contrast, eosinophilic fasciitis can be cured completely with corticosteroids, but this requires many months.

Fibrositis(fibromyalgia). These terms are more often used to refer to persistent widespread musculoskeletal pain that does not have a clear morphological basis and may be associated with impaired pain perception (pain exaggeration syndrome). It is observed mainly in emotionally labile women. As a rule, there are sleep disturbances, weakness in the morning and stiffness, rapid. The pain intensifies in stressful situation, in cold damp weather. Palpation reveals painful points that are characteristic in localization, which the patients themselves are not even aware of: in the area of ​​the trapezius muscles, anterior ribs, external epicondyles of the femur, etc. ESR and other laboratory tests are not changed. Light exercise, as well as mild analgesics at night, are necessary.

Bibliography: Astapenko M.G. and Erelis P.S. Extra-articular diseases of soft tissues of the musculoskeletal system, M., 1975; Bosnev V. shoulder - arm, . from Bulgarian, Plovdiv, 1978; Nasonova V.A. and Astapenko M.G. Clinical, p. 535, M., 1989; Travell JG and Simons D.G. Myofascial pain, vol. 1-2, trans. from English, M., 1989.

The term soft tissue rheumatism is used to describe symptoms such as acute pain, swelling or inflammation in the tissues surrounding the joints. These include ligaments, tendons, muscles, bursa or bursa. In the case of rheumatism of such tissues, from a medical point of view, it would be more correct to talk about bursitis or tendinitis and similar pathologies.

Problems with rheumatic soft tissue disorders may be caused by changes in the joints, excessive loads or a complication after suffering from rheumatoid arthritis. For office workers inflammatory processes of this nature may be provoked long stay in a constant position when typing on the keyboard or using the mouse.

Flat feet can create problems in the lower extremities - pain around the heel, ankle or in the popliteal area. Incorrect foot placement when walking - common reason the occurrence of bursitis or pain in outside hips.

• pain in the shoulder when raising the arm up - inflammation of the tendons (tendinitis);
• pain due to rotator cuff injury;
• pain in the hip joint and along the thigh - filling bursa fluid (bursitis);
• pain in elbow joint during strenuous activity - tennis elbow;

• tendinitis or bursitis of the knee;
• inflammation of the Achilles tendon, causing heel pain and stiffness when walking;
• inflammation of the tendons of the thumb or wrist - tenosynovitis, most often found in young mothers;
• stabbing pain in the thumb - tunnel syndrome;
• inflammation of the shoulder capsule - frozen shoulder, accompanied by limited mobility and acute pain, worsening at night.

Pain in muscles and ligaments is called fibromyalgia. This is common chronic illness which is accompanied by widespread pain, muscle tension or relaxation and fibrous tissue all over the body. Severe forms of fibromyalgia in some cases can cause temporary disability and a significant decrease in the patient’s quality of life.

People with muscle rheumatism are concerned about symptoms that differ in severity and different localization: in the neck, chest, back, elbows, knees, lower back, etc. Among them are:

• muscle pain of various types - cutting, throbbing, burning;
• numbness of the limbs;
• insomnia;
• fatigue;
• anxiety, panic attacks;
• headache;
• irritable bowel syndrome;
• depression;
• morning muscle stiffness.

Localization muscle pain of a rheumatic nature along the thigh or in the knee area - a sign of rheumatism of the leg muscles. Often these pains are the result of stress, injury, dampness, cold or systemic disease rheumatic in nature.

Used to treat fibromyalgia A complex approach, which includes medication and physiotherapeutic procedures. The selection of medications and treatment plan is carried out on an individual basis depending on the severity of the disease, the patient’s age, his lifestyle and other factors.

For treatment, non-steroidal anti-inflammatory drugs containing acetaminophen are mainly used - Ibuprofen, Naproxen, Aspirin. Medicines are used only as prescribed by a doctor. Antidepressants and muscle relaxants may also be prescribed. In severe cases, lidocaine is used to relieve pain, and corticosteroids are used to relieve inflammation. Physiotherapy includes systematic exercises to maintain muscle strength and elasticity, different kinds massage, hot baths, aerobics.